Women's Health Disorders in a Coeliac Disease Population After Diagnosis-A Nationwide Cohort Analysis

There is a female predominance of diagnosed coeliac disease with sex-related differences in clinical presentation. Delayed menarche, infertility and pregnancy complications have been linked to poor nutritional status and autoimmune mechanisms, but women's health data in coeliac disease are scant and contradictory.

To describe rates of women's health disorders in US patients with coeliac disease.

We used TriNetX, a database of 80 healthcare organisations, for a retrospective observational analysis. Coeliac disease was identified using ICD-10 code (K90.0) and positive coeliac serology. Women aged 10-60 years with coeliac disease were compared to ambulatory women without a diagnosis of coeliac disease or positive coeliac serology. We divided women into age groups matched by propensity score.

We identified > 25,000,000 outpatient women without coeliac disease, and 9368 with coeliac disease. Patients with coeliac disease were younger (mean 25 vs. 28.5 years) and had lower mean BMI (24.6 vs. 26.1). Women with coeliac disease had higher odds of later women's health conditions including absent/rare menstruation (4.6% vs. 2.0%; OR 2.34), infertility (1.4% vs. 0.9%; OR 1.69), polycystic ovarian syndrome (3.3% vs. 1.0%; OR 3.2), menopausal disorders (4.3% vs. 1.56%; OR 285) and primary ovarian failure (0.96% vs. 0.16%; OR 6.25).

Women with coeliac disease have higher frequencies of subsequent women's health disorders related to ovarian function, menstruation, fertility and menopause. Clinicians should be aware of these associations to detect women's health disorders during longitudinal coeliac care and promptly refer for a multidisciplinary approach with obstetrics and gynaecology.