Going with the Flow: How IBD and Your Period Interact

Inflammatory bowel disease (IBD) can make your periods painful or irregular, and your period can lead to IBD flares. Here’s why and how to cope.

As if having IBD wasn’t bad enough, it may also affect your period. IBD can cause menstrual cycles to be irregular and more painful, and your monthly cycle can sometimes worsen IBD symptoms.

I have ulcerative colitis, a form of IBD, so I’ve experienced this firsthand.

Like me, you may want to understand how IBD and the menstrual cycle are connected and what you can do to manage these effects.

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How your period affects IBD

One thing that IBD and the menstrual cycle have in common is inflammation. In IBD, the inflammation occurs in the digestive tract.

During menstruation, the body undergoes even more inflammation thanks to the release of hormone-like compounds known as prostaglandins.

While prostaglandins serve an important purpose — stimulating the smooth muscles of the uterus to contract and shed its lining — they can also lead to cramping.

They’re also responsible for the loose, frequent, and often smelly bowel movements, sometimes known as period poops, that many of us experience.

Basically, period poops occur when excess prostaglandins stimulate the smooth muscles of your digestive tract in much the same way they stimulate your uterus to shed its lining.

While people who menstruate may experience period poops, people with IBD also experience additional symptoms during their cycle, including stomach and back pain, fatigue, irritability, headache, and nausea.

In other words, the inflammatory effects of prostaglandins may lead to an IBD flare — or something very close to it — during your period.

If your menstrual cycle causes frequent or difficult-to-manage bowel symptoms, you may want to talk with your healthcare professional about possibly suppressing your period — as long as you’re not trying to get pregnant.

Some of the options available for this include:

• oral contraceptive pills
• an intrauterine device
• contraceptive implants

How IBD affects your period

The interplay between IBD and the menstrual cycle works in both directions. According to older research included in a 2023 review, nearly 60% of women with IBD report having irregular, absent, or heavy periods, which can affect an individual’s fertility as well.

I’ve personally experienced menstrual irregularities as a result of IBD. My ulcerative colitis started when I was 16 years old, and shortly after, my periods became more irregular and eventually stopped.

At 19, I was diagnosed with functional hypothalamic amenorrhea. This type of amenorrhea has many causes, but for me, it was due to the pronounced weight loss and inflammation my IBD caused.

After these discoveries, I was instructed to put on 10 kilograms (about 22 pounds) to reach the minimum normal weight for my height according to the BMI scale. It took me 18 months to gain that weight and for my periods to resume.

Experts believe several factors can contribute to menstrual irregularities in people with IBD. These include the physical and psychological stress of living with a chronic illness, nutrient malabsorption, and the impact of surgery. Additionally, some treatments, such as steroids and, in rare cases, biologics, may cause menstrual irregularities.

Some people with IBD may experience especially painful periods, even if the frequency isn’t altered.

Managing IBD and period changes

If your periods have become more painful, it may be helpful to try easing the pain with massage, gentle yoga, or a heating pad or hot water bottle. You may want to avoid nonsteroidal anti-inflammatory drugs (NSAIDs), though.

If these remedies don’t help, consider speaking with your healthcare professional. They may be able to help identify:

• whether your IBD medications may be affecting your menstrual cycle and if it makes sense to change them, particularly if fertility is a concern
• what treatments may be available for painful periods if home remedies aren’t helping
• ways to ease cramps from period poops
• ways to support and maintain your nutrition to promote cycle regularity

The takeaway

IBD and the menstrual cycle both involve inflammation, and each can worsen the other.

If you’re experiencing menstrual cycle irregularities or worsening IBD symptoms during your period, and they don’t improve with home remedies, it’s important to speak with your healthcare professional so you can get on the path to better health.