An IBD patient advocate recently brought the issue of period pain and IBD to our attention at Discover Therapies, wondering if researchers have identified a link between period pain and Crohn's or ulcerative colitis.
In fact, online IBD forums are filled with questions from women who experience changes in their menstrual cycle. Anecdotally, it appears to be common for women with IBD to experience increased premenstrual and menstrual pain in addition to changes in period duration and flow.
What is the link between IBD and the menstrual cycle—and what can women with IBD do to manage period pain? We sat down with IBD and pregnancy specialist Dr. Yvette Leung in order to find useful information for women looking for answers about how inflammatory bowel disease may affect their menstrual cycle.
Is it common for women with IBD to experience increased period pain, duration, and flow?
Although the relationship between IBD and the menstrual cycle hasn't been fully explored, studies examining IBD and periods found common reports of painful menstruation, abnormal bleeding, and irregular periods.(2)
In a 2014 study published in Inflammatory Bowel Diseases, approximately 25% of participating women with IBD reported a change in period intervals in the year before being diagnosed with IBD. One fifth of women reported a change in their duration of flow, and almost one third of women said they experienced an increase in menstrual pain intensity and duration over the previous year.
The study found that, especially for women who already experience some degree of dysmenorrhea (period pain/cramps), it was common to experience intensified menstrual pain in the year prior to diagnosis.
What causes the increase in period pain for women with IBD?
For many, it is intuitive to believe that the inflammation associated with IBD is at the root of increased menstrual pain, but so far, there isn't any research showing an objective increase in inflammation as it relates to menstruation.
Is it common for your period make your Crohn's or UC symptoms worse? Do many women experience worse flares during their period?
Anecdotally, Crohn's and colitis patients do have more IBD symptoms during their menses.
We also know that nsaids (aspirin, ibuprofen, naproxen) taken during time of menses can increase bowel symptoms.
There aren't many studies examining how IBD symptoms are affected by the menstrual cycle, but the few that exist have found evidence that women with IBD experience increased gastrointestinal symptoms during or before their period. A 2013 study published in Gut and Liver referred to various studies that identified similar patterns:
- Increased prevalence of diarrhea in women with Crohn's disease and ulcerative colitis during premenstrual and menstrual phases, compared to women without IBD.
- A pattern of gastrointestinal (GI) symptoms in women with IBD, with GI symptoms following the cyclic pattern of the menstrual cycle.
- Greater GI symptoms during menstruation in women with IBD independent of disease activity, when compared to healthy controls.
In their own study, the authors compared 47 IBD patients with 44 healthy controls who took notes on their daily symptoms. They found that IBD patients had significantly more frequent symptoms of nausea, flatulence, and abdominal pain. Altogether, these studies suggest that the hormonal fluctuations of the menstrual cycle affect gastrointestinal symptoms in women with IBD.
Many women seem to distinguish between normal abdominal pain associated with IBD and a new kind of abdominal pain that only occurs during periods. Any insight as to what this is caused by?
The studies that have been looked at the relationship between IBD and increase symptoms during menses have not been able to explain this observation.
What are the best ways for women with IBD to manage increased period pain?
At this time until there is research showing that the increase in symptoms are truly secondary to an increase in IBD related inflammation, we do not recommend any change in IBD medications.
Does going on birth control help to decrease period pain? What should women with IBD consider when they are thinking about using birth control to manage period pain? Mirena, seasonal birth control pills, etc?
We recommend patients discuss with their family doctor if they want to consider going on birth control to decrease period pain. Having IBD is not a contraindication to going on birth control pills.
- Lim, S. M., Nam, C. M., Kim, Y. N., Lee, S. A., Kim, E. H., Hong, S. P., … Cheon, J. H. (2013). The Effect of the Menstrual Cycle on Inflammatory Bowel Disease: A Prospective Study. Gut and Liver, 7(1), 51–57. http://doi.org/10.5009/gnl.2013.7.1.51
- Saha, S., Zhao, Y., Shah, S. A., Esposti, S. D., Lidofsky, S., Salih, S., … Sands, B. E. (2014). Menstrual Cycle Changes in Women with Inflammatory Bowel Disease: A Study from the Ocean State Crohn's and Colitis Area Registry. Inflammatory Bowel Diseases, 20(3), 534–540. http://doi.org/10.1097/01.MIB.0000441347.94451.cf
- Bernstein MT, Graff LA, Targownik LE, Downing K, Shafer LA, Rawsthorne P, Bernstein CN, Avery L. Gastrointestinal symptoms before and during menses in women with IBD Aliment Pharmacol Ther. 2012 Jul;36(2):135-44. doi: 10.1111/j.1365-2036.2012.05155.x. Epub 2012 May 24.PMID: 22621660