I’m Pregnant and My Sinuses Are Miserable — What Can I Do?

Pregnancy is hard enough without not being able to breathe through your nose. And yet nasal congestion is one of the most common complaints I hear from pregnant patients — and one of the most undertreated, because both the patient and sometimes her physician are understandably hesitant to reach for any medication during pregnancy.

The good news is that there is more you can safely do than you may realize. The key is understanding what is actually happening in your nose, what is safe, what is not, and when you need to be seen in person. Here is what I tell my pregnant patients.

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Pregnancy Rhinitis vs. Sinusitis — They Are Not the Same Thing

The first thing to understand is the difference between rhinitis and sinusitis — because they feel similar but have different causes and different treatment implications during pregnancy.

Rhinitis is inflammation of the nose. Sinusitis is inflammation of the sinuses — the air-filled cavities behind and around your nose. Rhinitis of pregnancy is a specific condition driven by the hormonal shifts that occur during pregnancy, particularly the rise in estrogen and progesterone. These hormones cause the nasal turbinates — the soft tissue structures inside your nose that regulate airflow — to swell. The result is congestion that has nothing to do with infection or allergy. It is hormonal. It is real. And it affects a significant percentage of pregnant women, typically starting in the second trimester and often persisting until delivery.

A true sinus infection during pregnancy — sinusitis — is a different problem. The sinuses are infected or significantly inflamed, not just the nasal tissue. The distinction matters because the treatment approach differs, and because a sinus infection during pregnancy that is not responding to safe conservative measures may need more aggressive management to protect both mother and baby.

What You Cannot Use During Pregnancy

Many of the medications that patients reach for first when their sinuses act up are not safe during pregnancy. Oral antibiotics, oral steroids, oral decongestants — many of these have restrictions or outright contraindications in pregnancy that vary depending on the trimester. I will not give you a specific list of what is and is not permitted, because that conversation needs to happen between you and your OB-GYN, who knows your specific situation, your trimester, your overall health, and any other factors that affect what is safe for you and your baby.

What I will tell you is this — do not assume that something is safe during pregnancy just because it is available over the counter. Many common sinus and allergy medications carry warnings for pregnancy that patients never read. Before you take anything that was not explicitly approved by your OB-GYN for this pregnancy, ask first. That applies to everything — decongestants, antihistamines, nasal sprays, and anything else you might reach for without thinking.

What Is Safe — and What Actually Works

The safest and most consistently effective tool for managing nasal congestion and sinus symptoms during pregnancy is saline nasal rinse. A NeilMed rinse with distilled water and the standard saline packet — done once or twice daily — mechanically flushes allergens, irritants, thick mucus, and inflammatory debris from the nasal cavity. It works. It is safe. There is no systemic absorption. Whatever goes into your nose drains out into the sink. Mom is fine, baby is fine.

Steam inhalation is another safe option — a warm shower, a bowl of warm water with a towel over your head, or a personal steam inhaler. Adding a drop or two of eucalyptus oil to your steam can help open the nasal passages further. Eucalyptus contains a compound called 1,8-cineole that has genuine mucolytic and anti-inflammatory properties in the nasal lining — this is not folk medicine, it has published evidence behind it. One or two drops is all you need. More is not better.

For patients who tolerate nasal rinse and want to take the rinse a step further during a bacterial flare, I sometimes suggest adding a small amount of Manuka honey, Johnson’s Baby Shampoo at a very low concentration, and xylitol to the rinse solution. These are the same components we use in our tiered sinus restoration protocol for non-pregnant patients. The rinse drains out of the nose, it does not absorb systemically, and the concentrations involved are low and topical. That said — I still ask every pregnant patient to run this past her OB-GYN before adding anything beyond standard saline. You are caring for two people, and I want her physician to know what is going in.

Sleep positioning can help significantly. Elevating the head of your bed or sleeping with an extra pillow reduces the gravitational pooling of congestion that makes nighttime symptoms worse. Humidity in the bedroom — a cool mist humidifier — keeps the nasal mucosa from drying out, which worsens irritation.

The Nasal Steroid Conversation

One of the most important conversations I have with pregnant patients who are not getting adequate relief from saline and steam alone is about topical nasal steroid sprays. Many pregnant patients are frightened of any steroid — and I understand why. But I try to put this in perspective with an analogy that resonates.

Pregnant women with asthma are routinely advised to continue using their inhaled steroid medications to prevent asthma flares during pregnancy — because uncontrolled asthma is more dangerous to the baby than the inhaled steroid. A topical nasal steroid spray works even farther upstream than an inhaled asthma steroid. The dose is lower, the surface it contacts is smaller, and the systemic absorption is minimal. It is not the same as taking an oral steroid.

I try to convince my pregnant patients to consider a topical nasal steroid when their symptoms are significantly affecting their sleep and quality of life — but always with one condition: it must be approved by their OB-GYN first. I give them the clinical reasoning I just gave you and ask them to bring that conversation to their OB. In most cases, their OB is comfortable with it. But that decision belongs to the physician managing the pregnancy, not to me.

When to Come In

Most cases of pregnancy rhinitis and mild sinus congestion during pregnancy can be managed conservatively with the measures above. But there are situations where you need to be seen — by your OB, by an ENT, or potentially in an emergency setting.

If you develop a fever, that changes things immediately. Fever during pregnancy requires evaluation. If your symptoms escalate to severe facial pain or pressure, significant worsening congestion, or thick purulent post-nasal drainage that is not responding to appropriate conservative management — that is the time to see an ENT. These symptoms may indicate a true bacterial sinus infection that needs treatment, and during pregnancy the calculus of risk and benefit shifts because you are caring for two people, not one. In the worst case scenario — a sinus infection severe enough to cause systemic symptoms — hospitalization may be necessary. That is rare, but the stakes of undertreating a serious infection during pregnancy are high enough that I would rather you come in and be evaluated than wait it out.

What Happens After Delivery

Here is the part that gives pregnant patients the most relief to hear — for most women with pregnancy rhinitis, the nose clears up remarkably quickly after delivery. The hormonal shifts of pregnancy reverse. The fluid balance in the body changes back to the non-pregnant state. The turbinate swelling that was driven by estrogen and progesterone resolves. Patients often tell me that within days of delivering their baby, they can suddenly breathe through their nose again in a way they had not been able to for months.

To support the smoothest possible transition through the remainder of the pregnancy and into the postpartum period, I encourage patients to continue their saline rinse and, if their OB has approved it, their topical nasal steroid spray. These measures help keep the nasal mucosa as calm as possible in the final weeks. After delivery, continuing the saline rinse for a few weeks while the body rebalances supports the recovery of normal nasal function.

If you are still significantly congested several weeks after delivery — if the expected clearance has not happened — that is the time to come in for a proper evaluation, because at that point the pregnancy rhinitis excuse is no longer on the table and we need to understand what else might be driving the symptoms.

Want to Understand More?

This post is part of the Why Sinus Treatments Fail — And What Starts Before Them series on the Airway & Sinus Wellness Review.

→ Why Antibiotics Keep Failing Your Sinus Infection

→ Does Balloon Sinuplasty Actually Work?

→ Could My Husband’s Dementia Actually Be Brain Fog From Sinus Infections?

Airway & Sinus Wellness Review — Full Publication

Why Sinus Treatments Fail — And What Starts Before Them — Patient education from the Sinus & Allergy Wellness Center of North Scottsdale.

About the Author

Franklyn R. Gergits, DO, MBA, FAOCO is an otolaryngologist and rhinologist with over 30 years of clinical experience. He is the founder of the Sinus & Allergy Wellness Center of North Scottsdale, where he performs in-office balloon sinuplasty, turbinate reduction, NEUROMARK®, and swell body reduction procedures under local anesthesia. He performed the first balloon sinuplasty in Pennsylvania, holds dual Entellus Centers of Excellence certifications, and is the originator of the Posterior Sinonasal Syndrome (PSS) hypothesis, with a preprint available at Preprints.org (DOI: 10.20944/preprints202603.0858.v1). ORCID: 0009-0000-4893-6332.

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This content is for educational purposes only and does not constitute medical advice. All treatment decisions during pregnancy must be made in consultation with your OB-GYN and managing physicians. Do not use any medication or supplement during pregnancy without approval from your physician.