The impact of inflammatory bowel disease on women's lives

Inflammatory bowel disease (IBD) affects women differently than men. This review outlines the current thinking on the impact of IBD, Crohn's disease and ulcerative colitis, on women's health.

IBD symptoms worsen during the menstrual cycle without corelating to disease activity. Endometriosis is more frequent in women with than those without IBD. Low fertility rate is rather because of voluntary childlessness than severe disease, perianal involvement, and ileal pouch anal anastomosis (IPAA) surgery. For women with ulcerative colitis, in-vitro fertilization successfully overcomes the post-IPAA infertility. The use of biologics and thiopurines throughout pregnancy is well tolerated for both the mother and the child but the use of small molecule therapy still needs more data. These medications increase the risk of cervical cancer, anal cancer, and aggressive vulvar cancer. More screening efforts are required to keep patients healthy. Women with Crohn's disease report worse psychological well being less resilience than men but they develop more escape and avoidance strategies to cope with the disease. Depression impairs the quality of sexual life but sexual dysfunction is rarely discussed with the provider.

Understanding the effects of sex on IBD allows personalized care and improves women's quality of life.