Hormonal influences on asthma phenotypes and endotypes during the menopausal transition

Asthma heterogeneity remains a defining challenge driven by multiple factors, including hormonal influences that contribute to distinct phenotypic and endotypic manifestations during the menopausal transition. Fluctuations in sex hormones such as estrogen and progesterone during this period do not merely alter reproductive physiology but they fundamentally modulate immune regulation, airway homeostasis, and inflammatory thresholds in ways that give rise to distinct clinically underrecognized asthma phenotypes and endotypes. This review examines how the hormonal milieu during the menopausal transition, defined as the period marked by changes in menstrual cycle regularity and ending 12 mo after the final menstrual period (menopause), may influence the classical asthma subtypes. We highlight the hormonal dynamics, clinical features of asthma, asthma endotypes and phenotypes, and therapeutic modifiers of asthma during the menopausal transition. Collectively, this review underscores the need to reframe menopause-associated asthma as hormonally driven, biologically distinct subtypes while highlighting the critical gaps in knowledge that must be addressed to develop effective therapeutic strategies for this vulnerable and understudied population.