The Complicated Relationship Between IBD and Menstrual Cycles
It's probably completely normal to dread that time of the month, but for us ladies with Crohn's or UC, our relationship with our periods can get even more complicated. Today, I want to have a chat about how our menstrual cycle can be linked to our disease - and also how our hormones can impact our disease activity and symptoms.
Disappearing periods were the start of my Crohn's symptoms
But firstly, let's consider the opposite: what if your periods disappear altogether? Looking back, this was actually one of the first signs of my Crohn's disease - although it took me another 12 years to get my formal diagnosis.
My periods started fairly late - at around 16 years old - and then seemed to vanish altogether at 18. It was at this time that my suspected 'IBS-type' symptoms seemed to get a lot worse.
Missing periods, or amenorrhea as it's scientifically known, can happen for all sorts of reasons. But for those of us with IBD, it's often a sign we're in a flare-up. This happens because our bodies divert resources away from other parts of the body to deal with the inflammation (this is why stress can also cause your period to be delayed or skipped altogether). It can also be due to weight loss and nutritional deficiencies - anaemia being the most common.
Crazy periods and symptoms with IBD
Don't worry, it's normal for patients with IBD to have erratic cycles too. A 2014 study of about 120 women with IBD found that 25% experienced a change in cycle interval in the year prior to IBD diagnosis, and 21% experienced a change in the duration of flow 1. That's quite a significant number and it's a surprise that doctors aren't asking this as one of the key factors of diagnosis.
When the disease is under control, it's thought that the cycles eventually will regulate themselves again. But if your period is acting erratically, do talk to your doctor as it could well be linked to your IBD.
Endometriosis - a condition that is also associated with particularly heavy and painful periods - could also be linked to IBD. A 13-year-long Danish study found that those with endometriosis had a 50% higher risk of getting inflammatory bowel disease than those without 2. It doesn't necessarily suggest those with IBD will get the condition or vice versa, but certainly implies a possible link.
Do IBD symptoms get worse during your period?
This is a question I've always tried to find the answers to. Does having your period make it more likely to have a flare? It certainly feels like it. At the start and end of my period, frequent toilet trips are inevitable, regardless of what medication I'm on or what I've eaten.
Doctors have acknowledged a link between hormones and IBD (in fact, when women are pregnant they often find either a significant improvement or worsening of symptoms) but they aren't quite sure how periods fit in. There are not many studies, but one by Lim et al 2013 showed that women with IBD did have more frequent diarrhea during their period3.
Yet interestingly, other symptoms related to IBD (such as joint pain) did not seem to change at all, suggesting that the change in toilet habits we have during that time of the month could be because of a surge of hormones rather than disease activity.
It's clear there's lots more to understand in relation to our menstrual cycle and IBD, and that could perhaps be the key to understanding how hormones are linked to disease activity.
Do share your experiences of how IBD has affected your periods below!
Does exercising regularly help in the management of your symptoms?