Women’s Health in IBD

Women with inflammatory bowel disease (IBD) have gender-specific needs that should be recognized and addressed by their IBD provider, primary care physician, obstetrician, gynecologist, dermatologists, and mental health provider, team leader Kara De Felice, MD, said at the Advances in Inflammatory Bowel Disease annual meeting in Orlando, Florida, on December 14.

The panel included Jessica Caron, MS, Jill Gaidos, MD, Marla Dubinsky, MD, and Uma Mahadevan, MD.

Dr Caron is a health care professional and a patient advocate in the IBD community. Dr Gaidos is an associate professor of medicine and vice chief of clinical research in the section of digestive disease at Yale School of Medicine. Dr Dubinsky is a professor of pediatrics and medicine in the department of gastroenterology, and the chief of the pediatric gastroenterology division at Mount Sinai Kravis Children’s Hospital. Dr Mahadevan is a professor of medicine at the University of California San Francisco Colitis and Crohn’s Disease Center. Dr Felice is a gastroenterologist at the University of Cincinnati in Cincinnati, Ohio.

“Don’t forget about other health maintenance such as the risk of osteoporosis or colon cancer, and skin exams among others,” Dr Gaidos said.

Body image and sexuality are important aspects of quality of life. A diagnosis of IBD along with gastrointestinal symptoms, surgery, medications, and depression can negatively affect body image, the panelists cautioned. These issues have been reported as deterrents to and causes of pain during sexual intercourse, and voluntary childlessness. A good plan to combat these concerns would be early recognition, they said, in addition to referral to a mental health specialist or a gynecologist or a pelvic floor physical therapist.

Women suffer from anxiety symptoms (33.8% vs. 22.8%) and depression symptoms (21.2% vs. 16.2%) more than men. The numbers get worse with active inflammation. These conditions, because they are often under-recognized, may decrease quality of life, trigger IBD relapses, and/or increase functional gastrointestinal symptoms that can mimic an IBD flare. Early recognition, regular screening in GI clinics, referral to a mental health specialist, cognitive behavioral therapy, and medications could help these women, the panel said.

By tracking symptoms before, during, and after menstrual cycle and checking biomarker to help distinguish IBD disease activity from GI symptoms due to hormonal fluctuations could help monitor hormonal fluctuations during the menstrual cycle that often affect gastrointestinal symptoms in women with IBD.

For oral contraception, they advised to avoid all estrogen-based medications, as they increase the risk for thrombosis and surgery in future. To prevent the development of cervical dysplasia and cancer, the doctors recommended HPV vaccine for all women ages 9 to 45.

Pregnant women with IBD are at a risk for pre-eclampsia, which could lead to spontaneous abortion, low fetal birth weight or preterm birth. “The goal for every pregnant woman with IBD is to be in remission at conception and stay in remission throughout the pregnancy,” Dr Mahadevan said.

Can women with IBD breastfeed? “By all means,” she said. Breastfeeding is encouraged and may in fact be protective in the development of early onset IBD in the offspring, she explained. However, she advised changing or avoiding certain medications that are not suitable for breastfeeding such as methotrexate, tofacitinib, upadacitinib and ozanimod.

Studies have shown that between 5% and 20% of people with IBD have a first-degree relative, such as a parent, child, or sibling, who also has one of the diseases. The genetic risk is greater with CD than with UC, the doctors said. However, that’s no reason women cannot have a normal life if the symptoms are well controlled, the panel added. Women with IBD should aim to have a healthy balanced lifestyle and have a thorough discussion with their gastroenterologists about medications and supplements.

Reference:
Felice KD, Caron J, Gaidos J, Dubinsky M, Mahadevan U. Clinical breakout session: Women’s Health in IBD. Presented at: Advances in Inflammatory Bowel Disease Annual Meeting; December 14, 2023. Orlando, Florida.