The Relationship of Estrogen Changes With Sinonasal Symptoms and Disease in Women: A Scoping Review

Abstract

Objective: Rhinitis and chronic rhinosinusitis (CRS) are inflammatory-driven processes. Previous research has shown an influence of sex hormones on inflammatory processes, including asthma. The purpose of this scoping review was to assess the existing epidemiologic literature looking at the relationship of estrogen to sinonasal symptoms in women.

Data sources: PubMed and Embase were searched with "estrogen," "rhinitis," and "female," along with related terms.

Methods: All English language articles examining the relationship between estrogen changes and sinonasal symptoms in women were included; case reports were excluded. Data collected included hormonal exposure, presence of sinonasal symptoms, and the influence of hormonal exposure on symptoms.

Results: 57 studies were included. The literature suggests worsening of sinonasal outcomes with and throughout pregnancy. Early menarche (higher lifetime estrogen) may be associated with a higher rhinitis likelihood, which may also suggest a pro-inflammatory estrogen effect. The literature, however, also suggests menopause (low estrogen state) is associated with worse sinonasal outcomes. The literature examining oral contraceptives and hormone replacement therapy is overall too conflicting and limited to suggest any directionality. There are few studies on CRS or its outcomes.

Conclusion: The studies included in this review suggest a potential relationship between biological sex, sex hormones, and sinonasal outcomes, but the validity of the findings is limited due to the lack of rigorous and standardized study design. Given the growing evidence of the inflammatory-modulating effects of sex hormones, which form a pathophysiologic basis for this relationship, further research on the impact of sex hormones on sinonasal disease is required.

Keywords: allergy; estrogen; olfaction; rhinology; sinonasal disease.