As a woman, you might be wondering, how will prednisone affect me? In this article, I answer the question: “What are the prednisone side effects in women?”
I also cover:
- How does prednisone affect females?
- What is a complete list of prednisone side effects in women?
- What should women taking prednisone should look out for specifically?
If prednisone is a steroid, and my doctors prescribed me prednisone, a steroid, am I going to become like a Hulk or like a bodybuilder, or wrestler? …Somebody who hangs out in the gym all day? Is that what’s going to happen to me?
The Chemical Structure of Prednisone
The first thing we need to understand is that prednisone is a steroid. But not the same kind of steroid as what the bodybuilders use. In this image below, you can see that there’s prednisone on the left and on the right are a whole bunch of different hormones that are in our bodies.
- There’s cortisol, the stress hormone that prednisone is mimicking, in the top left.
- At the bottom, there are the sex hormones.
- Female Sex Hormones: progesterone and estradiol are the female hormones. Progesterone is really high during pregnancy.
- Male Sex Hormone: testosterone, the male hormone.
What we need to understand about all of this, (I’m not going make you memorize these structures and have to draw them like I did in pharmacy school!); what I want you to see is how similar prednisone is to these other hormones. Don’t these structures kind of all look the same?
Therefore, what happens when you take prednisone is that your body can sometimes get a little bit confused and mixed up and might just start treating prednisone like these other steroid hormones. There’s a cascade where these steroid structures all change into each other back and forth when your body needs them. Sometimes that steroid hormone cascade gets a little out of whack when we’re on prednisone.
Sometimes it feels like we have too much progesterone or too much estrogen or too much testosterone than it normally would. That is the foundation for understanding all of the other things that happen throughout the rest of this article.
How Does Prednisone Affect Women?
As a woman, you might be wondering how will prednisone affect me? Prednisone affects women differently than men in these ways:
- The side effects can be on female-specific issues.
- Women get different mood issues than men.
- Women have different effects on their hair.
- Women’s bones affected more than men
What are the prednisone side effects in women?
- Changes in Breasts: bigger, smaller or tender
- Menstrual Changes
- Mood Swings
- Changes in Female Hormones
- Bone Loss
We’ll start with the female issues. Females are the only ones who menstruate and who can get pregnant or do breastfeeding. We’ll go into each of those in depth next
Changes in Breasts
Women that report when they’re gaining weight because of prednisone that it makes their breasts get bigger. Other women find that their breasts shrink while on prednisone. Even other women report having more tender breasts than usual.
Menstrual Changes While on Prednisone
- Postmenopausal Bleeding
Essentially anything can happen to your period while on prednisone. You can have dysmenorrhea, which is when you have painful or extra bleeding or longer periods than usual.
You can have amenorrhea, which means you go without having a period.
Can I have Postmenopausal Bleeding on Prednisone?
Finally, you thought you were done. You thought you were out of the woods, that you were in menopause and then prednisone gives you postmenopausal bleeding!
Now with everything I say in this article, clearly you can’t have all of these happen to you. You can’t have dysmenorrhea and amenorrhea at the same time. This doesn’t happen to everyone. None of these happen to everyone. And they’re not that common.
All of these female-specific prednisone side effects in women mentioned are relatively rare side effects that people experience. My purpose in this article is for you to understand that you’re not alone, that these adverse effects to prednisone are possible as a female. You’re not going crazy. You’re not suddenly going back into perimenopausal bleeding. It’s just the prednisone!
Does Prednisone Cause Menopause?
Feeling like you’re going through menopause, even if you’re not, is possible. I am clearly not in menopause (way too young!), but I felt like I was going through that change because I had hot flashes, sweats, and mood swings. I had that beautiful red flushing of my cheeks and chin.
As you can tell, I have no makeup on, I’m not using a filter of any kind. That’s me, the real deal with nothing else.
I was clearly having hot flashes and it was no fun!
Is Prednisone Safe During Pregnancy?
Another female issue: pregnancy. So a lot of women are worried, “Can I take prednisone while I’m pregnant?”
The drug companies have this tiny little asterisk saying that there’s a slight risk of cleft palate in the first trimester.
While this is true, usually if somebody is taking prednisone, the benefit of taking prednisone far outweighs the tiny, tiny, tiny risk of cleft palate. And because of that, the doctors who take care of pregnant women, the American College of Gynecologists (ACOG) say that “Prednisone is the recommended drug to treat certain diseases in pregnant women.” So if they think it’s worth it, then I agree with them. They’re the experts.
This is from the ACOG Clinical Guidance, in which they call prednisone a “Low-Risk Medication:”
Low-risk medications typically are continued in pregnancy, or initiated during pregnancy as needed, because the benefits of therapy and disease control far outweigh any theoretic risks associated with the medication.
Glucocorticoid preparations are commonly given during pregnancy, both as maintenance therapy and in short “bursts” to treat disease exacerbation. Oral corticosteroids, such as prednisone, prednisolone, or methylprednisolone, are recommended during pregnancy because of their conversion to relatively inactive forms by the abundance of 11β-hydroxysteroid dehydrogenase found in the human placenta 7. Long-term glucocorticoid treatment during pregnancy may increase the risk of hypertension, preeclampsia, weight gain, hyperglycemia, immunosuppression, gastrointestinal ulceration, prelabor rupture of membranes (also referred to as premature rupture of membranes), and intrauterine growth restriction, but if these risks exist the magnitude is not known 8 9 10 11 12. Early data suggested that first trimester exposure to glucocorticoids may be associated with an increased risk of fetal oral clefts 13, but more recent data have failed to demonstrate an association 14 15.
There might not even be a risk of cleft palate according to this!
Is Prednisone Safe While Breastfeeding?
What about breastfeeding while on prednisone? I actually had to deal with this when I was prescribed high-dose prednisone. I was nine months into feeding my fourth child. And I was surprised that I was being prescribed prednisone. So I actually had to look it up to make sure prednisone was safe while nursing my baby.
I recommend that every woman who is breastfeeding and is questioning whether their drug is safe while they’re pregnant, download the LactMed app, it’s written by the United States National Institutes of Health (NIH). It gives really great information about what drugs do, what has been reported about the drugs in lactation. LactMed said that:
Amounts of prednisone in breastmilk are very low. No adverse effect have been reported in breastfed infants with maternal use of any corticosteroid during breastfeeding. With high maternal doses, the use of prednisolone instead of prednisone and avoiding breastfeeding for 4 hours after a dose theoretically should decrease the dose received by the infant. However, these maneuvers are not necessary with short-term use. High doses might occasionally cause temporary loss of milk supply.
And so I said to myself, “Great! I will take that prednisone so that I will not bleed to death.”
They had me staying in the hospital and I was away from my baby. It was really rough trying to figure out how to get that milk to my baby. The nurses were fantastic and they helped me succeed in continuing to breastfeed, even though I was hospitalized. What I didn’t realize was that next bullet right there, I kind of skimmed over that a little too fast, where it said:
High doses might occasionally cause temporary loss of milk supply.
So the first time I was on prednisone, I was on a high dose. The following week I was on a drug very similar to prednisone called dexamethasone. And I was on incredibly high doses. I’m talking 10 pills a day of the highest strength for four days (40 mg of dexamethasone). That’s like 267 milligrams of prednisone! I was on that for four days and it completely shut down my milk supply. I was surprised that I couldn’t give my baby any milk.
It shut it down! I had to stop breastfeeding. It was very sad. even though
The American Academy of Pediatrics says that prednisone is compatible with breastfeeding.
So the doctors who take care of the babies say that mamas can be taking prednisone while they’re breastfeeding. So I feel pretty good about that. If the doctors that take care of the babies say it’s okay for breastfeeding and the doctors that cake take care of the mamas say, it’s okay for pregnancy. Then I agree with both of them.
Psychiatric Side Effects of Prednisone in Women
- Female > Male
- Females > depression
- Males > mania, delirium
Moving on to another prednisone side effects in women and how it differently affect us differently than men. So they’ve noticed with mood side effects, things that are psychiatric, that women tend to have more depression.
Men might have more mania or delirium. Women generally have more psychiatric side effects than men.
So men might take prednisone and be like, “eh, it wasn’t that bad.”
Then a woman takes it and feels like she’s going crazy! But it’s not her; it’s the medicine. So you are not going crazy. The medicine is giving you a side effect.
Hair Loss from Prednisone
This question comes up tons “can prednisone cause hair loss?”
And it seems rather controversial because there’s not a lot of evidence in the literature about this, but essentially yes, prednisone can cause hair loss. For me, personally, I lost a third of my hair after I stopped taking prednisone. I finished prednisone in June. Then from August to September, every time I washed my hair I would lose an entire brushful of hair.
It was amazing; shocking to me. It’s been a year since then, and now my hair is growing back. There’s this strange thickness at the top and then where it’s thinner at the bottom.
So yes, alopecia or hair loss can happen from prednisone. It doesn’t tend to be bald spots like when you cure with chemotherapy or an entire lock of hair falls out, it’s more like thinning.
It’s more, you lose the thickness of your hair, but the thickness will come back.
Hirsutism from Prednisone
All right, then hirsutism, that’s a fancy word. That means facial hair and women will talk about peach fuzz or bigger sideburns than usual or having to shave their face for the first time ever. And that is related to that testosterone. Both of those, both of these hair issues are related to the testosterone hormone changes because of prednisone.
Another person posted recently on the Facebook support group, asking if prednisone could cause testosterone levels of zero, and yes, that is possible. If things like that are happening, you can supplement; your doctor can prescribe hormone replacement. You can give back testosterone as a cream, injection, or pill.
You can give back female hormones if they’re too low. So you could go on birth control pills or female hormone replacement if they are being lowered by the prednisone.
All right, finally bones. This is by far the most important side effect in women to me.
Prednisone is leaching calcium from bones. Everyone on prednisone should worry about this, but the people who should worry about it the very most are postmenopausal women. Women who have gone through menopause and are taking prednisone have a much higher risk of osteoporosis than any other population.
That’s why every single postmenopausal woman on prednisone taking over 7.5 mg should be taking calcium and vitamin D daily.
It’s because it can lead to osteoporosis! The most terrible form of bone destruction from prednisone is avascular necrosis, which is bone death! And this person’s x-rays, you can see here, they had to have their hip joint replaced because of avascular necrosis, which is terrible!
We don’t want to do that.
So what can we do all about these prednisone side effects in women? I created a checklist that I went through the top side effects that people experience when they’re on prednisone. It also has a list of ways to look out for these issues, ways to cope with anything that is affecting you, and my best tips to stay healthy while on prednisone. Get your prednisone checklist by signing up below:
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