Assessment of Changes in Sex Hormones, Cortisol and White Blood Cells during Menstrual Cycle in Female Asthmatic Students at NAU, Nnewi, Nigeria

Background: Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms due to triggers to which the patients are sensitive. Due to the hormonal variations in monthly cycles, women are at risk of increased asthma exacerbations which require close monitoring of those patients to ensure better control and management of the condition.

Aims of Study: This study was designed to assess the changes in sex hormones (progesterone and estradiol), cortisol and white blood cells in asthma female students in Nnamdi Azikiwe University, Nnewi Campus Nigeria.

Materials and Methods: A total of 120 female students with regular menstrual cycle, within the age bracket of 18-35 were randomly recruited for the study. 60 female participants were students who have been diagnosed of asthma exacerbations and use synthetic therapy (Inhaled corticosteroid therapy), while the remaining 60 female participants were apparently healthy control females students. The eligible female students were classified based on menstrual phases as: (i) Follicular asthma females (n=60), (ii) Luteal asthma females (n=60), (iii) Follicular control females (n=60) and (iv) Luteal control females (n=60). Blood samples were collected consecutively from each of the participant at the mid-follicular (4th-13th) and mid-luteal (14-23rd) phases of their menstrual cycle for determination of progesterone, estradiol and cortisol, using ELISA kit method and white blood cell indices using Sysmex K21N Hematology analyzer.

Results: 40 (66.7%) of the Asthma students reported increased exacerbations with reduced activities at mid-luteal phase of their menstrual cycle while 20 (33.3%) reported increased exacerbations with reduced activities at mid-follicular phase of menstrual cycle. The mean serum progesterone, and cortisol in asthma female subjects at follicular phase were significantly lower compared with the values at luteal phase of menstrual cycle (P=.05). Progesterone level was lower in asthma females compared with control females at luteal phase of menstrual cycle (P=0.05). Estradiol level was significantly higher at follicular phase compared with the value at luteal phase of menstrual cycle in asthmatic females (P=0.05). Estradiol level was significantly lower in asthma females compared with control females at both phases of menstrual cycle (P=0.05 respectively). The percentage neutrophils was significantly lower in asthma female subjects when compared with the value in control female subjects at both follicular and luteal phases of menstrual cycle (P=.05 respectively).

Conclusion: The changes noted in this study vary according to the phases of the menstrual cycle which may be indicative of a link between respiratory symptoms and hormonal changes through the menstrual cycle. This may be attributed to inhibitory effects of the synthetic glucocorticoids on hypothalamo-pituitary-adrenal axis and on the proliferation, growth and migration of white blood cells in asthma female students.