LAM usually progresses over time although the rate at which it progresses varies considerably between individuals. Since LAM generally occurs before the menopause it is thought to be influenced by female hormones such as oestrogen and progesterone.
Oestrogens may accelerate the disease and progesterone may slow it down. The effect of events such as pregnancy that cause hormones to change and the effect of hormones in "the pill" and in hormone replacement therapy (HRT) are not well established but he best evidence to date suggests the following:
Pregnancy Some patients with LAM have been pregnant without any worsening of their condition. In other patients, however, the disease has deteriorated and complications such as pneumothorax and a pleural effusion appear to occur more often during pregnancy.
Hormone replacement therapy (HRT) HRT contains oestrogens and it may therefore make LAM worse.
Menopause The rate at which LAM progresses may slow down after the menopause, although this is not always the case.
The contraceptive pill Most contraceptive pills contain oestrogen and progesterone and although the evidence that the contraceptive pill makes LAM worse is limited, a progesterone only contraceptive pill may be safer. Alternative means of contraception which do not use hormones could also be used.
Fertility treatment If oestrogen makes LAM worse it is likely that fertility treatment will do the same.
Patients who wish to consider becoming pregnant or who are taking or wish to take the contraceptive pill, hormone replacement treatment or fertility treatment should discuss this with their physician before making changes
Juliet Stevenson