In recognition of International Women’s Day, which is marked each year on March 8th, we present some recent research on the extra challenges faced by women with Crohn’s disease and ulcerative colitis.
Work and Romance
A recent study from Sweden found that, compared to men with Crohn’s disease, women with the disease were more likely to experience long-term sickness, be on a disability pension, and be single.1 Based on the health-related quality of life (HRQL) scale – a standard for measuring individuals’ beliefs about how a disease affects their lives – the women in the study also perceived a more negative impact on their lives from Crohn’s disease than did the men in the study.
The study included 505 Crohn’s disease patients and, for comparison, also collected data from 300 ulcerative colitis patients. Men with Crohn’s disease reported a similar level of HRQL as that reported by women with ulcerative colitis, but men with ulcerative colitis reported their disease as having only a very minimal impact on their quality of life. In terms of objective disease activity, there were no significant difference between genders in either Crohn’s disease or ulcerative colitis, though women with inflammatory bowel disease (IBD) are more likely than men to experience extraintestinal IBD symptoms and to also have irritable bowel syndrome (IBS). This may go some way toward explaining the discrepancy, but not entirely. This study’s authors speculate that differing coping strategies between genders or societal inequalities may also play a role, such as increased pressure on women to fulfil their daily functional roles – as mothers, employees, etc. – regardless of disease symptoms.
IBD Flare or Regular Menses Symptoms?
Researchers in Manitoba explored the relationship between gastrointestinal (GI) symptoms and menses in IBD. Their study’s findings, published in Alimentary Pharmacology and Therapeutics,2 showed that women with IBD have very similar symptoms before and during menses as those of women without IBD (e.g., bloating, fatigue, and mood changes). However, women in the study with Crohn’s disease had increased premenstrual diarrhea compared to women with ulcerative colitis and those in the control group. Both the Crohn’s disease and ulcerative colitis groups were more likely to experience diarrhea during menses than the healthy control group. The researchers suggest studies like this one, which help elucidate the cause of specific GI symptoms, may help gastroenterologists in making treatment recommendations for premenopausal women with IBD.
In The Inside Tract®, issue #180, we described the special factors that women with IBD must consider around pregnancy. A new literature review from researchers at the University of Toronto makes a number of updated recommendations for gastroenterologists.3 At the top of their list is proactive counselling for female IBD patients who are of reproductive age. These pregnancy-related discussions should include nutrition factors, vitamin and mineral supplements, smoking and alcohol cessation, and achieving and maintaining remission before becoming pregnant (if possible). The review also indicates that some medications, such as biologics, can be used safely during pregnancy for longer than was previously thought.
Another recent study, evaluating how well women with IBD understand pregnancy-related issues through a validated questionnaire called Crohn’s and Colitis Pregnancy Knowledge (CCPKnow), found that nearly half (45%) of the 145 women in the study had poor knowledge of pregnancy-related issues in IBD, 28% had adequate knowledge, 17% had good knowledge, and only 10% had very good knowledge of these issues.4 Many women with IBD report that they avoid becoming pregnant out of fear (e.g., infertility, medication risks, and possible birth defects) that is out of proportion with current scientific evidence. The researchers are also concerned that women with IBD who do choose to become pregnant could stop taking their IBD medications during pregnancy out of unwarranted fear that the medication puts her fetus at risk. As described in our previous article, ongoing research continues to show that the best pregnancy outcome occurs when the disease stays in remission during pregnancy and that, with few exceptions, most drugs used to treat IBD are safe for pregnant and breastfeeding women. However, we strongly urge women to have a thorough discussion with their gastroenterologists about the particular risk/benefit ratios for all medications and supplements taken during pregnancy.