Medically Reviewed by Jenny Blair, MD
Menstruation isn’t the easiest time of the month. For many people, uncomfortable symptoms like bloating, cramping, and mood swings can be downright disruptive to daily life. But for those living with inflammatory bowel diseases (IBD), such as Crohn’s, period-related symptoms like cramping, bloating and gastrointestinal (GI) upset, are often reported to be much more severe—and last much longer.
“I hear it all the time from Crohn’s patients,” says Katherine Freeman, MD, a gastroenterologist at Mount Sinai Hospital in Manhasset, New York. [Women usually experience] the trifecta of abdominal pain, bloating or diarrhea—or all of the above—during their period, and right before.”
What the Research Says
One study linked inflammatory bowel disease to cycle irregularity, increased pain and heavier flow. Of the study’s 121 participants, 25 percent experienced irregularity in the year prior to their IBD diagnosis; 21 percent reported longer periods. Among 48 participants with dysmenorrhea—very painful cramping during menstruation—16, or one-third, had increased period pain, while 12 of 48 patients with dysmenorrhea (25%) reported longer durations of period pain.
Another study looked at the link between GI health and menstruation by examining women with Crohn’s and ulcerative colitis, as well as a control group of women without gastrointestinal disorders. Researchers discovered that women with Crohn’s disease were statistically more likely than the control group women to report worsened gastrointestinal symptoms before and during menstruation—diarrhea being the most commonly reported symptom—while women with colitis were more likely than the control group to report diarrhea during their periods.
Emma Illingworth, 21, Leeds, UK, (Instagram: @quitesimplyemma), was diagnosed with Crohn’s at age 17, and says she experiences all of the above during her cycle. “I spot daily and have a heavy period every few weeks; I get cramps, as everyone does, but nothing soothes them; I feel weak and shaky, and have diarrhea that lasts two to three days. It definitely causes a lot of my symptoms to flare up, to the point that I’m on both the combined pill and contraceptive implant to try to control them.”
Eleanor Meghan, 26, Colorado Springs, Colorado, (Instagram: @emc_brown), who underwent surgery for a permanent ileostomy in 2016, dealt with extremely painful periods prior to her procedure. “Before my ostomy, my menstrual cycle was horrible—I dreaded it. If dealing with constant pain from Crohn’s disease wasn’t enough, once a month I had to add menstrual cramps into the mix.”
How Your Period Affects Your Digestive Tract
So, why do some people experience worse GI symptoms during their periods? More research is needed, but some evidence suggests that fluctuations in hormones throughout the menstrual cycle—such as estrogen, progesterone and prostaglandins—may be to blame.
Prostaglandins, for example, are responsible for the smooth muscle contractions that help the uterus shed its lining during menstruation, so they may also trigger muscle contractions in the intestines, according to Freeman. Other data says that, among those with slow-transit constipation, progesterone receptors in the GI tract may respond to fluctuations in prostaglandin levels.
Dr. Freeman adds, “Even in women who don’t have Crohn’s, there tends to be a prolonged GI transit time during the luteal phase [the time after ovulation that ends just before a period] of their cycle. That means you tend to have worsened gastrointestinal symptoms during this phase.”
Ways to Feel Better During Your Period
While many people with (and without) Crohn’s experience worsened GI symptoms with their periods, it’s important to note that not everyone will. If you do have severe cramping, bloating or diarrhea, however, there are ways to manage your symptoms—and feel better during your period.
1. Skip the NSAIDs.
Certain nonsteroidal anti-inflammatory drugs, like ibuprofen or naproxen, are often the go-to treatment for period pains. In people with Crohn’s, however, these drugs can make GI symptoms worse.
“The first thing I always recommend is to not take any nonsteroidal anti-inflammatory drugs. They can exacerbate Crohn’s and colitis whether or not women have their periods,” says Freeman. Over-the-counter painkillers containing acetaminophen may offer some relief.
2. Apply heat.
“Heating pads are my best friend!” says Stacy Ransom, 28, from Corona, California, (Instagram: @gutsygirlblog). “They relax crampy muscles and feel comforting.”
“I also keep Thermacare Heat Wraps handy to ease cramps and backaches while chasing around a 1-year old.” Whether you opt for a heating pad or warm bath, applying heat to achy muscles can soothe period pains and may relax tight muscles.
3. Stay active—if you’re up to it.
When you’re dealing with painful symptoms, exercise may be the last thing you want to do—but it can help reduce stress, a common trigger for IBD.
“Staying active can sometimes feel difficult when living with a chronic illness—there are some days it just isn’t going to happen! I listen to my body, and on days when I need to rest, I am sure to rest,” Meghan says. Staying active through yoga and biking on a recumbent bike allows me to exercise without overdoing it, she adds.
4. Practice self-care.
We all know that self-care is vital to physical, emotional and mental health. Illingworth recommends practicing self-care to manage severe period and GI symptoms.
During her period, Emma gets plenty of sleep; reduces her caffeine intake, which can worsen symptoms; wears loose clothing to deal with uncomfortable bloating; and stays hydrated. She adds, “I tend to take a few days to practice self-care and ease myself back into the normality of chronic illness.”
5. Give your body rest.
When you have a chronic illness, it’s important to listen to your body’s cues. Stephanie Dawn, 31, New York, New York, (Instagram: @lapetitecrohnie) was diagnosed with Crohn’s at age 9 and has found that rest can dramatically improve her symptoms: “The most important thing is to rest. Pushing yourself when your body is already struggling is only going to make things worse.”
“During my period, I focus on relaxing and try to create as calm an environment for myself as I can,” adds Dawn.
6. Manage your stress.
Stress has been linked to a number of chronic conditions—as well as body-wide inflammation—and Crohn’s disease is no different.
For many people, stress can be a major trigger for uncomfortable period symptoms: “My biggest trigger was (and still is) stress. Learning how to manage my stress has really helped me manage my disease,” says Meghan. Stress management techniques like meditation, journaling, listening to music and practicing self-care may help you get your daily stressors under control.
7. Take care of your mental health and talk to other people who get their period.
If your period leaves you feeling alone, confused or angry, try reaching out to other people living with Crohn’s. Dawn says, “One of the biggest things that helped me mentally cope with my illness was finding a community. [Using] applications like Instagram, I’ve met so many wonderful people fighting the same battle I am. So please, if you’re struggling or you feel lost and alone, reach out to some of us.”
Meghan adds, “There is a huge community of other women dealing with the same symptoms, disease flares, discomfort and mental upset that you may be facing. The best thing you can do? Connect with them!”
8. Talk to your doctor.
If you start to experience new or worsened symptoms, tell your gastroenterologist ASAP. “My best piece of advice is to get the disease under control as quickly as possible. It’s a lot harder to play catch-up when the disease gets out of control, and medications can only go so far. If you can get it under control in its infancy, you’ll be a lot better off,” says Dr. Freeman.
If you’re experiencing severe period symptoms or want to try a new treatment for painful periods, don’t hesitate to talk to your gastroenterologist or gynecologist. She’ll be able to help you determine the right course of treatment for your Crohn’s disease and lifestyle.
Jenny Blair is a writer and journalist covering science, medicine, and the humanities. She earned her MD at Yale University, then completed a residency in emergency medicine at the University of Chicago. After several years in practice, she transitioned to working with words and ideas full-time. Jenny has contributed to Discover, New Scientist, Washington Spectator, and Medtech Insight, among other publications. She lives in New York City.
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