Breathless In Menopause

Have you ever heard of dyspnea? I didn’t. Until a few months ago when I started experiencing a very distressing symptom - random breathlessness. Dyspnea has been linked to the menopause transition, but although I have been immersing myself in menopause research, working, and talking with menopausal women for over a decade, I had never heard of it before. I’d come across the possible correlation between decreases in lung capacity during menopause, but again, dyspnea had somehow eluded me; until I started experiencing it. Over the past few months, I’ve struggled with these odd episodes of shortness of breath that seem to come out of nowhere. It's like my lungs forget how to work, leaving me gasping for air. I could be sitting in my office working on something on the computer when suddenly I feel like there is this invisible weight that sits on my chest and sets off a sense of panic. I have to make a conscious effort to take deep breaths until the sensation goes away, and it does. At first, I attributed it to my menopausal anxiety, but because there is a history of lung cancer in my family, I started panicking, thinking that this could be the sign that led me to find out that I have it. I’m happy to say that after many tests and images, I found out that my lungs are perfectly healthy but it still doesn’t explain or ease the sensation that randomly appears. That’s when I decided to dig into the research to see if there is information available on the possible link between breathlessness and menopause, and there is. Here’s what I found: 

What Is Dyspnea?

Dyspnea is most frequently described as shortness of breath, inability to take a deep breath or chest tightness. What’s most interesting about this is that it is used to describe the sensation or experience from a subjective perspective, meaning that it is not just about the physical act of breathing or the incapacity of being able to breathe. For example, people with COPD, people with anxiety, and even pregnant women may report dyspnea but, clearly, it is not caused by the same underlying issue. Interestingly, over 60% of pregnant women report dyspnea, and pregnancy and menopause are two important life events that are linked to dyspnea. 

Dyspnea and Menopause

Although dyspnea can happen to anyone, there is evidence that links the hormonal changes during the menopausal transition to changes in respiratory health. According to a 2016 study, there appears to be a rapid decline in lung function during the menopausal transition through postmenopause. One thing to remember is that the pathology of dyspnea is quite intricate and reveals a tale of interconnected systems that could all play a part. Some of the mechanisms that could play a part are:

1. Lung Mechanics: Estrogen seems to have a hand in the elasticity of lung tissue, which may cause the lungs not to expand and contract as smoothly as they used to. This could be behind that frustrating feeling of not getting enough air like my lungs are a little rusty.
2. Airway Sensitivity: Estrogen is known to influence airway responsiveness, and with its levels dropping, the airways might become more sensitive to triggers, leading to a sudden bout of breathlessness.
3. Inflammation: A review in the Journal of Neuroinflammation describes perimenopause as “an inflammatory event, with associated systemic and central nervous system inflammation.” This increase in inflammation can affect most systems in the body including vascular inflammation, which can increase the risk for cardiovascular disease. It also extends to the respiratory system, causing irritation and narrowing of airways, which can lead to breathing issues. 
4. Anxiety: Last but certainly not least, anxiety can always be an underlying contributor. I’ve shared my journey with menopausal anxiety and am convinced it’s a piece of the menopausal dyspnea puzzle. 

What Can You Do?

As I weave through this intricate web of hormones and physiology, I've come to realize that I'm not alone in this journey. If you find yourself in a similar breathless boat during menopause, remember that there's hope and solutions:

1. Breathe: I put this one first because it is my number 1 go-to technique. It may sound silly because we breathe all day, but there is a big difference between breathing to survive and breathing for therapeutic reasons, such as to relieve stress, improve focus, and positively affect immune function and hypertension. When you truly know how to take a deep breath, you will feel its benefits. What has helped me is to keep it very simple, using diaphragmatic breathing. The focus is that your belly expands rather than your chest. Take long breaths in and long breaths out (I try to count to five in and out). This has worked tremendously for me, so I highly suggest giving this a try anytime you feel stressed, overwhelmed, or need to take a good breath. 
2. See your doctor and get checked out: Because many factors can cause dyspnea, some of the more critical than others, it is crucial to reach out to a healthcare provider. They can rule out other potential causes that may need medical interventions.
3. Exercise and Movement: Engaging in regular physical activity can strengthen your respiratory and cardiovascular systems.
4. MHT: Hormone therapy might be an option. A study investigating the decline in lung function over a 20-year period discovered that women that were on hormone therapy for 5 years had a slower decline in lung function. It’s definitely worth a talk with your doctor. 

The Importance of a Trusted Doctor

As I've unraveled the complexities of menopause and breathing issues, one vital lesson stands out: the significance of having a doctor I trust, someone who listens to my concerns and partners with me in my healthcare journey. A doctor who understands the unique challenges of menopause and can provide tailored guidance is worth their weight in gold. A trusted doctor creates a safe space where I can openly discuss my symptoms, fears, and hopes. Their expertise ensures that I'm not left guessing about potential solutions or worrying unnecessarily. With their support, I'm empowered to face these challenges head-on, armed with knowledge and a plan that's uniquely suited to my needs. I have a great team of doctors and I hope you have to. A great place to start finding a menopause practitioner is the NAMS search database. This list doesn’t guarantee that you’ll find your perfect practitioner right away, but it’s a great place to start. At least you’ll know that these healthcare practitioners have gone the extra mile to learn about menopause. 

Embrace the unpredictability of menopause, knowing that your resilience will carry you through to the much-quieter waters of postmenopause. Let's fortify our shared journey by sharing those less-discussed symptoms that others might be experiencing. Your insights can become a guiding light for us all. Reach out and share at [email protected] because together, we navigate this path with wisdom and compassion.