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 do to counteract prednisone side effects?

Prednisone, like any medication, can have potential side effects. While these side effects can vary from person to person, it’s important to be aware of them, especially when considering the impact on women’s health. In this article I will explain the common side effects of prednisone in women and provide some insights on how to manage them with a free gift at the end.

This article dives deep into the specifics of how prednisone affects women’s bodies across various stages of life, including during pregnancy and post-menopause. By exploring topics like breast changes, psychological impacts, hair alterations, and strategies for managing side effects after 50, readers will get comprehensive insights to better navigate their health journey while on prednisone.

Watch this video to hear me explain it in more depth, or keep reading below.

Watch Prednisone Side Effects in Women – Adverse Effects in Females

What are the prednisone side effects in women?

• Changes in Breasts: bigger, smaller or tender
• Menstrual Period Changes: dysmenorrhea, amenorrhea, postmenopausal bleeding
• Pregnancy: is prednisone safe?
• Breastfeeding: is prednisone safe?
• Hair: loss or male-pattern growth
• Mood Swings
• Bone Loss
• Changes in Female Hormones

Now with everything I say in this article, clearly you can’t have all of these happen to you. You can’t have heavy bleeding and miss periods at the same time. This doesn’t happen to everyone. None of these happen to everyone.

Most of these side effects are not that common. These female-specific prednisone side effects in women mentioned are relatively rare side effects.

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 specific ways:

• The side effects can be to female-specific issues.
• Women get different mood issues than men.
• Women have different effects on their hair.
• Women’s bones are affected more than men.

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 from Prednisone

Women may experience breast changes—ranging from enlargement or shrinkage—to increased tenderness; all signs pointing towards the drug’s interference with estrogen levels and other hormones.

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. Some women report having more tender breasts than usual.

Menstrual Changes While on Prednisone

• Dysmenorrhea
• Amenorrhea
• Postmenopausal Bleeding

Can prednisone affect your period? Can a steroid shot delay your period?

Prednisone and other steroids can affect women’s periods. It can both cause bleeding when it shouldn’t be, and prednisone may stop bleeding when it should be. For example, bleeding mid-period, or periods too early can happen.

Essentially anything can happen to your period while on prednisone. The introduction of prednisone into your system might mean your period becomes irregular or even stops altogether. You can have dysmenorrhea, which is when you have painful or extra bleeding, or longer periods than usual. So can prednisone cause heavy periods? Yes.

Surprisingly, prednisone can affect even postmenopausal women who shouldn’t be having a period anymore! Postmenopausal bleeding with full-blown periods years after a woman’s last period can happen while on prednisone.

Can prednisone stop your period?

But the more concerning for women still expecting a period is when their periods don’t happen. You can have amenorrhea, which means you go without having a period. Normally missing a period means that a woman is pregnant, but while on prednisone it’s a possibility to miss a period and not be pregnant.

Can prednisone make your period come early?

Yes, prednisone can change the timing of your period, from coming early to arriving late.

Not every woman experiences these relatively rare side effects though.

How Does Prednisone Affect Your Period?

Prednisone works by suppressing the immune system and reducing inflammation. While it primarily affects the body’s response to pain and inflammation, it can also disrupt hormonal balance. As a result, prednisone can interfere with the regularity of your menstrual cycle and potentially delay your period.

I made a video all about how prednisone affects a woman’s period. If this is affecting you, be sure to watch and get my best tips for how to cope with changes in periods caused by prednisone.

Watch: How Long Can Prednisone Delay Your Period?

How long can prednisone delay your period?

The length of time prednisone can delay your period can vary from person to person, depending on several factors. These factors include the dosage of prednisone, the duration of treatment, individual hormonal variations, and underlying health conditions. Changes in menstrual cycles highlight how sensitive female reproductive systems are to these hormonal shifts caused by prednisone. It’s important to note that the effects of prednisone on menstrual cycles are generally temporary and should normalize once the medication is tapered off.

Why does prednisone mess with my menstruation?

The reason changes to a menstrual period happen while on prednisone is because prednisone mimics our body’s natural stress hormone cortisol. Cortisol is normally released by our bodies in response to stressful situations like a famine or a war. It makes sense that Mother Nature would prevent periods and ovulation when we’re in that kind of stressful situation: babies wouldn’t do well! (Learn more about cortisol toward the end of this article).

Managing the Delayed Period from Prednisone

If you are experiencing a delayed period due to prednisone, it’s essential to speak with your healthcare provider. They can help assess your specific situation and provide appropriate guidance. In some cases, your doctor may suggest adjusting the dosage or timing of prednisone to minimize the impact on your menstrual cycle. However, abrupt discontinuation of prednisone without medical supervision is not recommended.

Can I have Postmenopausal Bleeding on Prednisone?

Finally, you thought you were done with periods for good. You thought you were out of the woods, that you were in menopause and then prednisone gives you postmenopausal bleeding!

Postmenopausal Periods on Prednisone: Is this normal?

A prednisone warrior asked about postmenopausal bleeding on prednisone and here’s what she said:

I’m on prednisone 60mg x 3 days
50mg x 3 days taper every 4th day by 10 mg
I’m 46 post menopausal now I’m having a full blown period. Haven’t had a period in 2 years. Started after 4 days of prednisone is this normal I’m very concerned.

Watch this video I made in response to her concern about postmenopausal bleeding.

Does Prednisone Cause Menopause?

Feeling like you’re going through menopause, even if you’re not, is a possible side effect of prednisone. 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. So prednisone does not cause menopause, but can cause similar symptoms of the menopausal transition.

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 put a tiny little asterisk in the package insert saying that the use of prednisone “requires that the possible benefits of the drug be weighed against the potential hazards to the mother and embryo or fetus.”

Usually if somebody is taking prednisone, the benefit of taking prednisone far outweighs the tiny, tiny, tiny risks to an infant (none are in the package insert).

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.

Glucocorticoids

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.

The doctors say that prednisone and other steroids “are recommended during pregnancy.” For women taking prednisone for asthma, it makes sense to take it during pregnancy because the risk of low oxygen to the baby from the asthma is much greater than possible prednisone side effects.

Does the baby have increased risk of insulin resistance?

A recent study looked at whether a mother taking prednisone while pregnant increased the risk of the baby having insulin resistance later on. They compared mothers with rheumatoid arthritis who took prednisone with those who did not take prednisone. They found “Children who are prednisone-exposed in utero (low dose) have no increased risk for insulin resistance at the age of approximately 7 years.” So that’s even more reassuring news about prednisone and babies.

Can a woman get pregnant while taking prednisone? Can pregnant women take prednisone?

Yes! A woman can get pregnant while taking prednisone. In fact, some infertility clinics prescribe prednisone for certain conditions to help a woman get pregnant. Watch this video all about Prednisone in Pregnancy to find more answers:

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. 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, 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.

Will Prednisone Harm my Baby if I Take it?

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.

Moving on to other prednisone side effects in women and how it prednisone affects women differently than men.

Mood Swings

Women generally have more psychiatric side effects than men. Women experience more depression, fatigue, mood swings, sleeplessness, and stomach complaints than men.

Psychiatric Side Effects of Prednisone in Women vs. Men:

• Female > Male
• Females > depression
• Males > mania, delirium

Men might have more mania or delirium. So men might take prednisone and be like, “eh, it wasn’t that bad.”

Then a woman takes prednisone 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.

Read More: Am I Crazy? The Psychiatric Side Effects of Prednisone

Hair Side Effects in Women

There are two types of hair-related side effects that women can experience: hair loss and male-pattern hair growth (facial hair).

Hair Loss from Prednisone

This question comes up often: “can prednisone cause hair loss?”

Yes, prednisone can cause hair loss. For me, personally, I lost a third of my hair after I stopped taking prednisone.

One article comparing men and women’s side effects stated,

“Altered appearance was 2.5 times more likely to be intolerable by women than men. Weight gain, acne, bruises, loss of sexual interest, depression, fatigue, increased hair loss, mood swing, moon face, weight gain, sleeplessness and stomach complaints all were more frequently noted as intolerable adverse events in women.”

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 that you temporarily lose the thickness of your hair, but the thickness will come back.

Facial Hair from Prednisone

Next hair side effect of prednisone is hirsutism. That’s a fancy word which means unwanted facial hair growth. Women will talk about peach fuzz or bigger sideburns than usual or having to shave their face for the first time ever.

Both of those hair issues are related to the testosterone hormone changes because of prednisone.

Bone Loss from 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 2.5 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! In 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.

Why do Adverse Effects in Females differ from Males?

If you’re wondering why women experience different side effects than men, it comes down to the science. When you see these images below, it will explain how the side effects differ between men and women.

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. Instead, prednisone is mimicking cortisol, our body’s stress hormone.

In this image below, you can see that there’s cortisol on the left and on the right are a whole bunch of different hormones that are in our bodies.

Steroid Hormones:

• 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 happened earlier in this article.

Female Hormone Changes

A woman posted in a 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 also 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.

Frequently Asked Questions about Prednisone Side Effects in Women

How soon do prednisone side effects in women happen?

Prednisone side effects in women can occur soon after starting the medication. However, it’s important to note that not all women will experience these side effects, and the severity and timing can vary. Some women may notice side effects within a few days of starting prednisone, while others may not experience them until weeks or months later.

Prednisone side effects happen at different times depending on the side effect. Hot flashes from prednisone can happen on the first dose if the dose is high enough. Other side effects like osteoporosis can start happening in the first three months on prednisone but can continue to cause further bone loss over time.

Read More: When Do Prednisone Side Effects Start?

How long do the prednisone side effects generally last in women?

The length of time a side effect lasts depends on the side effect. Most side effects go away as the prednisone dose goes down especially once a woman stops taking prednisone.

Read More: Prednisone Half-Life: When Will it Be Out of My System?

Are there any long-term effects of taking prednisone for women?

Yes, there are long-term side effects of taking prednisone in women. The most concerning long-term side effect is osteoporosis, or severe bone loss. The bone loss from prednisone is one of the few, permanent, irreversible side effects in women. It’s a concern for both men and women, but usually worse and more common in postmenopausal women.

Read More: Prednisone Long-Term Side Effects You Should Know About

Do prednisone side effects in women ever require medical attention? What can be done to treat them?

Yes, prednisone side effects can require medical attention. One large study showed that people on prednisone are more likely to suffer fractures (broken bones) from osteoporosis, sepsis (a full body infection that can be fatal), and pneumonia (lung infections) than those who haven’t taken prednisone. These rare but severe side effects require hospitalization, and the infections require antibiotics. Staying in touch with your doctor while on prednisone about your prednisone side effects is vital to make sure what you’re experiencing is expected or whether you need further medical care.

How to Cope with Prednisone Side Effects in Women?

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!

So what can we do all about these prednisone side effects in women? I created a checklist that includes the top mistakes that people make 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:

References

1. Lee I, Kaminski HJ, McPherson T, Feese M, Cutter G. Gender differences in prednisone adverse effects: Survey result from the MG registry. Neurol Neuroimmunol Neuroinflamm. 2018 Oct 15;5(6):e507. doi: 10.1212/NXI.0000000000000507. PMID: 30345333; PMCID: PMC6192695.
2. Cahill, AG. Immune Modulating Therapies in Pregnancy and Lactation. Committee Opinion. ACOG Clinical. 2019;776.
3. Hari Cheryl Sachs, COMMITTEE ON DRUGS, Daniel A. C. Frattarelli, Jeffrey L. Galinkin, Thomas P. Green, Timothy Johnson, Kathleen Neville, Ian M. Paul, John Van den Anker; The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics. Pediatrics September 2013; 132 (3): e796–e809. 10.1542/peds.2013-1985
4. de Steenwinkel, F.D.O., Dolhain, R.J.E.M., Hazes, J.M.W. et al. Does prednisone use in pregnant women with rheumatoid arthritis induce insulin resistance in the offspring?. Clin Rheumatol 42, 47–54 (2023). https://doi.org/10.1007/s10067-022-06347-0
5. Waljee AK, Rogers MA, Lin P, Singal AG, Stein JD, Marks RM, Ayanian JZ, Nallamothu BK. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ. 2017 Apr 12;357:j1415. doi: 10.1136/bmj.j1415. PMID: 28404617; PMCID: PMC6284230.
6. Warrington TP, Bostwick JM. Psychiatric Adverse Effects of Corticosteroids. Mayo Clin Proc. 2006;81(10)1361-1367. Link