Correlation of menstrual distress to severity of gastrointestinal symptoms in inflammatory bowel disease patients

Inflammatory bowel diseases (IBD), namely, Crohn’s disease (CD) and ulcerative colitis (UC) are idiopathic chronic, relapsing, inflammatory diseases of the gastrointestinal (GI) tract. Triggers for disease flares include medications, infection, acute stress, and the menstrual cycle. Varying ovarian hormone levels i.e. prostaglandins and progesterone may exaggerate GI symptoms in IBD. We aimed to determine the relationship between quality of life, endoscopic and clinical disease activity and the menstrual cycle among females with IBD through a questionnaire based cross-sectional study. The first 75 women of child-bearing age seen at IBD clinic completed a questionnaire incorporating the short IBD questionnaire (SIBDQ). Menstrual symptoms were evaluated using the validated Moos Menstrual Distress Questionnaire (MDQ) to measure cyclical peri-menstrual symptoms. Endoscopic disease severity was assessed using the Rutgeert’s score (post ileo-cecal resection patients) or Simple Endoscopic Score for CD and the Mayo score for UC. There was a statistically negative correlation between MDQ and SIBDQ scores (p<0.001); i.e. patients with lower menstrual distress scores had better quality of life. We found no correlation between the SIBDQ, MDQ and endoscopic scores (p = 0.094, 0.626 respectively). Previous studies suggest that the severity of menstrual symptoms correlate with a poorer quality of life among women with IBD. However, this may not be reflective of the endoscopic disease severity. Larger studies are necessary to evaluate adjusting medication closer to menstrual period and adding supportive therapy peri-menstrually in anticipation of symptoms.