Women's health

Ulcerative Colitis (IBD) and Menstrual Cycle

For women with Crohn’s disease or ulcerative colitis, it is important to understand how the events in a woman’s life—menses, pregnancy, and menopause—can affect the course of their disease, and how their disease, in turn, can affect these milestones. Some commonly asked questions and answers about women and IBD are discussed below.

IBD and Menstruation

Why are my periods irregular with this disease? Many factors contribute to irregular menstrual periods, including hormone levels, adequate nutrition, and stress. When a woman’s IBD is active, the inflammation itself can cause the body to shut down normal hormone function. Restoring health is the way to restore regular periods.

My IBD symptoms always seem worse the week before or the week of my period. Is this common?  Yes, this pattern is common for many diseases. Research suggests that fluctuating hormones and hormone-like substances during the menstrual cycle may affect IBD symptoms.

Can inflammatory bowel disease (IBD) affect my monthly period? Yes. Many women with active IBD have irregular periods. When the disease goes into remission, regular periods sometimes return. No one knows for sure why. But inflammation does affect the hormones that cause periods. Nutritional problems may also interfere with the monthly cycle of women with IBD.

Some women with IBD tend to feel worse right before and during their menstrual periods than at other times. Diarrhea, abdominal pain, exhaustion and other symptoms are often more severe during these times. It is important for women and their doctors to keep track of these monthly changes in symptoms. This will prevent over-treating the disease.

Does having your period make it more likely to have a flare? It certainly feels like it. At the start and end of my period, frequent toilet trips are inevitable, regardless of what medication I’m on or what I’ve eaten.

Doctors have acknowledged a link between hormones and IBD (in fact, when women are pregnant they often find either a significant improvement or worsening of symptoms) but they aren’t quite sure how periods fit in. There are not many studies, but one by Lim et al 2013 showed that women with IBD did have more frequent diarrhea during their period.

Yet interestingly, other symptoms related to IBD (such as joint pain) did not seem to change at all, suggesting that the change in toilet habits we have during that time of the month could be because of a surge of hormones rather than disease activity.

It’s clear there’s lots more to understand in relation to our menstrual cycle and IBD, and that could perhaps be the key to understanding how hormones are linked to disease activity.

Will pregnancy harm a woman with Crohn’s disease or ulcerative colitis? Any woman contemplating pregnancy should consider the state of her health before conceiving. The best time for a woman to get pregnant is when the disease is in remission and she is off steroids. According to recent studies, women with IBD do well during pregnancy if their disease was inactive at the time of conception. If a pregnancy occurs during a period of active disease, however, the disease is likely to remain active or to worsen during pregnancy.

During pregnancy, it is important for women to continue taking IBD medications to prevent disease flares and negative outcomes. Most medications are safe to use during pregnancy (and breastfeeding). However, there are some
medications that are not safe, such as methotrexate. If you are planning a pregnancy, talk to your gastroenterologist and discuss which medications are safe and appropriate so that you can keep your disease under control and have a healthy pregnancy.

What are the chances that the child of a mother with IBD will develop one of these diseases? It is possible, but not inevitable. Evidence suggests that if one parent has IBD, the chance of a child developing the condition is approximately 2-9%. If both parents have IBD, the child’s chances may be as high as 36%.

Does IBD have an effect on menopause? No. If the disease is inactive and menstrual periods are regular, menopause occurs naturally. Surgical menopause has been noted to have a positive effect on IBD symptoms that otherwise occur with menses.

Bowel symptoms: Cyclical changes

About half of women with IBD report that their bowel symptoms get worse just before and during their period. (Interestingly, many women without IBD report the same). Hormones called prostaglandins might have a role. The lining of the uterus (endometrium) releases prostaglandins. These hormones help the uterus to contract during a period. Prostaglandins also help smooth muscles in the digestive tract to contract. This can lead to diarrhea and abdominal pain. Prostaglandins also have a role in inflammation. Other links between bowel symptoms and the menstrual cycle are less clear. Estrogen and progesterone seem to affect movement of food through the digestive tract. They also affect pain perception and sensitivity to changes in internal organs.

Bowel Symptoms and Menstruation

Symptom Before Menses (Frequency) During Menses (Frequency)
Diarrhea 48% 60%
Abdominal Pain 51% 46%
Bloating 68% 57%
Fatigue 56% 56%

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