Shortness of breath and breathing difficulties in both daytime and night-time breathing are common in menopausal women (1). These issues can be attributed to several factors including:
- Decline in lung function
- Increased prevalence of obstructive sleep apnea
- Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis
- Dysfunctional breathing patterns
Addressing the underlying pathological, functional, and psychophysiological drivers of these breathing difficulties, through appropriate medical and non-medical interventions, can significantly enhance the quality of life for peri-menopausal and post-menopausal women.
Lung Function Decline
Research indicates that women who have not menstruated for the last six months exhibit significantly lower lung function values (FEV1 and FVC) and more frequent respiratory symptoms compared to pre-menopausal women (1). This decline in respiratory health is particularly noticeable in women with a history of asthma, which can become more difficult to control due to the reduction in estrogen levels. Interestingly, asthma can also develop in menopausal women without a previous history of the condition (1).
Hormone replacement therapy (HRT) has been shown to improve lung function in some cases, though there are reports of increased bronchospasm as a side effect of estrogen therapy (2). Breathing retraining aimed at improving respiratory muscle function, managing hyperventilation, and optimising breathing patterns can be a valuable supplementary treatment when HRT and asthma medications are insufficient (3) .
Sleep-Disordered Breathing
Menopausal women are more prone to sleep-disordered breathing conditions such as obstructive sleep apnea, upper airway resistance syndrome, and restless legs syndrome. These conditions significantly impair sleep quality and can lead to insomnia (4,5). Unlike typical predisposing factors like body weight or neck circumference, the increased incidence of these conditions in post-menopausal women is linked to hormonal changes.
Specifically, reduced pharyngeal muscle dilator activity due to low progesterone levels has been implicated (6). Additionally, hormonal changes can diminish central chemoreflex drive, contributing to airway collapse during sleep (7).
HRT can improve sleep disordered breathing, however these effects appear to be linked to supplementation with estrogen rather than progesterone (8). Strengthening the pharyngeal muscles and employing specific breathing retraining techniques can also help manage these disorders (9).
Sympathetic Nervous System Hyperarousal and Dysfunctional Breathing
Menopausal women often experience heightened stress and physiological hyperarousal, which can lead to breathing difficulties along with various psychological and physical symptoms (10).
Dysregulation of the HPA axis and elevated sympathetic nervous system (SNS) activity are thought to be underlying factors contributing to hot flashes and other post-menopausal symptoms . This general hyperarousal can disrupt the feedback mechanisms necessary for maintaining efficient breathing control, resulting in dysfunctional breathing (11).
Symptoms of dysfunctional breathing, such as unsatisfied respiration, irregular breathing patterns, and unexplained shortness of breath or chest tightness, can be assessed using tools like the Self Evaluation of Breathing Questionnaire (12).
Comprehensive breathing retraining programs that address the biochemical, biomechanical, and psychological aspects of breathing dysfunction have been shown to reduce these symptoms. Additionally, these programs can help mitigate stress and hyperarousal.
Techniques such as paced breathing, mindful breathing, and relaxation combined with guided imagery have been particularly effective in targeting stress response dysregulation, thereby improving overall health. Regular practice of these techniques has been found to reduce hot flashes, night sweats, and sleep disturbances in menopausal women (10, 13).
References
- Real, F.G., et al. (2008). Lung function, respiratory symptoms, and the menopausal transition. J Allergy Clin Immunol, 121(1), 72-80.e3.
- Cevrioglu, A.S., et al. (2004). The effects of hormone therapy on pulmonary function tests in postmenopausal women. Maturitas, 49(3), 221-227.
- Courtney, R. (2017). Breathing training for dysfunctional breathing in asthma: taking a multidimensional approach. ERJ Open Research, 0(00065-217).
- Jehan, S., et al. (2015). Sleep disorders in postmenopausal women. Journal of Sleep Disorders & Therapy, 4(5).
- Guilleminault, C., et al. (2002). Chronic insomnia, postmenopausal women, and sleep-disordered breathing: part 1. Frequency of sleep-disordered breathing in a cohort. Journal of Psychosomatic Research, 53(1), 611-615.
- Popovic, R.M., & White, D.P. (1998). Upper airway muscle activity in normal women: influence of hormonal status. Journal of Applied Physiology, 84(3), 1055-1062.
- Preston, M.E., et al. (2009). Effect of menopause on the chemical control of breathing and its relationship with acid-base status. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 296(3), R722-R727.
- Manber, R., et al. (2003). The effects of hormone replacement therapy on sleep-disordered breathing in postmenopausal women: a pilot study. Sleep, 26(2), 163-168.
- Courtney, R. (2020). Breathing retraining in sleep apnoea: a review of approaches and potential mechanisms. Sleep Breath.
- Saensak, S., et al. (2014). Relaxation for perimenopausal and postmenopausal symptoms. The Cochrane Database of Systematic Reviews, 2014(7).
- Wilhelm, F.H., Gervirtz, R., & Roth, W.T. (2001). Respiratory dysregulation in anxiety, functional cardiac, and pain disorders. Assessment, phenomenology, and treatment. Behavior Modification, 25, 513-545.
- Courtney, R., & Greenwood, K.M. (2009). Preliminary Investigation of a measure of dysfunctional breathing symptoms: the Self Evaluation of Breathing Questionnaire (SEBQ). International Journal of Osteopathic Medicine, 12, 121-127.
- Innes, K.E., Selfe, T.K., & Vishnu, A. (2010). Mind-body therapies for menopausal symptoms: a systematic review. Maturitas, 66(2), 135-149.
