How Your Menstrual Cycle Affects Crohn's Disease

Hormonal changes during your menstrual cycle can make Crohn’s symptoms, like diarrhea worse. Here are ways to ease the discomfort.

It’s safe to say most women aren’t enthused when that time of the month rolls around. Right before and during their periods, many women contend with unpleasant symptoms such as bloating, cramps, and mood swings. But for women with Crohn’s disease, the menstrual hassles don’t end there.

In fact, many women with Crohn’s disease find that their symptoms are worse during their menstrual cycle.

Evidence suggests that hormones that fluctuate during your menstrual cycle, like estrogen and progesterone, and hormone-like substances called prostaglandins, can affect digestive disorders such as inflammatory bowel diseases (IBD), including Crohn’s disease.

Researchers who studied 121 women with IBD found 25 percent of them experienced a change in their menstrual cycle one year before their IBD diagnosis. The study published in March 2014 in Inflammatory Bowel Diseases noted some good news: the irregular cycles typically evened out over time. Researchers advised that screening for menstrual irregularities should be considered in women with newly diagnosed IBD.

Apart from that study, researchers haven’t discovered why a woman’s menstrual cycle can affect her Crohn’s disease symptoms. Miguel Regueiro, MD, an associate professor of medicine and head of the Inflammatory Bowel Disease (IBD) clinical program at the University of Pittsburgh, says, “The relationship between hormonal changes and Crohn’s symptoms has been researched, but we’re not yet sure how they're connected.”

Still, Dr. Regueiro adds, “Many women do report that when they are getting their periods, their symptoms seem worse.”

Your Menstrual Cycle and Your Digestive System

One study took a look at the relationship between menstrual cycles and digestive disorders. This study included women with IBDs like Crohn’s disease and ulcerative colitis, women with irritable bowel syndrome (IBS), and women with no digestive conditions.

While 93 percent of all the women experienced premenstrual symptoms, the women with Crohn’s disease were among the most likely to report these symptoms. The women with Crohn’s disease were also more likely to report gastrointestinal problems during their menstrual period, the most common being diarrhea.

Jill K. Powell, MD, an adjunct associate professor in the obstetrics/gynecology department at the St. Louis University School of Medicine says, “Women with Crohn's disease, as well as women with irritable bowel syndrome, and even women with no bowel diseases, can have diarrhea just prior to and during their menstruation. This is likely caused by an increase in progesterone and prostaglandin levels made by our bodies during the premenstrual phase.”

Dr. Powell explains, “Prostaglandins in particular are responsible for smooth muscle contraction, whether that is in the form of labor pain, menstrual cramps, or increased contractions of the smooth muscle in the intestines that leads to diarrhea.”

Taking Control of Your Menstrual Cycle and Crohn’s

If you have Crohn's disease and experience an increase in your Crohn’s symptoms during your menstrual cycle, oral contraceptives and at least one dietary supplement may be able to provide some relief. Here's how they work:

• Oral contraception. Many women who use oral contraceptives (birth control pills) to prevent ovulation and block high premenstrual levels of progesterone, see an improvement in their menstrual cycle bowel symptoms, according to Powell. Progesterone levels increase after ovulation and are highest in the days leading up to your period. High levels of progesterone can also slow down the muscle activity of the bowels, resulting in constipation.
• Evening primrose oil. Research has shown that women with Crohn's disease who take a prostaglandin blocker have significant improvement in their premenstrual and menstrual diarrhea, Powell says. This potent prostaglandin blocker is available in evening primrose oil, an herbal supplement you can buy in gel cap form. Evening primrose oil is also prescribed for women with premenstrual breast tenderness. Evening primrose oil has high levels of gamma-linolenic acid (GLA), an essential fatty acid that has been shown to reduce inflammation. Powell recommends that patients “take two gel caps with food every eight hours during the days when you typically have symptoms.” One note of caution: Primrose oil should be avoided if you have a type of seizure disorder known as temporal lobe epilepsy.
• PMS medications. Other medications may also be helpful if you suffer from specific premenstrual or menstrual symptoms like mood swings, sleeping difficulties, and appetite disturbances (commonly known as PMS or premenstrual syndrome). A class of medication known as SSRIs (selective serotonin reuptake inhibitors), in particular, may provide some relief from a severe form of PMS called premenstrual dysphoric disorder (PMDD).

Talk to Your Doctor About How to Safely Manage Your Symptoms

If you have Crohn's disease or any other inflammatory bowel disease, talk to your doctor before using any over-the-counter or prescription non-steroidal anti-inflammatory drugs (NSAIDs, like ibuprofen and aspirin) for relief from PMS and menstrual symptoms like headaches and cramping.

Some NSAIDs, when used excessively, can cause bleeding, ulceration, or irritation in your digestive tract and may not be the best choice for you.

You should also work with your doctor in managing your specific menstrual symptoms depending on when they most commonly occur. Together, you can consider the use of oral contraceptives, evening primrose oil (which you can buy at your local drugstore), and other medications that may be helpful.