How Hormones Can Affect Your Sinuses.
The hormonal shifts in a woman's life are not discussed enough. My initial symptoms started at aged 21 with headaches, pressure and dizziness. Over time my symptoms eventually abated only to crop up again in my late 30's. I've lived long enough to see a pattern and before anyone mistakes this as only an article for women, men produce oestrogen too, so it's not impossible for some men to feel the effects of oestrogen in the nasal passageways it just might not be so acute.
However, women, before I start you are welcome!
Oestrogen receives the most interest in its relation to rhinitis studies due to the biological link between the hormone and sinus congestion. To speak personally, I believe this is a large part of my problem. But it's only a problem for some months not all. I guess some months I have more oestrogen in my body than others? And I know it's more complicated than that, which you'll see but that's what it feels like and it has been easily identifiable over the years as I have tracked my cycle. It wasn't acknowledged until after I had brought it up which I shouldn't have had to do but once again, this brings us back round into there needing to be a more open-minded, more comprehensive way of diagnosing sinus issues in the medical industry.
Researchers have found that oestrogen (I am using the English spelling here, but you can mentally drop the 'o' for estrogen if you need to) receptors are present in the lining of the nasal passages and when oestrogen levels fluctuate, several things can happen.
Blood vessels in the nasal lining dilate causing more blood flow which in turn causes more tissue swelling. Swollen tissues narrow the passageway creating that blocked nose feeling. Mucus production can increase as oestrogen can stimulate mucus-secreting glands which contributes to more congestion and that annoying post-nasal drip down the back of your throat. Hormonal changes can make the nasal lining more reactive to external irritants such as temperature changes, pollution or allergens.
So, I question if many women are being overly prescribed anti-allergy meds (read Are Doctors Too Quick to Blame Allergies? post for more.) when their problems lie in hormonal changes. In women sinus issues can be more keenly felt during pregnancy (I come down hard on medicine, but pregnancy rhinitis is widely acknowledged by them, so we'll take the win for this one) when starting contraception or HRT. Strangely enough, being low in oestrogen e.g. during menopause, can also cause issues with drier nasal passageways and mucus changes causing more irritation and inflammation which can create a 'blocked-nose' sensation. The fluctuation of oestrogen may be more of an issue in women going through perimenopause more so than the general decrease in oestrogen though.
If you're a male reader and you've reached this point well done and thank you for sticking it out because I'm about to talk about testosterone.
The research on sinus issues relating to testosterone is less clear but it seems to have the opposite effect on nasal passageways of protecting the tissues rather than inflaming them.
That's it that's generally the research on testosterone and rhinitis.
Unfortunately, testosterone research leaves us with more questions than answers, which sent me down another rabbit hole entirely: if hormones don't explain everything, could anatomy?
I can't help but wonder if men are more prone to sinus issues relating to physical injury or through anatomical skull differences. Men experience higher rates of facial trauma, are more likely to have participated in contact sports and have different facial anatomy on average. Whether these factors contribute to sinus disease is still being investigated, but researchers have suggested that anatomical differences may form part of the picture. This is cited below, but more is needed to explain the exact mechanisms. There is also a self-reporting bias where women are more likely to seek help although I feel like this is changing in the social media era. There isn't a universally agreed figure because different studies report different prevalence rates of male and female patients, but it seems that rhinosinusitis is more common in women particularly without nasal polyps which points to immunology differences between men and women also (another post for another day).
The fact that this is even an area of study is great and I hope the hit-and-miss journey to diagnosing sinus issues becomes more streamlined in the future which will be a benefit for the community and the science in general.
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