For example, hormonal changes that occur during menstruation and pregnancy can trigger more UC symptoms, and UC, in turn, can cause problems such as yeast infections, body image issues, and more, according to the Crohn’s and Colitis Foundation. Here are nine facts about UC that women should know, plus tips and information to manage the condition.
1. Menstrual periods may aggravate your UC.
More than half of women say their IBD symptoms get worse when they’re on their period, according to a study of more than 1,000 females published in January 2018 in the journal Inflammatory Bowel Diseases. These symptoms may include increased frequency of bowel movements, more gas or bloating, or increased abdominal pain, says Emanuelle A. Bellaguarda, MD, an assistant professor at the Feinberg School of Medicine at Northwestern University in Chicago. Experts aren’t exactly sure why women experience more symptoms during menstruation, but the Inflammatory Bowel Diseases research suggests it may be caused by hormonal changes. During menstruation, women produce more hormone-like compounds called prostaglandins, which cause increased contractions of the smooth muscles in the colon. This may cause gastrointestinal problems such as diarrhea and abdominal cramps. The good news is that these symptoms don’t necessarily lead to a flare or increased inflammation, says Dr. Bellaguarda, and they should subside after your monthly period. “I reassure my patients that they’re not experiencing a flare every month,” she says. Some women might also be worried about weight fluctuations. Malabsorption of nutrients can lead to weight loss, while corticosteroids, which may be used to treat a flare, can cause weight gain. Body image problems can contribute to an increased risk of anxiety and depression and also discourage some women with UC from being sexually intimate, says Erin Gross, MD, an obstetrician-gynecologist and assistant professor of reproductive medicine at UC San Diego School of Medicine. “The brain is our biggest sex organ,” she says, so the way you think about your body can have a huge impact on how you feel about sexual attractiveness." Generally, says Dr. Gross, women with UC “have a higher risk of anxiety and depression,” which may result in part from distress over body image. If you’re experiencing any of these concerns, consider asking your gastroenterologist, obstetrician-gynecologist, or primary care doctor for a referral to a therapist, who can help you work through this problem.
3. Immune-suppressing drugs can cause yeast infections.
The immune-suppressing drugs commonly used to treat UC can result in vaginal yeast infections, says Gross. But Dr. Matro notes that gastroenterologists are less likely than obstetrician-gynecologists to detect this problem, unless the patient raises concerns. “My patients have yeast infections more [often] diagnosed by their ob-gyns,” she says. Tell your gastroenterologist if you suspect you have a yeast infection or have been diagnosed with them in the past, because it may be an issue to take into account in your treatment plan. “If it gets to be a problem,” Gross says, “sometimes we’ll put women on antifungal medications.”
4. You may develop fistulas after bowel surgery.
Fistulas are abnormal, extra connections between two organs or between an organ and the skin: Imagine a hollow tube connecting different parts of the body that isn’t supposed to be there. In people with IBD, they most commonly occur in the anal canal, connecting it to the outside of the body in what’s known as a perianal fistula. A rectovaginal fistula can also develop between the anus and the vagina, causing contents of the bowel to leak into your vagina, which increases the risk of infection and other complications. Some rectovaginal fistulas may close on their own, but some require surgical repair. While fistulas are much more common in people who have Crohn’s disease, they can develop after bowel surgery, which is routinely performed for both types of IBD, says Matro.
5. Your risk for sexual dysfunction and vaginal pain is heightened.
Sexual dysfunction can take two forms: lack of sexual desire and pain during sex. In a review of studies on IBD and sexual dysfunction published in September 2019 in the World Journal of Gastroenterology, researchers found that more than 50 percent of women with IBD experienced sexual dysfunction, and that body image and intimacy were some of their major concerns. People with UC “can experience depression because of their chronic disease and their symptoms,” says Matro, “and so [they] have less of an interest in sex.” Gross notes that UC symptoms can make vaginal sex uncomfortable and even painful. “Everything in the pelvis is interconnected,” she says. “When one organ system [isn’t functioning properly], it can affect all of them.” Women may also experience pelvic floor spasms, in which the muscles of the pelvic floor tighten, making intercourse difficult. These spasms are more likely to occur in women who have inflammation or scar tissue in their pelvis, Gross notes. A therapist trained in relaxation techniques for the specific muscles involved can treat this complication. If you’re experiencing pain or discomfort during intercourse, says Gross, consider trying different sexual positions that might help ease the pain, or focus on physical intimacy other than traditional intercourse. Try sitting shoulder-to-shoulder, hip-to-hip, or knee-to-knee, or give each other back or foot rubs. These are “simple things to make you feel physically connected to your partner,” Gross says. “That takes the pressure off actual intercourse.” If you’re experiencing sexual problems, talk to your doctor. The researchers of the World Journal of Gastroenterology study noted that doctors and patients should talk about sexual problems just as they would talk about psychological and physiological issues caused by colitis.
6. Talk to your gastroenterologist and your obstetrician-gynecologist about your family-planning goals.
UC doesn’t usually affect a woman’s ability to become pregnant, unless there is scar tissue from surgery that blocks the fallopian tubes, according to the American Gastroenterological Association (AGA). If you do have scar tissue and are trying to conceive, in vitro fertilization (IVF) may be an option. While UC doesn’t necessarily interfere with the ability to get pregnant, women with UC need to plan a pregnancy carefully. That’s because if you conceive during a flare, there’s a chance your symptoms could worsen throughout the pregnancy. “If a woman is considering starting a family, we always like to have a discussion ahead of time to try to plan things as much as possible,” says Bellaguarda. “According to the data and studies that have been published, the best time to conceive for a woman is when she’s feeling well and the disease is in remission.” According to Bellaguarda, women who become pregnant while in remission tend to have a much easier pregnancy than those who conceive while the disease is active. “[In that case,] the chance of them having a flare is the same as if they were not pregnant,” says Bellaguarda. Conversely, if a woman conceives during a flare, the disease is likely to remain active or worsen during pregnancy, according to the Crohn’s and Colitis Foundation. A review of studies on IBD, infertility, and pregnancy published in May 2019 in Therapeutic Advances in Gastroenterology found that women whose UC was well managed at the time of conception were no more likely to experience flares than those who weren’t pregnant, and pregnancy, in turn, did not appear to exacerbate IBD. Also be sure to talk to your doctors about your UC treatment plan during pregnancy. For instance, it’s important to keep taking medication to prevent flares, so discuss which medications are safe for your baby during pregnancy and breastfeeding, says Bellaguarda. Together, you can find ways to control your disease safely while ensuring your baby thrives.
7. Your children may or may not be at greater risk for UC.
The risk that you will pass your IBD on to your child is between 5 and 7 percent, according to the AGA. If your partner also has IBD, the risk may increase to about 35 percent. Whether someone will inherit UC isn’t fully understood, as it’s likely due to a number of genetic and environmental factors, according to the U.S. National Library of Medicine.
8. Your doctor wants to hear your concerns.
Many women are reluctant to broach the subjects of bowel movements, sex, and sex organs with their doctor, says Matro, but it’s important to bring your concerns out into the open. “Sometimes people feel embarrassed to talk about [their symptoms],” says Gross. If you’re hesitant to bring up a topic face-to-face, she suggests writing your concerns on the intake form used at many medical practices. Another option, suggests Matro, is to contact your doctor in writing using a secure online messaging system. Many hospitals and practices now have such systems in place. “That can trigger a response from the doctor to see you for an appointment,” she says, “or at least let the doctor know [you’re] struggling with that problem.” Remember, Matro adds, that however odd or embarrassing your concern might seem, your doctor has probably heard it before. “You’re going to be taken seriously,” she says. Your doctor “will want to help in any way that he or she can” or will refer you to someone else if your problem would be best addressed by another healthcare professional.
9. Other women can be a major source of support.
Talking to other women who’ve gone through what you’re experiencing can be invaluable, says Bellaguarda. For instance, if you’re in your 20s and facing surgery, and you’re worried about how it may impact your life, talking to a woman who faced similar challenges at your age may be helpful. “Ask your provider if they have patients who have gone through this who may be willing to share their story with you,” says Bellaguarda. Or, if that isn’t possible, seek a support group. “It’s good to hear from someone who has gone through this at your age to see how they feel about it.”
