Correlation of Menstrual Distress to the Severity of Gastrointestinal Symptoms in Inflammatory Bowel Disease Patients

Introduction: The pathogenesis of inflammatory bowel disease (IBD) remains unclear to date. Although numerous risk factors have been identified, the disease is thought to be multifactorial in origin. It is suggested that varying ovarian hormone levels, estrogen and progesterone withdrawal may contribute to the exaggerated gastrointestinal (GI) symptoms in IBD. Furthermore, women with IBD on hormonal contraception (HC) were also observed to have improvement in cyclical menstrual-related IBD symptoms. Aim: To determine the relationship between GI symptoms and the menstrual cycle among females with IBD in a questionnaire based cross-sectional study. Methods: 60 women of child-bearing age (18-45 years) seen at our IBD clinic completed a questionnaire incorporating the Harvey Bradshaw index (HBI) for Crohn's disease (CD) or ulcerative colitis activity index (UCAI) for ulcerative colitis (UC), and the short IBD questionnaire (SIBDQ) with Menstrual Distress Questionnaire (MDQ). Higher HBI, UCAI and MDQ scores are reflective of greater symptom severity. Higher SIBDQ scores correlate with better quality of life. Scores were evaluated for linear associations using the Pearson correlation coefficients. Women on HC, status post hysterectomy/oophorectomy, and pregnant women were excluded.Figure: Correlation between MDQ scores and SIBDQ scores in the sample population.Results: Of the 60 patients, 48 had CD and 12 had UC with mean age of 29±7 years standard deviation (SD); 36(60%) were on anti-TNF therapy. There was a negative correlation between MDQ scores and SIBDQ scores (r = -0.46). We noted a weak positive relationship between MDQ and the Harvey Bradshaw Index score (r = +0.15). There was a higher negative correlation of MDQ scores and SIBDQ scores among patients under 35 years of age (r= -0.46) in comparison to those older than 35 (r= -0.39). Furthermore, patients on anti tumor necrosis factor (TNF) therapies had lower correlation of MDQ scores with higher SIBDQ scores compared to those on other therapies (r = -0.42 vs -0.52) suggesting improved disease control. All p values were less than 0.0001. Conclusion: Severity of GI symptoms in women with IBD are correlated to severity of menstrual symptoms. Understanding changes in GI symptomatology during the menstrual cycle may help determine appropriate management strategies. Further studies are necessary to evaluate adjusting medication doses closer to menses (i.e timing medications during this time to provide higher drug levels or adding symptomatic therapy such as anti-diarrheals in anticipation of symptoms).Figure: Correlation between MDQ scores & SIBDQ scores in patients on anti TNF therapy Vs patients on other therapy.