Gender-related issues in the female inflammatory bowel disease patient

Inflammatory bowel diseases (IBDs) commonly affect women in their childbearing years. Women identify unique psychologic issues compared with men related to body image and their ability to bear children. The menstrual cycle can be disrupted because of disease activity, medications and/or malnutrition. Oral contraceptives can be used; however, monitoring for thromboembolic events should be performed. Women with IBD are potentially at risk of higher rates of cervical dysplasia and should be screened as are other immunocompromised women. Fertility rates are comparable to those of women without IBD. The risk of disease activity during pregnancy depends on the disease activity at the time of conception. Pregnancy for the majority of women is uncomplicated, although women with Crohn's disease do tend to deliver children of lower birthweights than do healthy women. The majority of medications used in the treatment of IBD are not harmful to the fetus and should be continued throughout pregnancy in order to maintain maternal health. Breastfeeding should not be discouraged and the majority of medications are safe for nursing. Menopause tends to occur earlier in women with IBD; the cause of this is unclear.