Hormone fluctuations associated with lung function in women with cystic fibrosis

Among women with cystic fibrosis, potentially important hormone fluctuations were associated with changes in lung function, symptoms and inflammation, according to research published in the Annals of the American Thoracic Society.

“There is a known sex disparity in outcomes of people with cystic fibrosis where women have more exacerbations, increased rate of pseudomonas infections and short life expectancy,” Raksha Jain, MD, MSc, associate professor of medicine in the department of pulmonary and critical care medicine and director of the Adult Cystic Fibrosis and Therapeutics Development Program at the University of Texas Southwestern Medical Center, told Healio. “Cystic fibrosis is a chronic inflammatory disease, so this study was designed to determine if natural fluctuations in sex hormones correlate with alterations in inflammatory markers.”

This study included 23 women with cystic fibrosis (mean age, 29.3 years) who had regular menstrual cycles, were not currently on hormonal contraceptives and had study visits at points corresponding with menses, ovulation and the luteal phase. A subset of 12 women (mean age, 27.4 years) were also placed on standard oral estrogen/progesterone combination contraceptive pills, ethinyl estradiol/norethindrone, and then reevaluated.

Researchers measured lung function, recorded reported symptoms, and conducted laboratory tests of sweat and blood for hormone concentrations and sputum for inflammatory markers, bacterial density and cytology.

During the ovulatory cycle, participants had normal hormone fluctuations similar to the hormone patterns of women without cystic fibrosis. Estrogen and luteinizing hormone concentrations peaked during ovulation (119.08 pg/mL and 13.56 IU/L, respectively) but were observed lowest during menses (49.19 pg/mL and 5.63 IU/L, respectively), according to the researchers. However, progesterone concentrations were low during both menses (0.36 ng/mL) and ovulation (0.68 ng/mL) but peaked during the luteal phase (6.32 ng/dL).

In addition, women on oral contraceptive pills reported an improvement relative to menses in the revised Cystic Fibrosis Questionnaire (8.54 points; P = .04). These women also reported a 7.24-point increase in respiratory symptoms (P = .06), a 7.92-point increase in treatment burden (P = .1) and a 7.71-point increase in health perceptions (P = .12) improvement during ovulation, the researchers reported.

For lung function, women on oral contraceptive pills demonstrated a 2.59% increase toward improvement (P = .07) during menses and a 2.53% improvement (P = .05) during ovulation. Additionally, researchers observed higher neutrophil-free elastase for sputum inflammatory markers of 57.8 ng/mL during ovulation vs. menses (P = .04).

“Further research involving a larger population that prospectively follows women with cystic fibrosis off and on contraceptive therapy would be valuable,” Jain told Healio. “This work would also be worth extending to groups of people with non-cystic fibrosis bronchiectasis and even asthma and COPD.”

For more information:

Raksha Jain, MD, MSc, can be reached at raksha.jain@UTSouthwestern.edu.