Periods! This one word immediately makes you think of mood swings, cramps, bloating, sore breasts, breakouts, and more. These symptoms stem from hormonal fluctuations during the menstrual cycle. While the menstrual cycle is challenging for most women, those with ulcerative colitis (UC) suffer from severe and intense symptoms. Many women complain of irregular menstrual cycles and painful periods with severe PMS. It might have something to do with ulcerative colitis, which is another cause of irregular periods.

What is ulcerative colitis?

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that primarily affects the colon and rectum. It causes ulcers, inflammation, and irritation in the lining of the large intestine, leading to symptoms like abdominal pain, diarrhoea (often bloody), rectal bleeding, fatigue, and weight loss. The exact cause is unknown, but it’s believed to involve a combination of genetic, environmental, and immune system factors. While there is no cure, treatments aim to manage symptoms and reduce inflammation through medications, lifestyle changes, and, in severe cases, surgery.

Symptoms of ulcerative colitis

A person with ulcerative colitis can experience these symptoms:

• Abdominal pain (often on the left side)
• Persistent diarrhea (sometimes mixed with blood or pus)
• A constant feeling that you need to pass stools
• Nausea
• Vomiting
• Lack of appetite
• Fatigue
• Fever
• Weight loss

Ulcerative colitis symptoms are more common in women who are menstruating, which include irritability, nervousness, restlessness, headache, anxiety, nausea, vomiting, leg swelling, low back pain, constipation, increased urination, abdominal pain, and exhaustion.

What is the link between ulcerative colitis and menstruation?

People with UC sometimes experience changes in their periods or an irregular menstrual cycle. Gastroenterologist Sharad Malhotra says, “Ulcerative colitis can be influenced by hormonal fluctuations related to menstrual cycle. Fluctuations in estrogen and progesterone levels can affect the immune system and gastrointestinal function. This may exacerbate inflammation in individuals with ulcerative colitis, leading to increased symptoms such as abdominal pain, diarrhoea, and rectal bleeding during certain phases of the menstrual cycle.”

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Research published in the journal Inflammatory Bowel Diseases revealed that out of the 1,200 women studied, half reported heightened symptoms of inflammatory bowel disease during menstruation. While this is how the menstrual cycle impacts UC, chronic inflammation and malnutrition associated with UC can also disrupt the normal functioning of the reproductive system, leading to hormonal imbalances and menstrual irregularities.

This interplay between UC and menstruation can be complicated to manage. Additionally, the stress associated with menstruation can also trigger or worsen flare-ups of ulcerative colitis, as it causes hormonal imbalance.

UC medications can affect the period cycle!

“Medications commonly used to manage symptoms of ulcerative colitis, such as corticosteroids and immunosuppressants, can potentially interfere with the menstrual cycle and exacerbate menstrual symptoms,” explains Dr Malhotra.

A study published by Therapeutic Advances in Gastroenterology focused on females aged 18 to 50 with UC or another IBD type. It revealed that those taking medication reported notably heightened symptoms like irritability, fatigue, lower back pain, and pelvic pain before menstruation. These symptoms were worse in women who smoked.

If you experience menstrual irregularities or unexpected side effects from UC medication, discuss your concerns with your doctor for better management.