Menstrual cycles may affect the course of inflammatory bowel disease (IBD) and the symptoms a person experiences. In turn, IBD may alter the regularity and severity of periods.
This article examines the effects IBD has on a person when they start their period and during their cycle.
We also explore how periods affect IBD itself, the effects of IBD medications and periods, additional effects of IBD on reproductive health, and frequently asked questions.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
Research has yet to determine the average age of menstruation commencing in those with IBD. However, experts suggest various factors may delay it, including:
- disease activity
- low weight
- insufficient nutrient intake
- medications, such as steroids
For some younger females, their periods may start when the disease is in remission. This refers to when someone is managing their IBD symptoms with medications or other remedies.
What the research says
Changes in menstrual function
- the cycle length
- the duration of flow
- menstrual pain
The older study above found that females with IBD may have more pain and a heavier flow during their periods than those without IBD.
Researchers suggest doctors screen for menstrual irregularities in newly diagnosed IBD females. However, further studies need to determine whether other factors determine the differences in cycles and symptoms.
Many factors may contribute to irregular periods. Some of these include:
- differing hormone levels
- inadequate nutrition
The Crohn’s & Colitis Foundation suggests that fluctuating hormones during the menstrual cycle may affect IBD symptoms.
A further 2020 study found that 73% of females experienced at least one gastrointestinal (GI) symptom either pre-menstruation or during their cycle. Additionally, of the study participants:
- 58% experienced abdominal pain
- 28% experienced diarrhea
- 53% had fatigue
The researchers also noted that people experiencing the emotional effects of periods were more likely to experience multiple GI symptoms.
In the study, researchers tested steroids, such as immunomodulatory and anti-tumor necrosis alpha inhibitors, to investigate these possible effects.
Doctors generally prescribe low doses and short courses of steroids to prevent complications that can affect various parts of the body.
A person should discuss concerns and possible alternatives with a doctor before starting any treatment.
Other areas of reproductive health that IBD may affect include:
- Sexual intercourse: Some people with Crohn’s may experience dyspareunia — pain during sexual intercourse. If this occurs, it may signal active disease, and with UC, it may signal severe inflammation. Read more from our dedicated sexual health hub.
- Fertility: IBD does not tend to alter the fertility rate of females with UC. However, those who have undergone surgery for UC may have a reduced fertility rate. Keep reading with our women’s health hub.
- Pregnancy: Females with IBD may likely remain in remission during pregnancy if their disease is inactive at conception. Learn more about pregnancy from our hub.
- Menopause: If the disease is inactive and menstrual periods are regular, menopause tends to occur with no issues. Find out more about menopause from this hub.
Research has also shown that females with UC experience worsening symptoms during pregnancy more
People can consult a medical professional, such as an obstetrician, gynecologist, or gastroenterologist, to find out what to expect during any aspect of reproductive health.
There is a possible increased risk of human papillomavirus — the virus that causes cervical cancer — in females taking immunosuppressive drugs for their IBD. As standard, people should undergo cervical screening when they receive an invitation, but there is no need to have more frequent tests.
People can also discuss any concerns or risks with their gastroenterologist.
Below are some frequently asked questions regarding IBD and periods.
Does the menstrual cycle affect ulcerative colitis?
Menstrual cycles can affect ulcerative colitis and the symptoms a person may experience. The fluctuating hormones before and during a period may worsen IBD symptoms for some people.
Can other gastrointestinal symptoms occur with your period?
Although this research suggests there are some possible links, currently, there has been limited research to examine potential predictors of GI symptoms and periods.
Periods may worsen IBD symptoms, either before or during a cycle, due to specific IBD medications or disease activity. In turn, IBD may affect the regularity and severity of period symptoms due to hormone fluctuation.
IBD may have additional effects on reproductive health, which a person can discuss with their gastroenterologist or gynecologist to ease any concerns.