It’s safe to say most women aren’t thrilled when that time of the month rolls around. Right before and during their period, many women contend with unpleasant symptoms, such as bloating, cramps, and mood swings. But for women with Crohn’s disease, the Menstrual hassles don’t end there.

According to a research review published in Therapeutic Advances in Gastroenterology in 2020, more than half of women with IBD have worsening symptoms around their menses.

Evidence suggests that hormones that fluctuate during your Menstrual Cycle — estrogen and progesterone — and hormonelike substances called prostaglandins can affect digestive disorders such as inflammatory bowel diseases (IBD), including Crohn’s.

Researchers who studied 121 women with IBD found that 25 percent of them experienced a change in their menstrual cycle one year before their IBD diagnosis. The study, published in the journal Inflammatory Bowel Diseases, also noted some good news: The irregular cycles typically evened out over time. Researchers advised that screening for menstrual irregularities be considered in women with newly diagnosed IBD.

Apart from that study, researchers haven’t discovered why a woman’s menstrual cycle can affect her Crohn’s disease symptoms. Miguel Regueiro, MD, the chair of the department of gastroenterology, hepatology, and nutrition at Cleveland Clinic, says, “The relationship between hormonal changes and Crohn’s symptoms has been researched, but we’re not yet sure how they’re connected.”

Still, Dr. Regueiro adds, “Many women do report that when they are getting their periods, their symptoms seem worse.”

Your Menstrual Cycle and Your Digestive System

Another study published in a 2020 issue of Therapeutic Advances in Gastroenterology took a closer look at the effect of menstrual cycles on IBD. This study included women with Crohn’s disease or ulcerative colitis (UC) and women with no digestive conditions.

Interestingly, the healthy women were more likely to report changes in their bowel habits during menstruation than those with IBD were. But those with Crohn’s or UC experienced multiple other symptoms during menstruation more often, including irritability, nervousness, restlessness, headache, anxiety, nausea, vomiting, leg swelling, low back pain, constipation, excessive urination, abdominal pain, and fatigue.

Jill K. Powell, MD, an associate professor in the department of obstetrics, gynecology, and women’s health at Saint Louis University School of Medicine, says, “Women with Crohn’s disease, as well as women with irritable bowel syndrome, and even women with no bowel diseases, can have diarrhea just prior to and during their menstruation. This is likely caused by an increase in progesterone and prostaglandin levels made by our bodies during the premenstrual phase.”

Dr. Powell explains, “Prostaglandins in particular are responsible for smooth muscle contraction, whether that is in the form of labor pain, menstrual cramps, or increased contractions of the smooth muscle in the intestines that leads to diarrhea.”

How to Take Control of Your Menstrual Cycle and Crohn’s

If you have Crohn’s disease and experience an increase in your Crohn’s symptoms during your menstrual cycle, some medications, and at least one dietary supplement, may provide some relief. Here’s how they work.

Oral contraception Women who use oral contraceptives (birth control pills) to prevent ovulation and block high premenstrual levels of progesterone see an improvement in their menstrual cycle bowel symptoms, according to Powell. Progesterone levels increase after ovulation and are highest in the days leading up to your period. High levels of progesterone can slow down the muscle activity of the bowels, resulting in constipation.

Evening primrose oil While evidence is mixed, some research has shown that women with Crohn’s disease who take a prostaglandin blocker see an improvement in their premenstrual and menstrual diarrhea, Powell says. You can find this in evening primrose oil, an herbal supplement you can buy in gelcap form. It contains gamma-linolenic acid (GLA), an essential fatty acid that has been shown to reduce inflammation. Powell recommends that patients “take two gelcaps with food every eight hours during the days when you typically have symptoms.” One note of caution: Primrose oil should be avoided if you have a type of seizure disorder known as temporal lobe epilepsy.

PMS medications Other medications may also be helpful if you suffer from specific premenstrual or menstrual symptoms — commonly known as PMS — such as mood swings, sleeping difficulties, and appetite disturbances. A class of medication known as selective serotonin reuptake inhibitors (SSRIs), in particular, may provide some relief from a severe form of PMS called premenstrual dysphoric disorder (PMDD), per MedlinePlus.

Talk With Your Doctor About How to Safely Manage Your Symptoms

If you have Crohn’s disease or any other IBD, talk with your doctor before using any over-the-counter or prescription nonsteroidal anti-inflammatory drugs, (NSAIDs, such as ibuprofen and aspirin) for relief from PMS, headaches, or cramping. When used excessively, some NSAIDs can cause bleeding, ulcers, or irritation in your digestive tract and may not be the best choice for you.

You should also work with your doctor on managing your specific menstrual symptoms, depending on when they most commonly occur. Together, you can consider the use of oral contraceptives, other helpful medications, and evening primrose oil, which you can buy at your local drugstore.