Valerieva E, Vasileva M, Baynova K et al. Women hormones and hypersensitivity: allergic diseases in menopause. Frontiers in Allergy, 2026. https://www.frontiersin.org/journals/allergy/articles/10.3389/falgy.2026.1777688/full
Key takeaways
- Oestrogen and progesterone directly regulate the immune system, including the cells that trigger allergic reactions. When these hormones fluctuate and fall, the threshold at which your immune system reacts can change significantly.
- New or worsening hay fever, skin reactions, asthma, and persistent cough have all been reported in women going through perimenopause and menopause, each with a specific hormonal mechanism behind it.
- Menopause doesn’t always worsen allergies: some women find existing allergies actually improve. But for those whose symptoms have worsened, addressing the hormonal root cause alongside standard allergy management makes sense.
How menopause changes your immune system
Most people know that oestrogen and progesterone control the reproductive cycle. Fewer people know that both hormones are also deeply involved in regulating the immune system.
Oestrogen has complex effects on mast cells: the immune cells that store histamine and other inflammatory chemicals and release them in response to allergens. A 2026 review in Frontiers in Allergy described how declining and fluctuating oestrogen and progesterone during perimenopause and menopause alter several aspects of the immune system which contribute to distinct changes across a range of allergic conditions.
The key point here is not that menopause creates new allergies but that it alters the threshold at which your immune system reacts. Allergens or triggers that your immune system previously tolerated may now tip it over the edge.
Progesterone also matters here. Progesterone has mast-cell-stabilising properties, counteracting some of oestrogen's immune-activating effects. When progesterone falls in perimenopause, often before oestrogen does, that stabilising influence weakens. The result is a period of heightened reactivity that can catch women completely off guard.
The immune system's response to hormonal change is genuinely individual. Some women find that existing allergies actually improve at menopause. Oestrogen can sometimes have pro-inflammatory effects and it’s decline can sometimes reduce immune activation.
Hay fever and allergic rhinitis: why symptoms often worsen at midlife
Oestrogen and progesterone both affect the nasal mucosa, the tissue lining the nasal passages, and the immune signalling that governs how the nose responds to allergens. As these hormones fluctuate during perimenopause, nasal passages can become drier, more congested, and more reactive.
A 2025 study published in the Laryngoscope and confirmed in Frontiers in Allergy 2026 review found a significant association between menopause and nasal symptoms, both allergic and non-allergic.
The distinction matters in practice. Allergic rhinitis is driven by an immune response to specific allergens (pollen, dust mites, animal dander). Non-allergic rhinitis, which also increases at menopause, is driven by hormonal and neurological changes in the nasal passages rather than by allergens themselves. The symptoms look similar: congestion, runny nose, sneezing. But the triggers differ, and so does the management.
If hay fever that was manageable or improving in your thirties has come back with unexpected intensity, or if you have developed nasal symptoms without a clear allergen trigger, hormonal changes are a plausible contributing factor worth investigating.
A small observational study published in PMC in 2023 found that perimenopausal women taking hormone therapy had a reduced risk of allergic rhinitis, suggesting that stabilising the hormonal environment may reduce reactivity. The evidence here is preliminary and needs looking into further..
Asthma: a menopause story that often goes unrecognised
Asthma can develop for the first time in midlife, and the hormonal changes of menopause are increasingly recognised as a contributing factor.
A large UK cohort study published in the Journal of Allergy and Clinical Immunology, following 353,173 women over 17 years, found that HRT use was associated with a meaningfully reduced risk of developing new-onset asthma.
What this means: stabilising hormonal fluctuations through HRT may reduce the immune changes that lower the threshold for asthma development.
Skin reactions: eczema, hives and contact dermatitis
Up to 64% of women attending menopause clinics report skin problems, according to a literature review by NHS-affiliated dermatologists published in Clinical and Experimental Dermatology (2022). Eczematous eruptions, including both irritant and allergic contact dermatitis, were the most commonly reported skin conditions in perimenopausal and menopausal women.
The mechanism explains why. Oestrogen receptors are present throughout the skin, and oestrogen plays an active role in maintaining the skin barrier. When oestrogen declines, ceramide production falls. Ceramides are the lipid molecules that hold skin cells together and form the waterproof barrier that keeps allergens and irritants out. Declining ceramide levels increase transepidermal water loss, meaning the skin becomes drier and more permeable. Allergens and irritants that the skin previously held at bay can now penetrate more easily and trigger a reaction.
“This is the explanation for why jewellery, cosmetics, fabrics, or household products that caused no problem for years now produce redness, itching, or rashes. The substances have not changed. The skin barrier's ability to resist them has.”
The Frontiers in Allergy 2026 review confirmed that both irritant and allergic contact dermatitis become more common at menopause, and noted that oestrogen therapy has been shown to reduce transepidermal water loss.
Hives (urticaria) are also associated with hormonal fluctuations. Research in Asia Pacific Allergy (2025) found significant associations between hormonal fluctuations and urticaria exacerbation, with a history of allergic conditions as a predisposing factor influenced by hormonal changes.
The chronic cough you didn't know might be hormonal
This one surprises most people: approximately one in three postmenopausal women report a chronic cough lasting more than eight weeks, even in the absence of pulmonary disease, according to the Frontiers in Allergy 2026 review.
A persistent cough that does not respond to treatment for chest infection, acid reflux, or post-nasal drip, and that started around perimenopause, may have a hormonal and immune component that is rarely considered in a standard GP appointment. Hormonal changes in airway reactivity can drive chronic cough through mechanisms similar to those driving asthma and rhinitis: altered mast cell behaviour, airway hyperresponsiveness, and mucosal changes.
If you have been managing a persistent cough without resolution and the timing roughly coincides with perimenopause or menopause, it is worth raising this possibility with a specialist. It may represent an underrecognised dimension of hormonal immune dysregulation rather than an independent respiratory problem.
The diagnostic challenge: when allergy and menopause symptoms overlap
Many allergy symptoms share territory with menopause symptoms. Flushing, fatigue, nasal congestion, palpitations, skin reactions, and anxiety appear on both lists. This creates two distinct problems.
The first: women dismiss new allergy symptoms as "just menopause" and do not investigate further. The second: clinicians attribute allergy-driven symptoms to menopause and miss a separately treatable condition, or vice versa.
The most useful tool is pattern recognition. Allergy symptoms tend to follow specific triggers: exposures, seasons, foods, environments. Menopause symptoms tend to be more diffuse and hormonally timed, often worsening in the days before a period during perimenopause, or during periods of stress. Keeping a symptom diary that records both timing and potential triggers can help distinguish what is driving what, and gives a specialist something concrete to work with.
Brain fog, fatigue, and cognitive effects are common to both: 73% of Voy members receiving menopause treatment reported improvement in brain fog (presented at The Menopause Society 2025, forthcoming in Climacteric). Where these symptoms overlap, addressing the hormonal picture often clarifies what remains.
For food-triggered reactions specifically, including responses to wine, aged cheese, fermented foods, or other high-histamine sources, the histamine intolerance mechanism is often involved.
Some women also notice new intolerances to medications they have taken without issue for years: another pattern linked to hormonal changes in immune reactivity described in the Frontiers in Allergy 2026 review. If this is happening, it is worth discussing with your GP.
What actually helps
Address the hormonal root cause where appropriate
By stabilising the hormonal fluctuations that are altering immune reactivity, HRT may reduce the allergic threshold changes driving new sensitivities. For rhinitis, the evidence is directionally encouraging. For asthma onset, the UK cohort data is the most compelling evidence available. For skin conditions, oestrogen therapy has been shown to support the skin barrier.
HRT is not an allergy treatment. It is a menopause treatment that may, as a secondary effect, reduce immune dysregulation contributing to allergic reactivity. The evidence is still developing, and the effect will vary individually. For women with existing asthma, specialist assessment before or after starting HRT is advisable.
Standard allergy management remains appropriate and effective
Second-generation antihistamines (the non-sedating type available from pharmacists) are a well-evidenced first-line option for managing hay fever, hives, and other allergic reactions, as confirmed by a 2023 comprehensive evidence review in the Annals of Allergy, Asthma and Immunology. They can be used safely alongside menopause treatments. Nasal steroid sprays are effective for persistent hay fever and allergic rhinitis. Your GP or pharmacist can advise on which is appropriate for you.
Support the skin barrier
For skin reactions, lipid-rich emollients that replenish ceramides, gentle cleansing routines, avoiding hot showers (which further strip natural oils), and switching to fragrance-free products address the underlying barrier weakness. This is a more targeted response than generic moisturisation.
Manage stress
Stress activates the immune system and can lower the threshold at which mast cells release histamine. Managing menopause-related anxiety through CBT, exercise, sleep support, or appropriate treatment may help reduce reactivity alongside other strategies. 83% of Voy members reported improvement in mood and emotional symptoms after starting treatment (presented at The Menopause Society 2025, forthcoming in Climacteric). Emotional stabilisation and immune stabilisation are not unrelated.
Track patterns
A symptom diary that records reactions, timing, and potential triggers is one of the most useful diagnostic tools available and requires no prescription. It helps distinguish allergy from hormonal symptom, helps identify specific triggers to avoid, and gives a specialist the clearest possible picture.
Getting the right support
New or significantly worsening allergies in midlife deserve proper evaluation, not indefinite self-management. The combination of immune and hormonal changes at menopause is genuinely complex, and untangling what is driving what often requires a clinician who has time to consider both dimensions together.
88% of Voy members felt more hormonally balanced at three months, compared to 62% receiving standard care (presented at The Menopause Society 2025, forthcoming in Climacteric). Addressing the hormonal picture properly changes the environment in which the immune system is operating. For women whose new sensitivities are hormonally driven, that is where lasting change begins.
Voy's menopause consultations are 45 minutes with BMS-trained (British Menopause Society) specialists who have the time to consider the full picture: your allergy pattern, your hormonal history, your existing conditions, and what treatment approach makes sense for your individual situation. Standard allergy treatments remain available alongside any menopause treatment and the two can be managed together.
