Ulcerative colitis (UC) symptoms vary from person to person, but they tend to affect males and females in a similar way. However, UC can also impact menstrual cycles, fertility, and pregnancy in females.

A woman sitting outside facing the sunShare on Pinterest
Gfilmfoto/Getty Images

UC is a form of inflammatory bowel disease (IBD). This long-term condition causes prolonged inflammation of the colon. Around 1.3% of adults in the United States have IBD.

While males and females have similar symptoms, UC may cause reproductive and sexual challenges for females. Genetic, environmental, and hormonal factors can play crucial roles in UC and its effects on a person.

UC affects people of all ages, and it often has two peaks. Most people develop UC between ages 15–30 years, and others between ages 50–70 years. Developing UC beyond 60 years old is more common in males.

Learn more about how UC can affect females, the additional risks it poses, associated conditions, when to consult a doctor, and the general outlook for the condition.

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.

People with IBD may go through periods where they experience no symptoms (remission). Or they may experience periods of remission and periods of active disease (flares). Symptoms can range from mild to severe.

Common symptoms include:

A person may also experience general symptoms, such as:

Learn more about IBD from our dedicated hub.

Hormonal factors

Hormonal fluctuations during different periods of a female’s life may impact their IBD symptoms.

A 2018 study found that females may have worse symptoms during their menstrual cycle. These may include worse abdominal pain and more frequent bowel movements.

Pregnancy may also affect disease activity. In turn, UC and treatments or procedures may impact fertility and pregnancy outcomes.

Postmenopausal females reported no change in symptoms due to menopause itself. Females with worsened symptoms after menopause were older when receiving an IBD diagnosis.

Treatment aims to maintain periods of remission or help manage a flare of symptoms.

Depending on the degree of symptoms, a doctor may recommend mesalamine, immunomodulators such as methotrexate, or biologics such as adalimumab (Humira).

In periods of flares, doctors may prescribe a short course of steroids to help quickly bring down inflammation until other medications can take effect.

Remedies

Alternative remedies are available for colitis, such as avoiding certain foods, consuming fruits and vegetables as juices, drinking probiotics, and following specific diets. People may wish to experiment with home remedies alongside their treatments.

Surgical

If nonsurgical treatments do not provide relief for symptoms, doctors may suggest surgery as an option. These may involve removing all or part of the colon (colectomy), connecting the small intestine to an external pouch (ileostomy), or connecting the intestine to the muscles around the anus (J-pouch).

Read more about the treatments for UC.

Certain factors may affect females with UC. These include their genes, environment, and hormones.

These factors may affect the course of the disease and, in turn, impact the person’s quality of life. Alongside worsened menstrual symptoms, a female with UC may have an increased chance of developing the following conditions:

Sexual dysfunction

Active symptoms may cause severe inflammation, making sex uncomfortable (dyspareunia) and even painful, indicating severe inflammation.

A 2017 study found that 54% of females with IBD have sexual dysfunction, driven by the psychological factors related to receiving a diagnosis of UC and independent of disease activity.

Fertility and pregnancy

A 2022 study found that proctocolectomy with ileal pouch anal-anastomosis (J-pouch surgery) resulted in decreased quality of life and potential adverse events associated with pregnancy.

However, a 2020 study examined fertility rates in females who underwent surgery for colitis as a child. It found that 88% had successful pregnancies.

The disease is likely to remain active in females who conceived with active disease. Up to 45% of people with UC who conceive while their disease is active may find that their condition worsens during pregnancy. In 24%, the colitis is active but stable. In the remainder of people, the disease goes into remission.

Iron deficiency anemia

Research recognizes that iron deficiency anemia (IDA) is a common complication with IBD, as a result of bleeding in the inner lining of the intestine.

IDA may also result from the decreased absorption of iron due to inflammation, though doctors suggest this is seen more often in Crohn’s disease.

In some people, heavy periods can lead to excessive blood loss and may cause anemia. If a person has UC or Crohn’s and experiences heavy periods, this could further increase their risk of IDA.

Read on for ways to manage heavy menstruation.

Osteoporosis

Females with IBD are at an increased risk of having osteoporosis, as their bone density is lower than average. This condition tends to be more common in females with Crohn’s disease, but it can also occur in UC.

Osteoporosis and bone loss may result from multiple factors:

  • Inflammation affects the rate at which the body removes old bone and forms new bone (typical bone metabolism).
  • Corticosteroids may decrease the amount of calcium absorbed by the intestines and reduce the production of the hormone estrogen, which contributes to strong bones.
  • People with IBD, particularly those who have had sections of their small intestine removed, are at increased risk of vitamin D deficiency, as this is the part of the body that absorbs most nutrients.

Body image issues

Taking corticosteroids can cause weight gain during flares, while malabsorption and a lack of nutrition due to dietary changes may lead to weight loss. These fluctuations in weight can cause body image issues.

A 2020 study found that many people with IBD experience “maladaptive attitudes” toward eating.

Females who had elevated scores on the eating attitude test as part of the study experienced the following:

  • low weight
  • a diagnosis of IBD in childhood
  • psychological distress
  • body image disturbance

Read more from our dedicated mental hub.

Fistulous tracts

Fistulous tracts are holes or tunnels on the intestinal walls or other organs. Fistulas may develop after a person undergoes bowel surgery or as a complication of IBD.

These tracts are more common in Crohn’s disease, with 33% of people with Crohn’s disease developing a fistula and only 3% of people with UC developing one.

People with UC usually develop fistulous tracts as a result of bowel surgery.

Doctors prescribe medications as the first line of treatment for UC. Corticosteroids such as prednisone are anti-inflammatory drugs that suppress the immune system. This type of drug may lead to infections such as yeast infections in the mouth and vagina or urinary tract infections (UTIs).

Females taking immunosuppressive drugs may also have a slightly increased risk of contracting the human papillomavirus, potentially resulting in cervical cancer. A person taking these drugs should ensure they attend cervical screenings when invited. However, there is no requirement for them to seek testing more frequently.

Moreover, doctors recommend that people trying to get pregnant not take certain immunosuppressant drugs, as they may impact fertility. There is also an increased risk of congenital disabilities or pregnancy loss.

A person should always speak with a doctor to discuss risks and medications when pregnant or trying to conceive.

Flares can range in intensity. While a person may be able to manage mild flares at home, severe flares may need urgent attention, as they may be a sign of a complication that could be life threatening.

The following symptoms warrant immediate medical attention:

UC is a long-term condition. People may experience periods of remission or flares when symptoms suddenly worsen.

Around 10% of cases will only have one flare and fully recover. In comparison, another 10% will experience rapid disease progression after a single flare, leading to severe complications such as hemorrhage and sepsis.

A person with active UC also has five times the risk of having colorectal cancer than someone without UC.

Read more about the link between UC and cancer here.

UC is a form of IBD that causes symptoms such as diarrhea, bloody stools, and abdominal pain. Treatments range from taking long-term prescription medications to making lifestyle and dietary changes, and in severe cases, having surgery.

Females with IBD may experience challenges, including worsened menstrual symptoms, osteoporosis, and fertility issues due to UC inflammation or its treatments.

A person should speak with a doctor to discuss the complications related to UC, and they may wish to explore alternative treatments to reduce risks.