Ulcerative Colitis Symptoms in Women

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Ulcerative colitis is an inflammatory bowel disease that causes inflammation in the lining of the large intestine, also referred to as the colon. Symptoms can include blood in stools, abdominal pain and cramping, an urgent need for bowel movements, and persistent diarrhea.

Females may face additional challenges with ulcerative colitis. These can include changes to the menstrual cycle, painful intercourse, pregnancy complications and anemia (lack of healthy red blood cells). Learn more about how ulcerative colitis can impact females in this article.

The word “female” is used here to refer to people who identify as female and have typical reproductive organs of a cisgender female. We recognize that some people who identify as female do not have the same anatomy as that depicted in this article.

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Menstruation

An inflammatory bowel disease (IBD) like ulcerative colitis can impact a woman's menstrual cycle in a number of ways.

Women who have IBD have an increased risk of premenstrual symptoms, including menstrual-related pain and headaches. Women with IBD may find symptoms like diarrhea, abdominal pain, and other symptoms related to IBD are worse before and during menstruation. Research suggests hormone fluctuations during the menstrual cycle contribute to the worsening of these symptoms.

Irregular Periods

Some women with ulcerative colitis may experience irregular periods. This can be due to a number of factors, including:

  • Hormone levels
  • Stress
  • Inadequate nutrition

Inflammation from active ulcerative colitis can cause the body to stop normal hormone function and make periods stop.

Sexual Health

Ulcerative colitis can have a significant impact on sexual health. Rates of sexual dysfunction (decreased arousal, desire, orgasm, and overall satisfaction) are higher among people with IBD than the rest of the population.

Mental and Emotional

Studies have found that 40% of people with IBD say their illness has stopped them from pursuing an intimate relationship. That rate is higher for females than males. In fact, 45%–60% of women with IBD reported sexual dysfunction compared with 15%–25% of men.

Sexual dysfunction in those with IBD can lead to a number of challenges. These include:

  • Anxiety (excessive and persistent worry)
  • Depression (mood disorder causing intense feelings of sadness and lack of interest in typically enjoyable activities)
  • Body image concerns
  • Impaired quality of life

It is believed psychological factors like depression not only cause sexual dysfunction but are also worsened by sexual dysfunction.

Physical

Women with ulcerative colitis may experience pain during intercourse. This can be an indication of severe inflammation. Women experiencing pain should speak with their healthcare provider, who may prescribe suppositories or hormonal creams to help with the pain. In some cases, women with ulcerative colitis may feel too tired or fatigued to have sex.

Women who have had surgery and have an external pouch (ileostomy) due to ulcerative colitis may have concerns about how this impacts their sex life.

Improving Sexual Comfort With an External Pouch

The Department of Health and Human Services Office on Women's Health says there are several steps women with an external pouch can take to feel more comfortable having sex. These include:

  • Emptying the pouch before having sex
  • Making sure the pouch is secure before sex
  • Wearing a pouch cover or clothing to cover the pouch
  • Using deodorizers, which are either placed in the pouch or taken orally as a pill or liquid
  • Trying different positions if the pouch causes discomfort during sex
  • Communicating with your partner about your concerns

Pregnancy

Ulcerative colitis may impact a woman's ability to get pregnant, and pregnancy may impact disease symptoms. Females with ulcerative colitis have the same fertility rates as females without the disease. However, females with UC who have also had a total colectomy with a j-pouch (total removal of the colon with a temporary pouch to collect stool) added have reduced fertility rates.

Women who have difficulty getting pregnant following surgery may get pregnant through in vitro fertilization (IVF). However, data suggest those with IBD who need IVF have lower success rates of getting pregnant than their peers without IBD.

The Benefits of Waiting Until Remission

The ideal time for a woman with ulcerative colitis to get pregnant is when her disease is in remission and when she is not taking steroids. Becoming pregnant when the disease is active can worsen disease symptoms.

Women should continue taking their medications during pregnancy to prevent flare-ups (times when symptoms increase) of their disease. A flare-up during pregnancy can lead to an increased risk of miscarriage, premature birth, and low birth weight.

The IBD medications Otrexup (methotrexate) and thalidomide should not be taken in pregnancy because these drugs can cause severe birth defects. All other IBD medications are safe to take in pregnancy.

Other Complications From Ulcerative Colitis

Women with ulcerative colitis may experience other complication due to their disease.

Anemia

Females in the general population are already at an increased risk of anemia due to blood loss associated with menstruation. Women with ulcerative colitis may experience bleeding in their digestive tract due to their disease.

Inflammation can also make the absorption of iron more difficult.

Osteoporosis

Women who have ulcerative colitis and other forms of IBD are at an increased risk for osteoporosis, a chronic disease that causes deterioration of bone tissue. This can be due to a number of factors, such as taking prednisone during flare-ups and malnourishment.

Those with ulcerative colitis may find they have a sensitive digestive system, and may avoid milk products because of this. This means they may not get enough calcium, which is important to bone health. In addition, women who don't feel well due to their disease are less likely to exercise regularly, which also raises risk of osteoporosis.

Summary

Ulcerative colitis is an inflammatory bowel disease that can cause uncomfortable symptoms like diarrhea, abdominal pain, and bloody stools. Women with UC face some unique challenges, including changes to the menstrual cycle, an increase in symptom severity during menstruation, pregnancy-related difficulties, and osteoporosis. Your healthcare provider will be able to help you cope with these challenges.

If you are concerned about your health, you should speak with your healthcare provider. Make sure your doctor is aware if you are planning to get pregnant or are pregnant.

A Word From Verywell

Ulcerative colitis is an uncomfortable and painful condition but is it also manageable with the right treatments. Working with a healthcare provider who specializes in gastrointestinal diseases, such as a gastroenterologist, can be especially beneficial. If you are experiencing issues with sexual dysfunction, your menstrual cycle, or pregnancy, an obstetrician-gynecologist (ob-gyn) may also be able to help.

Frequently Asked Questions

  • Is IBD common in women?

    IBD can affect men and women differently. Women are more likely to develop Crohn's disease than men, but men are more likely to develop ulcerative colitis.

  • Can IBD affect your vagina?

    Some women with IBD may experience symptoms that impact their vagina.

    A 2020 study of 1,250 women with IBD found that 41% reported experiencing at least one moderate to severe vulvovaginal (affecting women's genitalia) symptom. Vulvar or vaginal itch, burn, irritation, discharge and vulvovaginal pain were all more common in women who had active IBD.

  • How is the body affected by ulcerative colitis?

    Ulcerative can cause inflammation to the lining of the large intestine. This can cause uncomfortable symptoms like bloody stools, abdominal pain, and diarrhea. Ulcerative colitis can also cause other problems in the body like liver disease, osteoporosis, arthritis, and inflammation in the eye.

  • How does ulcerative colitis affect mental health?

    People with ulcerative colitis have higher rates of depression and anxiety than the general population. For some people, there may be feelings of sadness or stress that comes in short bursts related to their symptoms. But for others, these feelings persist for weeks or more.

    If you are feeling sad or stressed, you should speak with your doctor or a mental health professional.

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