Women’s health and Inflammatory Bowel Disease (IBD): pregnancy, contraception, endometriosis and beyond

Dr Robyn Laube

Dr Laube is a gastroenterologist who treats all types of gastroenterology conditions. She has a specific interest in women’s health and IBD, and has written the Australian guidelines for management of IBD in pregnancy.

Crohn’s disease and ulcerative colitis occur in people at all stages of life, and affect more than just the gut. Women and men can face different challenges with IBD, and many issues are unique just to women. These include pregnancy, fertility, contraception, menopause, gastrointestinal symptoms related to the menstrual cycle, endometriosis and postnatal mental health disorders.

Pregnancy and IBD

The majority of patients with Crohn’s disease and ulcerative colitis have normal pregnancies and healthy babies. The most important factor predicting a healthy pregnancy is to conceive during a time of IBD remission. It is therefore recommended for patients to discuss their pregnancy plans with their gastroenterologist prior to attempting conception, to allow time to optimise the disease activity, implement antenatal care and ensure the medications are appropriate. Most (but not all) IBD medications are able to be continued in pregnant women, and it is important to do so to maintain good IBD control and thus good outcomes for the mother and baby.

Fertility and IBD

Women with well controlled IBD are no less likely to become pregnant compared to women without IBD. The chances of conception may be reduced during IBD flares, therefore it is important to control IBD activity as best as possible. If required, assisted reproductive technology (such as IVF) is safe and effective in women with IBD.

Contraception and IBD

Some medications (such as methotrexate) should only be used in women who are using effective contraception. Long-acting reversible contraception (such as the Implanon and Mirena) are good and reliable options for many women. Progesterone-only hormonal contraception formulations have a lower risk of venous thromboembolism (blood clots) than formulations containing oestrogen, therefore may be a preferable option for women with IBD. Oral contraceptive pills may be less effective during IBD flares, short-term courses of antibiotics or extensive small bowel Crohn’s disease, therefore additional contraception (e.g. barrier contraception) may be temporarily required.

Gastrointestinal symptoms associated with the menstrual cycle

Many women experience fluctuations in gut symptoms with their menstrual cycle. Diarrhoea and abdominal pain may be worse during and before menstruation. Women with IBD may also experience more severe pre-menstrual and menstrual symptoms. Menstruation may be delayed by active IBD, malnutrition or low body mass.

Mental health and IBD

Women with IBD have a higher rate of mood disorders (including depression and anxiety), particularly during IBD flares. Mental health conditions may be overlooked or undiagnosed therefore a high index of suspicion is crucial. Women with IBD are also more likely to experience post-partum mental health disorders, including mood disorders and substance abuse disorders.

Fatigue and IBD

Fatigue is common in patients with IBD, even when IBD is in remission. Many women experience poor sleep quality during times of active IBD, exacerbating fatigue and contributing to stress/anxiety. It is important to exclude contributing factors such as iron and other nutritional deficiencies, anaemia, inflammation, hypothyroidism and mood disorders. Lifestyle intervention such as optimising sleep, exercise, diet and caffeine intake can be helpful.

Body image and IBD

Anxiety about body image is common amongst women with IBD, due to factors such as surgical scars, stomas and perianal disease.

Menopause and IBD

Menopause may occur at an earlier age in women with IBD. Women with IBD have an increased risk of osteoporosis, particularly with active disease, corticosteroid exposure and low body mass index. Hormonal replacement therapy for menopause can be used to control symptoms, however estrogen-containing formulations may increase the risk of venous thromboembolism (blood clots).

Cancer screening and IBD

Colon cancer screening via colonoscopy is important for all patients with IBD, with the frequency of endoscopic assessment guided by individual factors including the duration and activity of IBD. Women with IBD have an increased risk of developing cervical cancer and dysplasia (abnormal cells), therefore keeping up to date with cervical cancer screening is particularly important. Safe sun practices and regular skin examinations are particularly important for women taking immunosuppressive medications, including azathioprine, mercaptopurine and methotrexate. Breast cancer screening should commence at the age of 50 years unless there are individual risk factors or family history dictating earlier commencement.

IBD with irritable bowel syndrome (IBS)

Symptoms of irritable bowel syndrome are more common in women with IBD, and can be mistaken for active IBD. Treatment is different for IBD and IBS, and patients may require treatment strategies directed at both conditions simultaneously to minimise symptoms and maximise quality of life. Not all treatments are in the form of medications. Non-medication based treatments that may be effective in some patients include diets, lifestyle changes and psychological therapy (such as cognitive behavioural therapy, mindfulness and gut-directed hypnotherapy).

IBD with endometriosis

Endometriosis is more common in women with IBD, and the symptoms can mimic those of Crohn’s disease or ulcerative colitis. Women may require treatment directed at both the IBD and endometriosis to achieve the best symptom control.

Women with IBD may experience a variety of different health issues, not limited solely to the bowel. If you would like to schedule a consultation with one of our gastrointestinal specialists to hear more about this, contact us today to speak with our friendly staff.


Why does IBD cause fatigue?

Fatigue is one of the most common symptoms of inflammatory bowel disease (IBD), and can be debilitating. It is often described as feeling exhausted all the time, even after a good night’s sleep. Fatigue can make it difficult to carry out everyday tasks, and can also impact your mood, concentration and memory. There are many possible causes of fatigue in IBD, including anaemia (a low red blood cell count), inflammation, nutrient deficiencies, medications and psychological factors such as stress and anxiety.

What are some common body image concerns people with IBD face?

Body image concerns are common among people with IBD, and can be a result of the disease itself or the treatments used to manage it. This can be attributed to a number of factors, including the nature of the disease itself, the side effects of medication, weight loss or gain and the psychological impact of living with a chronic illness.

Many women with IBD are self-conscious about their appearance due to frequent diarrhoea, abdominal pain, and bloating. They may also have scarring from surgery. In addition, many women with IBD are on long-term steroid therapy, which can cause weight gain, facial puffiness, and thinning hair. All of these physical changes can lead to feelings of insecurity and low self-esteem.

Can IBD affect my mental health?

If you live with inflammatory bowel disease (IBD), you may find that your symptoms can eventually have a negative impact on your mental health due to the chronic nature of the disease. IBD can cause anxiety and depression, which can lead to feelings of isolation and loneliness. It is important to seek help from a mental health professional if you are struggling with your mental health.

What are the symptoms of menopause and IBD?

There are a number of symptoms that may occur during menopause and IBD. These include hot flashes, night sweats, vaginal dryness, sleep problems, mood changes, weight gain, and fatigue. Many of these symptoms are also experienced by women who do not have IBD, but the symptoms may be more severe in women with IBD. In addition to the above symptoms, women with IBD may also experience abdominal pain and cramping, diarrhoea, constipation, and rectal bleeding. If you are experiencing any of these symptoms, it is important to speak to your gastrointestinal doctor to determine if they are due to menopause or IBD.

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