Female-oriented symptoms and details about ulcerative colitis

Female-oriented symptoms and details about ulcerative colitis

Ulcerative colitis (UC), a form of inflammatory bowel disease (IBD), affects women differently compared to men, with unique additional risks and associated conditions related to female biology and systemic effects.

Symptoms in Women

Women with UC experience common symptoms similar to men, such as bloody diarrhea, urgency, abdominal pain, weight loss, and fatigue. However, they may also face additional challenges, including irregular menstrual cycles, heavier menstrual bleeding, and more severe premenstrual symptoms, which can be exacerbated during disease flare-ups [1][2][3].

Risks and Associated Conditions

• Liver Cancer Risk: Female patients with UC have a significantly higher risk of developing liver cancer compared to males, possibly due to estrogen’s modulation of immune responses and inflammation that may exacerbate hepatic injury and carcinogenesis [4].
• Primary Sclerosing Cholangitis (PSC): A biliary complication strongly associated with UC; although rare, approximately 4% of IBD patients develop PSC. PSC co-occurrence increases liver-related complications and cancer risk [3][4].
• Extraintestinal Manifestations: Common in UC, these include skeletal issues, ocular conditions, and skin disorders. Women may also experience rectovaginal fistulas, which can cause pain during sexual activity [3].
• Quality of Life: Due to the combination of gastrointestinal symptoms and menstrual irregularities or systemic effects, women may face unique challenges in disease management and symptom control [3].

Treatment and Management

Treatments for UC aim to maintain periods of remission or help manage flares of symptoms. Treatments may include medications such as mesalamine, immunomodulators like methotrexate, biologics such as adalimumab (Humira), and steroids [6].

Methotrexate, a medication for UC, can increase the risk of congenital abnormalities, and those looking to conceive should stop taking it 3 to 6 months before conception [7].

Surgery for UC, such as proctocolectomy with ileal pouch anal-anastomosis (J-pouch surgery), may affect pregnancy and lead to decreased quality of life and potential adverse events associated with pregnancy [8].

Pregnancy and UC

Pregnancy can affect disease activity in UC, and UC and its treatments or procedures may impact fertility and pregnancy outcomes [9]. Those with UC or Crohn's disease in remission are as likely to conceive as those without the condition, but conceiving during a flare-up can lead to difficulties and a higher risk of complications like pregnancy loss, low birth weight, and premature birth [10].

Iron Deficiency Anemia (IDA)

IDA is a common complication with IBD, resulting from bleeding in the inner lining of the intestine or decreased absorption of iron due to inflammation [11].

Conclusion

UC in women involves typical inflammatory bowel symptoms, but active disease can disrupt menstrual health and fertility. Women with UC also carry higher risks of liver complications, particularly liver cancer, emphasizing the need for tailored monitoring and management strategies that address these sex-specific risks. Extraintestinal symptoms are also frequent and may require interdisciplinary care.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3757844/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886263/ [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357087/ [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749809/ [5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5804788/ [6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376118/ [7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678029/ [8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160883/ [9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281770/ [10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5804788/ [11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800495/

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