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.

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IBD has two main types: Crohn’s disease and ulcerative colitis (UC). According to research, these immune-mediated diseases are typically more common in females.

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.

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Some people with IBD may find their periods start later than the standard age. Menstruation usually occurs between the ages of 10 and 16 years, but this may differ in people with and without IBD.

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 frequently occur in the year before a diagnosis of IBD. These changes include:

  • 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.

Research from 2015 showed that people may experience changes in their menstrual cycle during the initial disease stages. However, the researchers reported that cycle regularity increased over time with each year of greater disease duration.

Many factors may contribute to irregular periods. Some of these include:

  • differing hormone levels
  • inadequate nutrition
  • stress

Find out more about the period symptoms to expect.

The Crohn’s & Colitis Foundation suggests that fluctuating hormones during the menstrual cycle may affect IBD symptoms.

Additional research from 2020 showed that over half of the females with IBD had worsening symptoms around their menses, or menstrual period.

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.

Find out more about IBD from our dedicated hub.

Research from 2015 explored the association between IBD medication and menstrual cycle changes. The researchers associated steroid exposure with an increased risk for irregular cycles.

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.

Read more about IBD medications.

Other areas of reproductive health that IBD may affect include:

Research has also shown that females with UC experience worsening symptoms during pregnancy more often in comparison with those with Crohn’s.

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.

Possible risks

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.

Research showed that those with Crohn’s disease are more likely to experience diarrhea during the premenstrual phase of the cycle. Additionally, females with Crohn’s or UC are more likely to experience diarrhea during menstruation.

Can other gastrointestinal symptoms occur with your period?

An older study explored whether GI symptoms occurred during a period, even in people that do not have IBD. The researchers found that one or more GI symptoms were common in females before and during the menstrual cycle.

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.