Crohn's disease is a chronic inflammatory disease of the intestines. Any area of the gastrointestinal tract can be affected. The ileum, which is the lowest portion of the small intestine, is the most commonly affected area. The inflammation extends through the walls of the intestines and fistulas (openings) can form. Abdominal pain and chronic diarrhea are the result of the chronic inflammation. Most individuals are diagnosed between the ages of 20 and 30 years old. Though men and women are affected equally, women have gender specific concerns associated with Crohn's disease.
Amenorrhea, which is the unusual absence or suppression of menstruation can occur. Medical experts attribute disruption in the menstrual cycle to disease activity,the medications prescribed to treat Crohn's disease,and malnutrition which results from malabsorption due to chronic inflammation. There is a higher risk of developing cervical dysplasia, which is a potentially premalignant change in the cells on the surface of the cervix, among women with Crohn's disease. The use of oral contraceptives is not contraindicated,but women with Crohn's disease must be closely monitored for signs of thromboembolism, which is the blockage of a blood vessel caused by a blood clot. Women with Crohn's disease may experience worsening of the symptoms of abdominal pain and diarrhea during the premenstrual and menstrual periods.
There appears to be no difference in fertility rates between women with Crohn's disease and women without this disease. According to the University of Maryland Medical Center, women with Crohn's disease who are in remission at the time of conception generally, will have an uncomplicated pregnancy. The risk of disease activity during pregnancy is dependent upon the degree of disease activity at the time of conception. Women with active disease are more prone to miscarriages or spontaneous abortions, and stillbirths, which is the birth of a dead fetus after the 28th week of gestation. The symptoms of Crohn's disease can get worse during pregnancy. Women with active disease who are or wish to become pregnant are advised to continue taking the prescribed medication while under the guidance of their physician. Corticosteroids and sulfasalazine are considered to be relatively safe treatment during pregnancy (1).
Intestinal inflammation can lead to gynecological fistulas. Perineal pain with intercourse is commonly experienced in women with a perineal fistula or abscess. Some women experience severe rectal pressure during intercourse or feel sexually inhibited because of the fear of rectal incontinence (2).
Menopause tends to occur earlier for women with Crohn's disease. The cause remains unclear. An article, which appeared in the May 2008 issue of the American Journal of Gastroenterology, reports the significant protective effect of postmenopausal hormone replacement therapy on irritable bowel symptoms. Sunanda V. Kane, M.D., coauthor of the article suggest that the anti-inflammatory effects of estrogen may be responsible for the protective effect (3).
Resources:
(1) www.unm.edu
(2) www.aafp.org
(3) Hormonal Replacement Therapy After Menopause Is Protective of Disease Activity in Women With Inflammatory Bowel Disease by Sunanda V. Kane, M.D., Deepa Reddy, M.D., American Journal of Gastroenterology, May 2008
Maryann Gromisch is a registered nurse with clinical experience in medical, surgical, and critical care nursing. She has experience assisting a gastroenterologist in a private practice setting.