For many, menstruation can be a challenging time accompanied by cramping, bloating, fatigue, and tempestuous mood swings. But for those with ulcerative colitis, menstrual symptoms can be significantly more severe and worsen gastrointestinal function, which is obviously the last thing any of us need.
So, what exactly is the link between menstruation and UC, and what can you do to ease this most challenging of hormonal phases?
Ulcerative Colitis & The Menstrual Cycle
Aggravated GI function is common for all women during the pre-menstrual and menstrual phases. But according to a 2020 study (Lahat) from Israel, a host of other symptoms appear more commonly and severely in those with IBD. These include restlessness, nervousness, irritability, headaches, anxiety, nausea, vomiting, leg swelling, low back pain, constipation, excessive urination, abdominal pain, and fatigue.
Those with UC can also experience changes to the duration and flow of their cycle and changes to the intensity of pain. They can also start having irregular periods, although a U.S. 2014 study (Saha) noted that with treatment and management of the condition, patients’ cycles did become more regular in the years after diagnosis.
IBD clearly has an impact on menstruation, but the causes may differ. At this point, researchers can say that it has less to do with exasperated inflammation, and more to do with how certain medications, sex hormones, stress, or a potential iron deficiency may affect our cycle.
Can UC Medication Impact the Menstrual Cycle?
In the 2014 U.S. study mentioned above, researchers found an association between irregular periods and corticosteroids but found no correlation with other treatments such as thiopurine and anti-TNF agents.
The 2020 study from Israel did find an association between biologics and higher severity of certain symptoms, both before and during menstruation. PMS symptoms in women with IBD were significantly higher, including irritability, nervousness, leg swelling, pelvic pain, and fatigue.
During menstruating, those on biologics reported higher levels of low back pain, abdominal pain, pelvic pain, and fatigue than those not on biologics. Many of these symptoms were worse amongst those who smoked.
If you’ve experienced changes in your cycle duration or menstrual symptoms after taking certain UC medications, speak to your doctor about different treatment options as there may be a more suitable therapy for you.
UC & Sex Hormones: What’s the relationship?
Changes in GI function during one’s period may be due to the sex hormone receptors lining the GI tract. These changes affect all biological females but are more prevalent in IBD patients.
Researchers have pinpointed two hormones behind these GI changes in the case of IBD: prostaglandins (PG) and estrogen.
Prostaglandins (PG) & Gastrointestinal Function in IBD
We release a different cocktail of hormones throughout each phase of the menstruation cycle, which has a more pronounced effect on our mood, appetite, sex drive, and gut function than one would like to believe.
One of these hormones is called prostaglandins, which are a group of hormone-like lipids that control certain processes such as blood flow, inflammation, and induction of labor. During menstruation, we have an increase in uterine PGs, which can “possess a stimulatory effect on gut motor activity” (Occhipinti). Due to its role in inflammation in IBD, researchers believe high levels of PGs may cause more severe IBD symptoms (Bharadwaj).
Estrogen & Gastrointestinal Function in IBD.
On the first day of your period, estrogen and progesterone hormone levels are at their lowest. These low levels may cause GI changes during menstruation as estrogen has a marked influence on gastrointestinal function. This is due to the many estrogen receptors throughout the GI tract.
The estrogen receptor has 3 subtypes: ERα, ERβ & gpER. The upper GI tract has both ERα, ERβ, but ERβ is more “expressed” in the colon tissues and regulates colon tissues. This receptor has actually been found to help protect against chronic colitis (Pierdominici), and studies have found that a lack of ERβ is one of the risk factors for the development of IBD.
Essentially, the rise and fall of both estrogen and prostaglandins levels throughout our cycle can and do throw off the rhythm of our digestion and exasperate IBD symptoms.
Anemia & Ulcerative Colitis
Those with UC are at a higher risk of developing iron deficiency anemia. UC may have impacted your body’s ability to absorb iron. You might also develop anemia if you are unable to tolerate iron-rich foods, have a low appetite, or suffer increased bleeding.
Unfortunately, the risk of anemia is even higher if you have a heavy period and lose more red blood cells through bleeding than the body can produce. If you notice any of the following signs, it’s highly recommended to check your blood levels and explore treatment options with your doctor or nutritionist.
Signs of anemia to look out for include:
- Shortness of breath
- Paler skin than usual
- Fatigue /weakness
- Cold hands
- Faster, slower, or irregular heart rate
When to speak to your doctor
If you’ve noticed a change in your menstrual cycle from UC or your medications, it’s best to alert your doctor as soon as possible.
Signs to watch out for:
- Your period hasn’t come for 90 days
- Your period is more frequent than every 21 days
- Your period is less frequent than every 35 days
- Sudden, irregular periods
- Flow becomes unusually heavy
- Extreme pain before or during your period
- Menstruation for over a week
It’s important to remember that you don’t have to live with painful, irregular periods. A doctor or other healthcare practitioner can help pinpoint the causes and help offer solutions to ease the suffering.
Alternative Treatments for Menstrual Pain & UC
Many benefit from acupuncture to relieve cramping and discomfort. The practice involves the insertion of thin needles into specific points to stimulate the body’s natural healing response and is widely used to treat menstrual pain and help UC patients manage ulcerative colitis.
For menstrual pain, the needles are inserted into points on the abdomen and lower back to regulate the flow of blood and energy in the body. This can help to relieve pain and reduce stress, which aggravates both menstrual discomfort and UC symptoms.
In a systematic review (Woo) of 60 randomized controlled trials (RTCs), researchers found that acupuncture is more effective at reducing menstrual pain compared to no treatment and compared to nonsteroidal anti-inflammatory drugs. Some studies found that these positive effects were maintained after the short-term follow-up.
For ulcerative colitis, acupuncture may help reduce inflammation in the large intestine and help relieve abdominal pain and diarrhea. A 2020 meta-analysis (Wang) of 13 RTCs, including 1030 participants, assessed the benefits of acupuncture for UC. They found acupuncture combined with certain conventional medications achieved a much better effect than the medications alone.
Remember, it’s important to consult with a trained acupuncture practitioner before undergoing treatment, as acupuncture can have potential risks and side effects. It’s also important to continue working with your healthcare provider to manage your condition and ensure that you are receiving the most appropriate care.
What can you do at home?
There are a few simple tips you can try at home to relieve cramping and UC symptoms.
Firstly, applying heat with a heat pack or hot water bottle can relax the cramping muscles and soothe period pains.
Movement and exercise also do wonders. Even if it’s the last thing you want to do, gentle movement like yoga, qi gong, stretching, dancing, or a short stroll can greatly reduce stress, which is a common trigger for IBD symptoms. That said, it’s best to listen to your body’s needs and not push yourself too hard. There may be times when all you want to do is rest, which is just as important.
Relaxation techniques like meditation, deep breathing, or even listening to your favorite music can also help calm the body and ease exaggerated IBD symptoms. Gardening and getting into nature also reduce stress according to several studies. Essentially, if it feels like self-care, you’re on the right track.