IBD and Women

As a woman with IBD you may face many unique challenges that may significantly impact your quality of life and overall well-being. Body image, intimacy, sexuality, and reproductive health are just a few concerns that women with IBD often encounter.

Please know our office is a place where lines of communication are open. We are here for you to help you obtain the resources and help that you need so that you can achieve the best quality of life possible.

 

Body image, intimacy and sexuality:

Dissatisfaction with body image and concerns relating to intimacy and sexuality are common in patients with IBD, especially women. Unfortunately, these issues are rarely brought up in office visits. We understand that they can be sensitive topics that are uncomfortable to discuss with just anyone.

Fistulas, surgical scars, ostomy placements, and medication side effects, along with active disease symptoms such diarrhea, pain, and fecal incontinence can all affect your body image, leading to low self-esteem, anxiety, depression, and sexual dissatisfaction.

Women with IBD may find sexual intercourse painful or uncomfortable. Side effects from medications and body-image concerns can have a huge impact on intimacy and sexual desire.

If you have concerns about your body image or issues with intimacy relating to your IBD, please schedule an appointment with our staff so that we can better help you address these concerns.

 

Menstruation:

Women with IBD may have irregular menstrual cycles. Delayed menarche (or a female’s first ever period) is not uncommon. Hormonal fluctuations related to the menstrual cycle, including changes in estrogen and progesterone levels throughout the month, can influence IBD related GI symptoms such as abdominal pain or cramping, constipation, loose stools, and diarrhea. You may notice a cyclical worsening of your symptoms, or a fluctuation in your bowel patterns, on a monthly basis.

 

Cervical Dysplasia:

Women with IBD, especially those who use tobacco, are on immunosuppressant medications, or were diagnosed with IBD at an early age may be at increased risk for cervical dysplasia, and should be screened regularly by their OBGYN for cervical changes, dysplasia, and cervical cancer. Regular pap-smears are especially important in IBD patients, and should be discussed with your OBGYN.   

 

Fertility:

IBD if often diagnosed during our reproductive years. This can bring up a lot of concerns regarding fertility and pregnancy, especially in female patients.

When IBD is not active, the good news is that conception and pregnancy typically aren’t a problem for women. Research suggests that the general IBD population has normal fertility. Some women may be at risk for fertility problems due to the medications that they take to manage their IBD, nutritional deficiencies associated with their IBD, and surgical history that might cause problems with ovulation or fallopian tube function. The best thing you can do for your fertility is plan ahead. Discussing your fertility concerns with a qualified OBGYN who specializes in high-risk pregnancies is often advised. Please be sure to discuss these concerns with our office, too, so that we can refer you to the appropriate specialists to help meet your family planning needs.  

 

Pregnancy:

Research shows that women with IBD tend to have normal, healthy pregnancies; however they are more likely to have pregnancy complications than women without IBD.

If a woman becomes pregnant when her IBD is active, her disease is more likely to remain active throughout her pregnancy. Having active disease during pregnancy can increase your risk for premature birth and low birth weight.

Certain medications use to treat IBD like methotrexate can cause abortion and congenital defects. These medications should be discontinued prior to planning pregnancy. Folic acid supplementation, which helps to prevent spina bifida and other neural tube birth defects, is particularly important for women taking sulfasalazine, as this medication inhibits your body from absorbing folic acid.

Again, if you have IBD and are taking methotrexate, sulfasalazine, or any other medications and are planning to become pregnancy please talk with our office BEFORE GETTING PREGNANT about alternative treatment options to avoid loss of pregnancy and/or congenital abnormalities. 

 

Menopause:

Women with a low Body Mass Index (or BMI) and those who have never given birth are at increased risk of experiencing early menopause. Women with IBD are more likely than other women to have a low BMI and to have never given birth. Because of this research has suggested that women with IBD may experience menopause at an earlier age, although this research is conflicting. 

Your IBD symptoms may be aggravated by changes in estrogen and progesterone levels leading up to, and during, menopause.

Women often have questions about whether hormone replacement therapy (HRT) could make a difference in the management of their IBD before, during, or after menopause. We are a GI practice and do NOT prescribe HRT. Initiating HRT is a very complex decision that should be discussed with your OBGYN and individualized based on your own personal needs, medical conditions, and risk factors for other diseases and side effects associated with HRT.

 

Bone health:

30-60% of IBD patients are reported to have low bone density likely due to a combination of side effects of steroid medications used to treat IBD, elevated levels of inflammatory markers seen in IBD patients that disrupt normal bone metabolism, and Vitamin D deficiency, which is common in individuals with Crohn’s disease, especially, who have had sections of their small intestine removed. All IBD patients, especially menopausal, women should follow appropriate screening guidelines for osteoporosis, and discuss this regularly with their OBGYN or primary care provider.

We at Hunterdon Digestive Health Specialists take women’s healthcare very seriously. We understand that as a woman with IBD you may have specific gender-specific needs relating to your diagnosis. We are here for you to help you obtain the resources and care that you need so that you can achieve the best quality of life possible.

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