Impact of Crohn’s Disease On Your Menstrual Cycle

Crohn’s disease is a progressive type of inflammatory bowel disease that causes inflammation of the digestive tract. Crohn’s disease causes symptoms such as severe abdominal pain and cramping, severe diarrhea, weight loss, malnutrition, and fatigue. This condition can involve various parts of the digestive tract in different people and can impact multiple aspects of a person’s life. Everything from what you eat, to the activities you do, and even your menstrual cycle can get affected by Crohn’s disease. Many women find that their Crohn’s symptoms tend to worsen at the time of their period, while others experience irregular or painful periods. Here’s everything you need to know about the impact of Crohn’s disease on your menstrual cycle.

Crohn’s Disease and the Menstrual Cycle

Crohn’s disease does not only cause gastrointestinal symptoms.(1,2) It can impact many other aspects of your life, including your menstrual cycle.(3) The hormonal changes you experience during your menstrual cycle can worsen your Crohn’s symptoms, such as diarrhea. It can aggravate menstrual pain and also trigger abdominal cramps and bloating. Crohn’s impact on the menstrual cycle is especially harmful if a woman is trying to become pregnant.(4,5)

Some women find that their Crohn’s symptoms worsen at the time of their periods, while others experience irregular or more painful periods. If you start experiencing irregular periods due to Crohn’s and you are trying to conceive, then it can prove to be problematic. Here are a few ways in which Crohn’s disease affects the menstrual cycle and what you can do about it.

Crohn’s Disease and Your Period

The majority of people diagnosed with Crohn’s disease are typically between the ages of 15 and 35.(6) Girls get diagnosed with Crohn’s in their early teenage years. In such cases, they usually end up getting their first period at a later age than usual. At the same time, taking steroids for managing Crohn’s or being underweight due to malnutrition caused by Crohn’s can also delay the first period in girls. Many girls do not get a period until their Crohn’s goes into remission, which might take several months to even years in some cases.

Crohn’s disease has been found to have a direct effect on the period symptoms, and periods also have an impact on the symptoms of Crohn’s. Many women notice that their Crohn’s symptoms tend to worsen during the time of their period. A study in 2014 found that women who suffer from inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease, experience more pain and have a heavier flow during their periods as compared to those who do not have inflammatory bowel disease.(7) The study also found that women with Crohn’s also experience aggravated symptoms such as severe diarrhea, nausea, gas, bloating, and abdominal cramps.

For women who experienced painful periods even before they got diagnosed with Crohn’s disease tend to experience severe pain and other symptoms during their periods as compared to those who did not experience painful periods.(8)

Doctors believe that the release of prostaglandins could cause some of the Crohn’s symptoms that happen at the time of your period.

Prostaglandins are substances that cause the uterus to contract in order to expel the uterine lining.(9) However, prostaglandins also cause the muscles in the gastrointestinal tract to contract, which is what causes the symptoms of severe diarrhea and pain.(10)

Inflammation caused by Crohn’s disease can impact the levels of hormones that are associated with menstrual symptoms. Whether you experience more or worse, Crohn’s symptoms around the time of your period depend on the severity of Crohn’s and what medications you are taking to treat the condition.

Sometimes, it becomes difficult to understand whether Crohn’s disease or your periods are to blame for how you feel and your aggravated symptoms. Both conditions can cause similar symptoms, such as:

  • Diarrhea
  • Irritability
  • Body pain
  • Nausea and vomiting
  • Trouble sleeping

Crohn’s Disease and Irregular Periods

Even for women who have a regular menstrual cycle, Crohn’s disease can throw your cycle out of sync. You may find that your periods may become irregular, coming less often, more often, or sometimes not at all.

Such disturbances in the menstrual cycle are common in women with Crohn’s partly due to the changing levels of hormones. Furthermore, medications you are taking for managing the symptoms of Crohn’s could also play a role. Steroid medications are known to make your menstrual cycle more irregular and erratic.(11)

Irregular periods are problematic if you plan to get pregnant. However, after having lived with Crohn’s disease for several years, it has been observed that your periods start becoming regular again.

Crohn’s Disease and Fluctuations in your Menstrual Cycle

We already know that hormones control the monthly menstrual cycle in women. Every month, the pituitary gland located at the base of the brain releases hormones such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) that boost the production of follicles in the ovaries, causing them to mature and produce an egg.

The estrogen levels also rise gradually through the cycle, causing an increase in luteinizing hormone. This causes one egg to mature. During the cycle, the levels of the progesterone hormone also increase in anticipation of a possible pregnancy and therefore start preparing the uterine lining.(12)

If you don’t become pregnant, the hormone levels will fall, the uterine lining will shed, and you will get your period.

However, Crohn’s disease causes inflammation in the body, which changes the levels of these hormones that control the menstrual cycle. This is what causes more irregular periods in women who have Crohn’s disease.(13)

How to Treat Period Symptoms in Crohn’s?

Taking birth control pills is one way to manage the symptoms of both your Crohn’s disease and your period. Birth control pills can help make the periods more regular, less painful, and lighter. These pills can also help improve the symptoms of Crohn’s that tend to flare up during the time of your period.

However, you must be careful if you are taking certain over-the-counter treatments for managing your period symptoms. This is because medications such as non-steroidal anti-inflammatory drugs (NSAIDs) like Advil and Motrin (ibuprofen) and aspirin can worsen the symptoms of Crohn’s and may trigger a relapse or flare-up of the disease.(14) This is why you should not start taking birth control pills or any other over-the-counter medication for managing your symptoms without consulting your doctor.

If you find your symptoms getting worse around the time of your period every month, you should consult the doctor who is treating your Crohn’s disease. If your periods are irregular or painful, then consider seeing a gynecologist as well.

Your doctor may also check you for other diseases that cause the same type of symptoms, such as endometriosis. It has been found that women with endometriosis have a higher risk of developing Crohn’s disease.(15)

Conclusion

Crohn’s disease is known to affect various aspects of your life, including your menstrual cycle. Women with Crohn’s may find that their periods do not come as regularly as they used to before they developed Crohn’s disease. They are also more likely to experience severe pain, diarrhea, heavier bleeding, and other symptoms during your periods. However, over a period of time, your menstrual cycle starts becoming regular. It is essential that you manage your Crohn’s disease with the prescribed treatment as this can help keep a flare-up under control and also put your menstrual cycle back on the right rhythm.

References:

  1. Baumgart, D.C. and Sandborn, W.J., 2012. Crohn’s disease. The Lancet, 380(9853), pp.1590-1605.
  2. Shanahan, F., 2002. Crohn’s disease. The Lancet, 359(9300), pp.62-69.
  3. Feller, E.R., Ribaudo, S. and Jackson, N.D., 2001. Gynecologic aspects of Crohn’s disease. American family physician, 64(10), p.1725.
  4. Moody, G., Probert, C.S.J., Srivastava, E.M., Rhodes, J. and Mayberry, J.F., 1992. Sexual dysfunction amongst women with Crohn’s disease: a hidden problem. Digestion, 52(3-4), pp.179-183.
  5. Parlak, E., Dagli, U., Alkim, C., Dişibeyaz, S., Tunç, B., Ulker, A. and Sahin, B., 2003. Pattern of gastrointestinal and psychosomatic symptoms across the menstrual cycle in women with inflammatory bowel disease. Turk J Gastroenterol, 14(4), pp.250-256.
  6. Crohnscolitisfoundation.org. 2020. [online] Available at: <https://www.crohnscolitisfoundation.org/sites/default/files/2019-02/Updated%20IBD%20Factbook.pdf> [Accessed 8 September 2020].
  7. Saha, S., Zhao, Y.Q., Shah, S.A., Esposti, S.D., Lidofsky, S., Salih, S., Bright, R., Law, M., Moniz, H., Flowers, N. and Merrick, M., 2014.
  8. Menstrual cycle changes in women with inflammatory bowel disease: a study from the ocean state Crohn’s and colitis area registry.
  9. Inflammatory bowel diseases, 20(3), pp.534-540.
  10. Bharadwaj, S., Kulkarni, G. and Shen, B., 2015. Menstrual cycle, sex hormones in female inflammatory bowel disease patients with and without surgery. Journal of Digestive Diseases, 16(5), pp.245-255.
  11. Downie, J., Poyser, N.L. and Wunderlich, M., 1974. Levels of prostaglandins in human endometrium during the normal menstrual cycle. The Journal of physiology, 236(2), pp.465-472.
  12. Bennett, A. and Fleshler, B., 1970. Prostaglandins and the gastrointestinal tract. Gastroenterology, 59(5), pp.790-800.
  13. Rock, J., Pincus, G. and Garcia, C.R., 1956. Effects of certain 19-nor steroids on the normal human menstrual cycle. Science, 124(3227), pp.891-893.
  14. Cargille, C.M., Ross, G.T. and Yoshimi, T., 1969. Daily variations in plasma follicle stimulating hormone, luteinizing hormone and progesterone in the normal menstrual cycle. The Journal of Clinical Endocrinology & Metabolism, 29(1), pp.12-19.
  15. Sherman, B.M. and Korenman, S.G., 1975. Hormonal characteristics of the human menstrual cycle throughout reproductive life. The Journal of clinical investigation, 55(4), pp.699-706.
  16. Bernstein, M.T., Graff, L.A., Targownik, L.E., Downing, K., Shafer, L.A., Rawsthorne, P., Bernstein, C.N. and Avery, L., 2012. Gastrointestinal symptoms before and during menses in women with IBD. Alimentary pharmacology & therapeutics, 36(2), pp.135-144.
  17. Jess, T., Frisch, M., Jørgensen, K.T., Pedersen, B.V. and Nielsen, N.M., 2012. Increased risk of inflammatory bowel disease in women with endometriosis: a nationwide Danish cohort study. Gut, 61(9), pp.1279-1283.

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