Men and women are equally likely to develop Crohn’s disease, a form of inflammatory bowel disease (IBD), but women tend to experience a different set of concerns than men do.
For women, the symptoms of Crohn’s can include pain during sex, fertility problems, missed periods, and a host of other issues. Here are eight things to be aware of:
1. Crohn’s Disease in Women Tends to Fluctuate Along With Hormone Levels
Fluctuating hormone levels appear to affect Crohn’s symptoms in women.
What’s more, women with Crohn’s may experience worse premenstrual symptoms, such as headaches or cramps, than women without IBD.
2. Crohn’s Disease Is Associated With Missed Periods
Crohn’s disease may worsen during menstrual periods, but missed periods — a condition called amenorrhea — can also be tied to the disease.
Young girls with Crohn’s can be affected, too. According to one research review, malnutrition and IBD-related inflammatory chemicals can interfere with sex hormone production, which may delay puberty.
3. Body Image Issues Are More Common in Women With Crohn’s Disease
Women with Crohn’s disease are more likely to be dissatisfied with their body than men with the disease. Up to 75 percent of women with IBD say they have body image issues, according to one research review. Exactly why is unclear, Dr. Dubinsky says, but the review suggests that factors like surgical scars and ileostomy bags may take a toll on women’s body image.
4. Having Crohn’s Disease Can Affect a Woman’s Sex Life
“Crohn’s disease in women can affect the vaginal area,” says Robynne Chutkan, MD, a gastroenterologist at the Digestive Center for Wellness in Washington, DC, and the author of several books, including Gutbliss, The Microbiome Solution, and The Bloat Cure. “In addition to making life in the bathroom more challenging, it can complicate life in the bedroom.”
Specifically, Crohn’s disease may cause issues such as swelling in the genital area in women.
The development of fistulas — tunnels between two body parts that aren’t normally connected — can affect sex, too. This is particularly true for rectovaginal fistulas, which connect the rectum and the vagina.
“Some women with Crohn’s disease develop a fear of intercourse because of pain, and others may avoid sex because of fear that stool will leak,” Dr. Chutkan says. Some women may avoid dating altogether, because they’re embarrassed by the symptoms, including gas or frequent trips to the bathroom.
“If your doctor doesn’t mention it, it’s up to you to start the discussion,” Chutkan says.
Inflammation of the vulva may be treated with medication or surgery.
Some rectovaginal fistulas can be treated with medication and may heal on their own; others will require surgery.
It’s possible to have romantic relationships and a healthy sex life with Crohn’s disease, however, even if you experience complications.
5. Fertility May Be a Concern for Women With Crohn’s Disease
“If you’re in remission from Crohn’s disease [when trying to become pregnant], you’ll likely be able to conceive and have an uncomplicated pregnancy and healthy delivery,” says Dr. Schnoll-Sussman.
If your Crohn’s disease is active, though, it may be more difficult to conceive and have a healthy pregnancy. “Discuss your plans with your doctor well in advance of conception to help assure a healthy pregnancy,” Schnoll-Sussman says.
In fact, conception during a flare is connected to a higher risk of miscarriage, premature labor, and low birth weight.
Additionally, a study on IBD’s impact on women reported that endometriosis, which can lead to infertility in 30 to 50 percent of people who have it, may be more frequent in women with IBD than in those without.
6. Crohn’s Disease Can Affect Pregnancy
Just having Crohn’s disease, even if it’s in remission, slightly increases the possibility of pregnancy-related issues, such as miscarriage. “The gastrointestinal tract and the reproductive tract are next-door neighbors,” Chutkan says. “This means that what happens in one can affect the other.”
One research review found that not gaining enough weight during pregnancy is associated with premature births and babies who are smaller than others who spent the same amount of time in the womb. Other research, however, indicates that Crohn’s disease activity may actually get better during pregnancy and for some period of time after.
It’s important to work with your gastroenterologist as well as your obstetrician-gynecologist to determine which Crohn’s disease medications are safe to take during pregnancy. If you stop any of your medications and then have a flare, it can increase your risk of miscarriage, stillbirth, premature birth, and low birth weight. While many medications are already believed to be safe, a research review found that biologics weren’t associated with an elevated risk of negative pregnancy outcomes, such as low birth weight or premature birth.
Women with Crohn’s may also be at greater risk of nutritional deficiencies during pregnancy than women who don’t have IBD. “The ability to absorb nutrients can be compromised in Crohn’s disease, so you have to eat well during pregnancy, because the baby only has access to nutrients you absorb,” Chutkan says.
Once the baby arrives, the Global Consensus Group for Pregnancy and IBD as well as the Crohn’s & Colitis Foundation recommend breastfeeding. The Global Consensus Group notes that nursing isn’t connected to an increased risk of IBD worsening, and that breastfed babies of mothers on anti-TNF (tumor necrosis factor) medications aren’t at increased risk of infections in their first year of life.
Most Crohn’s medications are safe to take while nursing, though you’ll need to discuss specifics with your doctor if you want to breastfeed.
7. Crohn’s Disease May Be Linked to Cervical Cancer Risk
According to research, women with IBD are three times more likely than women without the condition to develop cervical cancer, high-risk human papillomavirus (HPV) infections, and precancerous changes in cells in the lining of the cervix, called cervical dysplasia or cervical intraepithelial neoplasia, which are caused by HPV. One research review notes that being on an immunosuppressant medication for IBD can make you more susceptible to persistent HPV infections, which can lead to cervical cancer, because such drugs reduce the protective activities of the immune system. That said, the overall risk of high-risk HPV, cervical dysplasia, or cancer is still low, even if you have Crohn’s.
This makes it important to get regular cervical dysplasia and cancer screenings, Schnoll-Sussman says. The American Gastroenterological Association also recommends that all adults ages 18 to 26 with IBD should get the HPV vaccine, as well as adults ages 27 to 45, if they might have a new sexual partner in the future.
8. Women With Crohn’s Disease May Be at Higher Risk of Anemia
Iron-deficiency anemia is a condition marked by low levels of iron in the blood. In women, the blood loss during menstrual periods diminishes iron stores, and if you have Crohn’s, any gastrointestinal bleeding that results from the disease can add to that loss. What’s more, intestinal inflammation from Crohn’s can make it harder to absorb iron. Talk with your doctor about whether you might need iron supplements.
It’s always a good time to be proactive and discuss any concerns about issues unique to women. Taking preventive measures or having a plan in place should something come up in the future can give you peace of mind.
The Takeaway
- While Crohn’s disease is believed to affect men and women in equal numbers, women face additional complications and concerns related to the condition.
- Women with Crohn’s may experience symptoms that fluctuate along with hormones, missed periods, fertility issues, and an increased risk of cervical cancer, among other issues.
- Talk to your Crohn’s healthcare team about ways to prevent and treat these complications.