menopause and shortness of breath

You climb the same stairs you have climbed for eleven years and at the top you have to stop and put a hand on the wall. Or you are sitting perfectly still and your chest goes tight, and for a second you cannot get a full breath in, and the fear of that is worse than the feeling itself.

Shortness of breath is on the menopause symptom lists, and it is real. It is also the one symptom on this whole blog where the first thing we want to say is not about hormones.

When should you stop reading and call a doctor?

Start here, because breathlessness has a long list of causes and some of them are urgent. Get medical help straight away if your shortness of breath:

• comes on suddenly, or is severe
• happens when you are resting or lying down
• comes with chest pain or pressure
• comes with cold sweats, fainting or lightheadedness
• comes with swollen ankles or feet
• comes with fever, cough or wheezing
• is getting steadily worse rather than staying the same

Dyspnea, which is the medical word for it, can come from a heart attack, low blood pressure, asthma, pneumonia or a pulmonary embolism, among many other things. None of those are menopause and none of them wait. Nobody has ever regretted getting a breathing symptom checked and turning out to be fine.

If you have had it looked at and nothing structural came back, then the rest of this page is for you.

Can menopause actually affect your breathing?

Yes, and there is better evidence for this than most people expect.

Kai Triebner and colleagues followed 1,438 women for 20 years and published the results in the American Journal of Respiratory and Critical Care Medicine in 2017. They found that lung function declined faster through and after menopause than age alone would predict.

Two measures moved. Forced vital capacity, which is how much air you can take in and push out in total, declined by an amount the researchers compared to smoking 20 cigarettes a day for 10 years. Forced expiratory volume in one second, which is how much you can force out in that first second, declined by an amount comparable to 20 a day for two years.

Read those comparisons carefully, because they are easy to misread and they get quoted badly. This is a population average across two decades, not a prediction about your lungs, and it does not mean menopause is doing the damage of a decade of smoking to any individual woman. It means the decline is measurable and larger than expected, which is enough to take the symptom seriously and not enough to panic about.

Why would hormones affect your lungs at all?

The Triebner team offered two mechanisms rather than one, and neither is dramatic.

The first is systemic inflammation, which rises through the menopause transition and does not confine itself to any one part of the body. The second is more mechanical. Falling estrogen affects bone density, and compression in the vertebrae of the upper back changes the shape of the chest. A chest that has quietly lost a bit of height has less room to expand into.

That second one is worth sitting with, because it is a reason to care about your bones now rather than at 70.

Is it your lungs or is it anxiety?

Often it is both, and the loop between them is the part nobody explains.

You notice you cannot get a full breath. That is frightening, so your breathing goes fast and shallow and moves up into your chest. Shallow chest breathing does not empty your lungs properly, so the next breath has less room, so you feel more breathless, so you get more frightened.

Panic does not mean it is not real. It means the fear has joined in, and the fear is treatable in a way that is separate from whatever started it. If your breathlessness arrives with a racing heart and a sense of dread, read menopause and panic attacks and menopause and heart palpitations alongside this page.

How do you manage breathlessness day to day?

Assuming you have been checked out, here is what is worth your effort.

Pursed lip breathing

This is the highest-value thing on the page and it is free. It slows your breathing down and helps you actually empty your lungs, which breaks the shallow-breathing loop.

Sit comfortably with your back straight. Breathe in slowly through your nose for 4 to 5 seconds, sending the air down into your belly rather than your upper chest. Purse your lips as if you are about to whistle and breathe out for 4 to 6 seconds. Repeat 10 to 20 times. Do it once a day when you are calm, so that it is already familiar when you need it.

Do not smoke, and get out of other people's smoke

Given what the lung function research shows, this is the one lifestyle factor with the clearest line to the outcome.

Move regularly

Steady aerobic exercise builds lung capacity, and the counterintuitive part is that being a bit breathless on purpose, regularly, makes you less breathless the rest of the time. Start well below what worries you and build.

Mind the air you are in

High air pollution days and elevations above about 5,000 feet both make this harder. If you live somewhere with air quality alerts, they are worth actually reading.

Where your weight sits matters more than what it is

Weight carried around the middle physically restricts how far the diaphragm can drop, which is a mechanical problem rather than a moral one. If your body shape has changed through perimenopause, that is common and it is worth reading changes in body shape rather than starting a punishing diet you will abandon in March.

Two things people mention that are worth knowing about

Caffeine has a mild relaxing effect on the airways, so if coffee agrees with you, it is not the enemy here. Ginger, fresh in tea or in food, is a traditional remedy for respiratory comfort. Neither is a treatment, and neither belongs anywhere near an urgent symptom.

If low energy is as much of the picture as the breathing, here are 16 reasons why your energy is low or depleted.

What should you tell your doctor?

Bring specifics, because breathlessness described vaguely gets filed under stress.

Say when it started. Say whether it happens at rest or on effort. Say what you can no longer do that you could do six months ago, in real terms, like the stairs or the walk to the car. Say what else arrives with it. Say where you are in your cycle or how long since your last period. Ask directly whether a lung function test is worth doing, because there is published evidence connecting menopause to lung function decline and you are allowed to bring it up.

The short version

Get sudden, severe, at-rest or chest-pain breathlessness checked immediately, because the serious causes are not menopause. Once that is done, know that lung function genuinely does decline faster through menopause, shown in 1,438 women followed for 20 years, probably through inflammation and through changes in the shape of the chest. Anxiety often rides along and makes it worse. Pursed lip breathing, regular movement and not smoking are what actually help, and a lung function test is a reasonable thing to ask for.

Related perimenopause and menopause symptoms

• Menopause and heart palpitations
• Menopause and anxiety
• Menopause and fatigue or low energy
• Menopause and panic attacks

Frequently Asked Questions

Can menopause cause shortness of breath?

Menopause is associated with a faster than expected decline in lung function. Kai Triebner and colleagues followed 1,438 women for 20 years and reported in the American Journal of Respiratory and Critical Care Medicine in 2017 that both forced vital capacity and forced expiratory volume declined beyond what age alone would predict. Anxiety through the menopause transition also drives shallow chest breathing, which feels like breathlessness.

When is shortness of breath an emergency?

Get medical help straight away if it comes on suddenly or severely, happens at rest or lying down, or arrives with chest pain, cold sweats, fainting, swollen ankles or feet, fever, cough or wheezing. Breathlessness can be caused by a heart attack, low blood pressure, asthma, pneumonia or a pulmonary embolism, and none of those should wait.

How much does menopause affect lung function?

In the Triebner study the decline in forced vital capacity was comparable to smoking 20 cigarettes a day for 10 years, and the decline in forced expiratory volume in one second was comparable to 20 a day for two years. These are population averages over 20 years, not a prediction about any individual woman, and they should not be read as menopause causing the damage of a decade of smoking.

Why do hormonal changes affect breathing?

Two mechanisms have been proposed. Systemic inflammation rises through the menopause transition and affects the whole body. Separately, falling estrogen affects bone density, and compression in the vertebrae of the upper back changes the shape of the chest, leaving less room for the lungs to expand.

What breathing exercise helps with breathlessness?

Pursed lip breathing. Sit with your back straight, breathe in through your nose for 4 to 5 seconds sending the air into your belly, then purse your lips and breathe out for 4 to 6 seconds. Repeat 10 to 20 times. Practicing it daily when you are calm means it is familiar when you actually need it.

Is my shortness of breath anxiety or something physical?

It can easily be both, and one feeds the other. Feeling breathless is frightening, fear makes breathing fast and shallow, and shallow chest breathing does not empty the lungs properly, which makes the next breath feel worse. Anxiety being part of it does not mean the symptom is imaginary, and it does not remove the need to have the physical causes ruled out first.