Gastrointestinal symptoms in occurrence with menstrual cycle in young women with inflammatory bowel disease: A complex relationship

Women with inflammatory bowel disease (IBD) often experience changes in gastrointestinal symptoms during the menstrual cycle. Little is known about the mutual influences between the menstrual function and gastrointestinal symptoms. We present the case of a girl affected by IBD who experienced a close relationship between gastrointestinal symptoms and disabling dysmenorrhea. The girl was diagnosed with pancolic UC at 12 years of age. Since onset, menses became painful and irregular and seemed to trigger relapses of abdominal pain, urgency and diarrhea. Gynaecological evaluations suggested numerous estro-progestinic treatments (transdermal norelgestromine and ethinyl estradiol; vaginal progesterone) but dysmenorrhea associated with diarrhea and urgency persisted. She had several courses of steroids, optimization of rectal steroids and mesalazine, and treatment escalation with mesalazine, azathioprine and infliximab with poor symptom control. Finally transdermal gestodene and ethinyl estradiol were prescribed continuously (suppressing menses) achieving symptom resolution and stable remission for 7 months. Unfortunately the latter treatment was withdrawn from the market and had to be suspended; the patient started to feel unwell again with menses. It is likely that she also suffers from a degree of irritable bowel syndrome (IBS). The relationship between IBD, IBS and menstrual cycle is complex; often one aspect may mimic, mask, worsen or activate another and it is often difficult to differentiate which component is truly responsible of the clinical picture. A better understanding of the relationship between hormonal fluctuations due to the menstrual cycle and gastrointestinal symptoms in young women with IBD is crucial for an appropriate management of disease.