Hormones and Hives: How Shifting Hormones Can Trigger Flare-Ups

If your chronic spontaneous urticaria (hives) seem to get worse around your period, you’re not imagining it.

Chronic urticaria affects women about twice as often as men. As your hormones rise and fall throughout your menstrual cycle, they can trigger itching, redness and swelling that show up like clockwork.

Allergist Rim Ishak, MD, explains why hormonal hives happen and what you can do to manage them.

Can your hormones trigger hives?

Hormones can be at least partially responsible for hives flare-ups, especially around your period. That’s because hormonal changes can fire up your mast cells. Those are the cells in your immune system that, among other things, can start the domino effect that leads to urticaria.

“Mast cells have estrogen and progesterone receptors on them,” Dr. Ishak says. “So, they can react to changes in your hormones throughout your menstrual cycle.”

Dr. Ishak explains the different ways hormones can affect chronic hives.

Your period

About 20% to 30% of women with chronic urticaria report worsening around their periods, Dr. Ishak shares.

Estrogen and progesterone rise and fall over the course of your cycle. Hives often flare when these hormones are at their peak. So, you’re most likely to see those itchy, red welts in the three to five days before your period.

“Your hives can peak during menstruation, and then typically improve once your period is over,” she says. “Your hives should get better within a week after your period ends.”

You may also notice hives during ovulation, when hormone levels briefly rise again. That’s about halfway through your cycle.

If you take certain over-the-counter (OTC) medications to manage cramping and other period symptoms, they can make urticaria worse, too.

“A lot of women use medications like ibuprofen (Advil^®) and other NSAIDs during menstruation,” Dr. Ishak points out. “The trouble is that NSAIDs lower the threshold to activating mast cells, which can actually worsen hives.”

That’s why healthcare experts recommend avoiding NSAIDs if you live with chronic hives. Your provider may recommend acetaminophen (Tylenol^®) or other OTC pain relievers instead.

Pregnancy

Pregnancy can affect hives, too — for better or worse.

“We know that about 30% of pregnant women will see a worsening of their hives during pregnancy,” says Dr. Ishak. “But about 50% will see an improvement in their hives. So, it can go either way.”

Menopause

If your hives worsen around your period, you might wonder (and hope!) that menopause will bring relief. Unfortunately, it’s not guaranteed.

If your hives are due to hormonal imbalances, then yes, menopause should clear that up. But there may be other factors at play, too.

“We can’t promise that your hives will go away with menopause because your hives may have other intrinsic causes or other autoimmune triggers in addition to hormonal changes,” Dr. Ishak notes.

Progesterone hypersensitivity (PH)

Sometimes “hormonal hives” aren’t actually caused by chronic spontaneous urticaria. A rare reaction called progesterone hypersensitivity can cause similar symptoms, including hives, rashes, itching and swelling. These signs typically flare about three to 10 days before your period.

“Progesterone hypersensitivity [PH] and chronic hives aren’t the same conditions,” Dr. Ishak clarifies. “But progesterone hypersensitivity can cause symptoms very similar to chronic hives.”

PH rashes typically appear on your arms, legs, face or even your lips, tongue or throat.

PH typically happens when there’s an overload of progesterone in your system. So, your risk for PH can be higher if you have a history of:

• Long-term use of progesterone-containing birth control
• Postmenopausal hormone therapy
• Infertility treatments
• Pregnancy

“Research shows that of those who develop progesterone hypersensitivity, 45% received progesterone from an outside source, such as oral contraceptives or infertility treatments,” Dr. Ishak says.

In severe cases, PH can even lead to a life-threatening allergic reaction called anaphylaxis, so talk with a healthcare provider to determine what’s causing your hives and how to best treat them.

Seeking help for hormonal hives

If your hives keep returning around the same time each month, talk to a provider. Even better, if you can, bring a symptom diary (including photos) with you. Note when your period begins and ends and how that matches up to your hives flare-ups.

After reviewing your symptoms, your provider may recommend allergy testing, blood work or urine tests. If they suspect progesterone hypersensitivity, they can order more specific tests.

Managing hormonal hives

Depending on the cause of your hives, your provider may recommend treatments like:

• Antihistamines to manage flare-ups
• Short courses of corticosteroids for severe symptoms
• Birth control pills to stabilize hormone levels
• Advanced therapies that block histamine release

Again, hormonal changes may not be the only thing contributing to urticaria. Your provider may also advise avoiding common triggers, like:

• Wearing tight-fitting clothing
• Spending time in the heat (including hot tubs and hot showers)
• NSAIDs

They may also recommend strategies to lower stress, which can contribute to chronic hives.

Bottom line

Hormonal hives can be frustrating, but you don’t have to manage them alone.

“It’s important to see an allergist for help with diagnosis and management,” Dr. Ishak advises. “Once we know what all is contributing to your hives, we can help you find the best strategies for addressing them.”