We know now that women experience health conditions differently than men do. Different health needs, however, are not limited to reproductive health and “bikini medicine” – the idea that men and women are physiologically different only in their reproductive function – can significantly lower women’s quality of life. From the way they metabolize drugs to diseases and conditions that mostly affect women (like migraines) and so remain under-researched, there is a medical bias that unfairly affects half the population.

Knowing this, it’s no surprise that the way IBD affects women’s menstrual cycle hasn’t been thoroughly researched, even though a significant percentage of women with IBD report menstrual irregularities as well as intensifying of GI symptoms before and during their period. There are speculations as to how IBD affects menstruation and how hormonal changes in women affect IBD symptoms but more in-depth research is needed in order to understand the underlying dynamics. In honour of Crohn’s and Colitis Awareness Month on the FindMeCure blog, we’ll take a look at what we know about IBD and menstruation. 

Painkillers not allowed. 

The standard treatment for painful menstrual cramps are NSAIDs – nonsteroidal anti0inflammatory drugs like aspirin and ibuprofen. Although some women who experience intensely painful menstruation don’t report improvement of symptoms after taking an NSAID, most women can manage pain with ibuprofen. For women with IBD, however, NSAIDs are not an option. 

This class of drugs can worsen IBD symptoms and add fuel to a flare. Many women are left with ineffective options that mean they simply suffer through the pain. Some doctors caution that women in remission can sporadically take NSAIDs to manage painful periods but others warn against these drugs. Checking with your doctor is recommended although research suggests women’s pain is often dangerously underestimated and thus – undertreated. 

In order to keep your period symptoms in check if your IBD is also active, you may need to resort to at-home remedies. For some of those, you’ll still need a heads-up from your treatment team because they could interact with your IBD drugs. An antispasmodic should be generally safe to take for the pain or you could opt for peppermint oil which has been researched for its antispasmodic properties (especially for treating IBS). Loose stool can be managed naturally with fibre or antidiarrheal loperamide. Warm pads could relieve spasms to an extent and can also improve your IBD symptoms but the most important thing remains to address the issue with your IBD team. 

Period irregularities. 

According to a 2014 study in the Inflammatory Bowel Disease journal, women with IBD experience more painful symptoms with a heavier flow and irregular periods are not rare either. In theory, inflammation in the pelvic area as, difficulty maintaining a steady weight, steroids for the treatment of IBD as well as the psychological distress people with IBD experience can affect the regularity and duration of periods as well as the symptoms that women have during this time of the month. However, more in-depth research is needed to understand the link between IBD and menstrual irregularities. 

IBD symptoms such as diarrhoea, blood in the stool, and faecal incontinence can, in turn, be exacerbated by menstruation and even women who don’t have IBD report GI symptoms around their period. Estrogen and progesterone receptors in the GI tract may be responsible for these symptoms, according to doctor Sumona Saha, the lead author of the 2014 study. 

Other hormones, prostaglandins, may play an important role as well. Prostaglandins help smooth muscles like those of the uterus and the digestive tract to contract. Uterus contractions during menstruation help expel the thickened lining but GI contractions too can lead to abdominal pain and result in diarrhoea.    

Non-steroidal treatments for IBD have less of an effect on menstruation and according to the study findings, period irregularities and painful symptoms abate in time with each year after the initial IBD diagnosis. If no such improvement occurs for you or if symptoms are worrying, you should address this with your treatment team. Period irregularities may seem like a minor issue but if you’re planning a family it’s important that you ask about issues of fertility. Even if you’re not thinking about children, however, painful menstruation and GI symptoms can lower your quality of life.  

Can hormonal contraception help?

Balancing your hormonal levels can have a positive effect both on you menstruation symptoms and on your period-related IBD symptoms and it’s worth considering the option if your quality of life is at stake. However, hormonal contraception is not a cure-all for every issue women experience related to their reproductive organs. Hormonal birth control has a specific function and even as such it can have debilitating side effects and should be carefully selected and adjusted to every woman. 

Different symptoms concerning the female reproductive system have different causes and should be approached as individual issues that deserve specific treatments. In order for this to happen, however, we need to demand more research into female-specific health issues and ask for better treatments. 

One thing you can do right now is to join a clinical research study looking into the relationship between IBD and menstruation. You don’t have to test an innovative treatment, although this could be a good opportunity to find something that works better for you and your way of life. There are clinical trials for observation, prevention, as well as non-medicinal treatment and by joining one of them you can help further scientific understanding of under-researched or marginalised topics. Helping healthcare and clinical professionals make progress makes the future a little brighter for everyone. 


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