Hormones & asthma - question for a doc (WARNING - Contains sensitive information)

Hi, wondered if you can shed any light?

Unfortunately, I've just had a miscarriage at 10 weeks. I had to have the medical management to clear my womb. Whilst pregnant my asthma was non existant - yeah!! Now its troubling me again (no attacks dont worry) & I cant get to see the doctor until next week & the epau nurse said it was just my body changing. I am just am aware my lungs feel heavy & tight & I feel very tired. The ventolin helps. But was wondering do you think this is a hormonal thing that should settle down or do you think its because of the drugs they gave me? Cant remember the name of the drug which induced the miscarriage - mistofortil or something but they also gave me ibuprofen 400mgs to have 6 times a day, paracetamol & codene (had last ones yesterday & they knew i was asthmatic). Am rather hoping it was the drugs so it calms down when they work their way out of my system in a day or so because I've been told my hormones will be all over the place for a few weeks! Thanks for your help.

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  • Hi there,

    I'm so sorry to hear that you've had a miscarriage, and that you've had to have the medical treatment as well. It must be a traumatic time for you and you are in my thoughts.

    To try to answer your question, there are several possibilities really. It is thought that roughly a third of people find that pregnancy improves their asthma, a third stay the same, and a third experience worsening of asthma in pregnancy. It seems that you are in the third that experience improvement of asthma during pregnancy - in your case, dramatic improvement. This is thought to be often due to the effects of high levels of progesterone, one of the sex hormones, which acts to relax smooth muscle and stop it contracting - smooth muscle is the type of muscle that both the airways and the womb (and also the gut and the bladder) are lined with.

    A miscarriage is often precipitated by a sharp drop in progesterone levels, which in itself is going to reverse the effects of the pregnancy-related improvement in your asthma, and cause a worsening of your symptoms.

    The medication given to clear your womb can also have a similar effect - I can't quite identify the drug that you mention, but usually a drug called misoprostol with or without another drug called mifepristone is used. It sounds like it is misoprostol that you have had.

    Misoprostol is a prostaglandin, another type of hormone which affects how easily the smooth muscle in the body contracts - prostaglandins typically make smooth muscle more likely to contract. Mifepristone is an anti-progesterone, which is given to counteract the effects of the body's own progesterone, again making the smooth muscle more likely to contract and making the womb more sensitive to the effects of misoprostol. Both drugs are known to worsen asthma in susceptible people.

    To put it simply (and I am very sorry if this sounds a little insensitive, in the circumstances), any drug which makes the smooth muscle of your womb contract in order to induce labour, may also have the same effect on the smooth muscle of the airways - ie it may make them contract, causing asthma symptoms.

    The ibuprofen that you were given for pain relief may also be causing a worsening of your symptoms - about 10% of asthmatics are sensitive to NSAIDs, the class of drug that ibuprofen is from. Codeine can occasionally cause worsening of asthma, too, as it causes release of histamine, although this is rare.

    Lastly, don't underestimate the physical and psychological effects of going through a traumatic event like this - even someone who doesn't normally get stress-induced asthma might well feel its effects after something like this. That is not intended as a dismissal of your problems, at all - just as another reason why you might not be feeling too great at the moment.

    It's likely that the way you're feeling at the moment is due to some or all of the above interacting. Once the drugs work their way out of your system and your hormones settle down, things should settle. As they said, your own hormone levels may well be up and down for a while, but the effect of the artificial hormones and the painkillers that you have been given should wear off sooner. Hopefully in a few days your breathing should improve. In the mean time, obviously, my best advice would be to take it easy as much as you can and to keep taking your Ventolin as and when needed. Obviously, if things should worsen, you should suffer an acute attack, or the Ventolin starts to become less helpful, please do seek medical attention sooner rather than later - seeing your out-of-hours doctor or dialling 999 if necessary.

    I hope this helps, and once again, I am very sorry that you are going through this traumatic time.

    Take care

    Em H

  • Thanks Em H. I really really appreciate it - its just making a bad time worse & not knowing what the hecks going on is very unsettling. So thanks for the advice - there's a whole lot you have said thats never been mentioned to me. Its been a tough couple of weeks (had inconclusive scan & had to wait a week to see if there was any change) & the pain of the mc was much more than I had expected actually it was agony (think would have rather had the surgery but I'm allergic to antibiotics & my hosp gives them as a precautionary measure apparently but at least that way the worst would be over without you seeing it all). Anyway, turned a corner now at least just want to get back to feeling as normal as poss & try to come to terms with the mental side of things. Maybe that is contributing too - dont know - have been having nightmares that wake me up shouting every night for a couple of weeks now so am obviously more stressed out than I think I am.

    Hope you're doing ok anyway & its not too cold where you are bbrrrrrr think we're in for a very chilly winter!

    Take care, love Sarah x

  • It does sound horrendous, Sarah, really stressful and distressing. It must have been a physical and emotional rollercoaster for you, I'm not surprised that your asthma is playing up. I do hope you feel better soon.

    Em

  • Sarah - thinking of you. I've looked after a number of women who've miscarried and ""medical management"" is probably the most traumatic, as you say. Have you been given contact details for any support/aftercare?

    I agree that it's probably multifactorial with the asthma, as Em has described and you yourself say the emotional impact may also be affecting it.

    Take time and be gentle with yourself.

    CathBear

  • Hi CathBear,

    Thanks for your message. No I havent been given anything follow up/support wise other than been told not to exercise until I've had a period including not going swimming. It was only my first pregnancy & so first miscarriage & they were quite matter of fact about it all - not saying they didnt care or anything as they did they were all excellent but I think they only really put you in touch with support if its happened to you before a couple of times. God I hope it never happens ever again - its very very cruel! :o( I just have to take a wee in to be tested in a couple of weeks to make sure its negative for the pregnancy hormone & thats it - they have scanned me to make sure its all out so I guess thats just to double check? Have found a forum on the net - its other people its happened to - not like this site there are no docs I guess its a kind of help each other thing through it. Do you mind if I ask you a non asthma question if you know - its been bothering me a lot? Someone made a comment to me thats got me worrying & even more upset - I had thought it wasnt my fault about the miscarriage - but it made me think maybe it was? She said it was all my own fault for not taking enough folic acid or omeaga 3. I dont drink, dont smoke, am a bit overweight but not by much - about a stone - I exercise (swim a mile & do aqua aerobics every week). I did take folic acid from Lloyds pharamcy for the 3 months we were trying but I did forget it a few times when I actually was pregnant but no more than 3 or 4 times..... did I cause it by doing that? Surely its not that vitally important?! I didnt have omeaga - my doc never mentioned that to me at all. Thanks CathBear x

  • Good lord, no wonder you're upset.

    I thought about replying to this via PM, but I think it may be an issue that several others on the boards have experienced or may know of other who have been, so it may be useful for everyone to read the response.

    Miscarriage in early pregnancy (up to about 12 weeks) is very, very common. Some reckon the rate may even be as high as 1 in 4 pregnancies - some of these will be so early that the woman would not even know she was pregnant. But even discounting these, miscarriage is still common.

    It is usually nature's way of saying that it wasn't meant to be. It is NOT YOUR FAULT in any way. The only real function of folic acid when you're pregnant is to try to prevent spina bifida and associated neural tube defects (NFDs) in the developing baby. Certainly missing the occasional tablet wouldn't make one jot of difference to this *at* *all*. And omega 3? What? No. Doctors do not recommend anything other than folic acid and a sensible diet for pregnant women.

    You have done everything you could to be healthy and help your baby to grow - sadly this time it just wasn't meant to be.

    Glad you have found a support site - I often recommend the Miscarriage Association (www.miscarriageassociation.org.uk) which has a lot of advice and helpful information on it.

    CathBear

  • Good lord, no wonder you're upset.

    I thought about replying to this via PM, but I think it may be an issue that several others on the boards have experienced or may know of other who have been, so it may be useful for everyone to read the response.

    Miscarriage in early pregnancy (up to about 12 weeks) is very, very common. Some reckon the rate may even be as high as 1 in 4 pregnancies - some of these will be so early that the woman would not even know she was pregnant. But even discounting these, miscarriage is still common.

    It is usually nature's way of saying that it wasn't meant to be. It is NOT YOUR FAULT in any way. The only real function of folic acid when you're pregnant is to try to prevent spina bifida and associated neural tube defects (NFDs) in the developing baby. Certainly missing the occasional tablet wouldn't make one jot of difference to this *at* *all*. And omega 3? What? No. Doctors do not recommend anything other than folic acid and a sensible diet for pregnant women.

    You have done everything you could to be healthy and help your baby to grow - sadly this time it just wasn't meant to be.

    Glad you have found a support site - I often recommend the Miscarriage Association (www.miscarriageassociation.org.uk) which has a lot of advice and helpful information on it.

    CathBear

  • Thanks so much CathBear thats a big weight off my mind - I really have been beating myself up about it all since that comment. I feel a lot better now knowing I didnt do anything to cause it & it was just one of those things. Doesnt help really when you're vulnerable & people are so cruel & say stuff to you like that when they have no real knowledge like doctors do when you already have enough thoughts whizzing round your brain & you feel like your whole world has just collapsed in around you & you cant imagine ever feeling happy again. So thanks - hopefully I'll be sleeping a bit better tonight.

    Hope you're alright & thanks for your kind words & support.

    x

  • just to say so sorry to hear about what has happened, and that Cath is right, it is SO NOT YOUR FAULT! miscarriarges are much more common than people think - I suppose partly because people don't want to talk about it because it can be so emotional, as well as the fact that people don't always know they were pregnant. But there isn't anything you should have done different - please don't beat yourself up about it.

    Many hugs and prayers

    S

  • Hi Sarah

    I just wanted to back up what Cathbear and Owl say.

    There is NO way at all that any of this is your fault so please dont carry on thinking that you are to blame.

    It is nature's way of saying all is not well and unfortunatly this is very common indeed.

    I had a miscarriage before i had my daughter and i found it very traumatic and like you i had no after support and was told this was very common. I also went through a phase of blaming myself too. I then went on to have a trouble-free pregnancy with my daughter.

    If i can offer any help or support please get in touch.

    My thoughts are with you.

    Kymiii

  • Hi Sarah,

    I've just caught up with your latest posts - and I just wanted to echo what everyone else has said - there is no way this is your fault! Whoever said those things to you was both ill-informed and very cruel.

    Even not taking any folic acid at all would not be particularly expected to cause an early miscarriage - as Cathy says, it would be more likely to increase the risk of abnormalities that would become apparent later on in pregnancy - and missing the odd dose would certainly do no harm at all. As for omega oil - no evidence whatsoever for that!

    You've obviously been through a horrendous experience, made worse by these insensitive comments from these people. Please don't underestimate the stress and distress of what you've gone through - you are grieving and it is still very early days. Be gentle with yourself and take care of yourself, call on any support systems you have in place (family, friends etc) and if things aren't improving, don't hesitate to seek professional help, whether that be from your GP practice or from one of the voluntary organisations that exist for women who have had miscarriages.

    Do take care

    Em

  • Sorry to hear your sad news. In the days of long ago when I was training as a midwife we were told that the miscarriage rate for 1st pregnancies is possibly 50% but a good number of those may not have known they were pregnant in the first place e.g. me. If miscarriages were caused by not taking folic acid regularly then the majority of women my age, and older, wouldn't have managed to have a baby at all because we were only given folic acid if we were actually anaemic and couldn't tolerate iron. It is only fairly recent that it has been recommended as a routine. Midwifery was my former life b.c (before children) so I am not up-to-date with all the recommendations but I do know that it is no way your fault that you lost your baby. There are many different reasons why people have miscarriages, your GP should be able to give you advice on te possible cause of yours. If you want to chat more personally then please feel free to pm me.

    Ange xx

  • Hi everyone,

    Thanks for all your support & words of wisdom! Kymmi & Ange sorry youve been through the same thing but heartening to know you've both had kids since. Feeling much brighter today - actually managed to sleep through last night with no nightmares. I'm so glad its not my fault - I dont know what I'd do if it was - my husband & I so badly wanted this baby & we are finding it very hard to deal with the fact its now gone. A family is all I've ever wanted. Oh well, guess over the next few weeks we'll just have to take it easy & treat ourselves & then try again when we're ready & my body is back to normal. & I think when things have settled down a bit I will tell that person exactly what I think of them & how much harder they've made this whole thing on us - normally I let things slide but not this time! I cant tell you what a relief it is to know that its not my fault. Thanks so much your help means more to me than you could ever know.

    & also thanks for the tip on the miscarriage association site - I've had a read its very helpful. Lungs feeling better today too.

    You all look after yourselves. Love Sarah x

  • Sarah, I'm so glad you're feeling a little better and have found some sources of support. I can't imagine how difficult it must have been to go through all of that, especially when you want a family so badly. As everyone has said, early miscarriage is an incredibly common experience, and there is absolutely no reason at all to think that you will have any difficulty in future in carrying a pregnancy to term and having a healthy child - the vast majority of women who have been through what you have been through go on to have the families they want.

    Please do give yourself time, if you can, though, to allow your hormones and emotions to adjust and settle after this experience. It might take a while before you feel physically and emotionally ready to try again, and again, that is very common.

    Only you can make the decision, but I would certainly be tempted to say something about the 'professional' who made such insensitive (and incorrect) comments to you - they need to know how much worse they are making things by their behaviour.

    Thinking of you and your husband

    Em

  • Sarah, my heart goes out to you. I lost 3 babies before I had my first and lost the twin to Maddie's and Joshua's pregnancy. I can understand the beating yourself up. I spent so much time wondering if everything from taking a paracetamol to having a hot bath made it happen. Of course they had nothing to do with but I refused to even take gaviscon through Mike, Nick and Maddie's pregnancy in case it harmed them. The irrational guilt is part of the grieving process however idiots dishing out comments like the folic acid one are just that idiots. My thoughts are with you, take time to grieve I still remember what would be the birthday for all 5 of the babies I lost. Thankfully I have 4 wonderful children now and I feel blessed. Do not give up hope and most of all don't bottle it up, it is fine to upset, angry puzzled etc if you need to get those feelings out then you are amongst friends who understand.

    Bex

  • I've also had 3 mc in between my having my 3 girls. It's not until you start talking to people you realise how common it is. All of my friends with children have had at least one mc and all of them found it traumatic and that the emotional impact is enormous and made worse by the fact noone talks about it and you are expected to carry on regardless after about 5 days!

    I hope you are feeling calmer and your asthma has improved. Day at a time.

    Hugs

    Marmite

  • Thanks Bex & Marmite, sorry you have had those terrible experiences but pleased you've both had babies since & have families to love. Marmite, I know exactly what you mean by being supposed to forget about it so quickly, its already happening to me - but I refuse too at the moment! Had a little cry yesterday more a frustrated cry than an upset cry because its just that people want me to have forgotten about it already & move on! Anyway, as each day goes on I'm feeling better, physically anyway. Got a docs appointment on Wednesday so we'll see what happens. Got a cold on the way now :o( First since last years flu jab so I suppose I shouldnt complain! Got the next jab on Saturday - cant believe its that time of year already!

    Em, thanks for the information - I really do hope next time it works out well. I'll keep you all posted but dont know when it will be obviously! I'll make sure the woman who said the cruel comment gets a piece of my mind & I've printed off your messages & those from the other people on here in the health profession to show her that she's completely wrong! Dont want her upsetting others needlessly.

    Anyway, you all look after yourselves & thanks for your continued support.

    x

  • hi Sarah,

    Just back from a trip away and read this thread. I wanted to say that I completely agree with everyone this was NOT YOUR FAULT at all, in any way, sounds as though you did everything ""right"" (whatever that means). I too had a miscarriage, at 9 weeks, two years ago now, and what happened to my asthma was a bit like you - in fact I was worse for the first couple of weeks, but by 7 weeks it was as though I didn't have asthma at all! Then after the m/c things were worse again for a few weeks, but settled back to ""normal"" after that.

    I've never managed to get an answer as to whether my longterm steroid use had anything to do with it, but looking at the literature it doesn't seem to. All the emphasis is just on making your asthma control as good as possible.

    Sadly we havent managed to get pregnant again, but I am almost 43 and my partner also has some problems on his side - so we had only a tiny chance of pregnancy in the first place, and our problems in that area have nothing at all to do with my asthma.

    I can also say that the loss does recede - like any loss - but it is a real grief, and it is absolutely fine that it takes a long time - don't let anyone tell you otherwise. I also found that people were really sympathetic for about a week then it was all supposed to be over, but of course it wasn't. Glad you are finding the m/c website helpful, I did too.

    All the very best to you,

    EJ

  • Hi Sarah,

    Like you, I miscarried at 10 weeks and it's still quite fresh as it happenned in the middle of August. For me also it was my first pregnancy and of course you worry that it's something that you've done but it's really not. I've been amazed at the number of people who have come back to me when I've told them saying that they've been through it as well, it's just very little talked about. We desperately wanted this baby and it is heartbreaking, never mind all the physical agony we have to go through (I opted for a natural miscarriage as it had already started of its own accord but if I have to go through it again would opt for surgery). I steered clear of Ibuprophen as I know I can't take it but was dosed up on paracetamol and codeine for about 2 weeks but that didn't touch the worst of it. Personally the first 3 weeks were the toughest and going back to work to find that one of my colleagues had just announced her pregnancy while I was off (they had no idea why I was off, only my boss knew that I was pregnant) made it all the much harder as it is a constant reminder of where I should have been now. I'm holding on to the positives in that so many people have been through it and now have healthy children, hopefully we can too! I've been on holiday in the meantime which helped me to move on and feel ready to try again now.

    I was actually the reverse with my asthma, night time asthma got a lot worse during the weeks I was pregnant, it has settled down again but now I'm recovering from a stinking cold and stuck at home off work as my chest won't let me move anywhere without kicking up a fuss!

    I'm thinking of you Sarah, and if you want to chat then feel free to message me...

    love Fi xxx

  • Hi Fi,

    Sorry to hear about what you have been through - it really is tough going isnt it especially when life carries on as normal around you & others get the news you wanted. It must be hard with the person at work announcing she was pregnant whilst you were going through that very sad time - I know I'm finding it hard as our neighbours have a new born & our friends are 8 weeks pregnant so I can relate on that one. I admire you for being so positive about things already - when its still very recent & must still constantly be in your minds. As each day goes by we're feeling more positive too & looking forward to trying again. I am saving up like mad so when it happens again I have more money to have time off work for longer with the baby, so even though I'm not pregnant I feel like now I am doing something positive towards it already even though physically we cant start trying for a while yet. Please let me know how you get on trying again - I wish you lots of luck with it all & I hope everything goes well for you next time round! & I hope this next time your asthma gets better - it was amazing waking up in the morning & not coughing for a solid half an hour every day or wheezing when I was doing the housework!

    x

  • EJ,

    Thanks too for your message, thats very kind. Sorry you have not managed to get a positive since - its happened before so it can again. But having problems getting pregnant must have made your loss so difficult I am very sorry for everything you went through. Thanks - I am finding it easier as each day goes by too - its always in my mind but we have to move on or we'll be sad for ever. We've got our 10 year anniversary to look forward to - we're going for a weekend away & holiday to look forward to in November & hopefully by then we can start trying again - not long till the new year - new & full of promise. All my best wishes to you - I hope you get everything you dream of. x

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