About IBD Podcast Episode 125 - Amber's Year in Books 2022

Menopause and IBD – About IBD Podcast Episode 139

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Menopause is a topic that’s not well understood in general and there’s even less information when it comes to menopause and inflammatory bowel disease (IBD, Crohn’s disease and ulcerative colitis). October is World Menopause Awareness Month. World Menopause Day is on October 18th every year. The purpose of the day is to raise awareness of menopause and the support options available for improving health and well being. Learn more about how IBD may affect perimenopause and menopause, as well as the reverse.

Concepts discussed on this episode:

Find Amber J Tresca at:

Find Mac Cooney (mix, sound design, and theme music) at:

Episode transcript and more information at: https://bit.ly/AIBD139

These show notes contain affiliate links. If you choose to purchase after clicking a link, Mal and Tal Enterprises, LLC may receive a commission at no extra cost to you.

Transcript

[Music: IBD Dance Party]

Amber Tresca  0:04  

I’m Amber Tresca and this is About IBD.

Amber Tresca  0:08  

I’m a medical writer and patient educator who lives with a J-pouch due to ulcerative colitis. It’s my mission to educate people living with Crohn’s disease or ulcerative colitis about their disease, and to bring awareness to the patient journey.

Amber Tresca  0:20  

Welcome to Episode 139.

Amber Tresca  0:24  

October is World menopause Awareness Month. World Menopause Day is on October 18 every year, and I bet that you didn’t even know that this was a thing. The purpose of the day is to raise awareness of menopause and the support options available for improving health and well being.

Amber Tresca  0:44  

Menopause is a topic that’s not well understood in general and there’s even less information when it comes to menopause and IBD. I happen to be a woman and I also happen to be 50 years old at the time of this recording. The topic of menopause has been on my mind for some time. I have been in the perimenopause stage for a few years now.

Amber Tresca  1:04  

And of course, that leads me to want to learn more about what to expect when it comes to managing my IBD through this stage of life. For that reason, I’ve put together this episode of information about hormones, perimenopause, menopause, hormone replacement therapy, and IBD.

Amber Tresca  1:24  

First, I’m going to start with a level set. When I talk about inflammatory bowel disease, or IBD, I’m talking about the three main forms, which are Crohn’s disease, ulcerative colitis, and what might be called either indeterminate colitis, or IBD unclassified.

Amber Tresca  1:41  

We don’t have a cure for any of the forms of IBD right now. And to me, a cure means that the health problem is gone, and that it doesn’t come back. And unfortunately, that doesn’t happen with IBD right now, even after surgery.

Amber Tresca  1:59  

I will say that there are some people who might go years or decades without symptoms, but I still wouldn’t say that was considered a cure. Some people might disagree with me about this, and that’s fine. But I want you to understand where I’m coming from here when I talk about IBD.

Amber Tresca  2:16  

I have to point out also that research on IBD and menopause is really lacking. That will not surprise anyone I’m sure. But again, it’s something to know because there might not be hard and fast answers to all of our questions about IBD and menopause. And of course, what we know will evolve over time as more research is done.

Amber Tresca  2:39  

All right, let’s get into it. menopause and peri-menopause. Before we even get into menopause we have perimenopause. According to the National Institute on Aging, perimenopause can last anywhere from seven to 14 years.

Amber Tresca  2:56  

What happens is that the ovaries slow down releasing eggs and in producing estrogen. estrogens are hormones that are produced by the ovaries, adrenal glands and fat cells. They affect periods but also other parts of the body such as the urinary tract, blood vessels, pelvic muscles, and even the brain. In puberty, estrogen levels increase and that leads to the growth of hair under the arms and between the legs. And these are called secondary sex characteristics.

Amber Tresca  3:29  

What is menopause? Menopause is a natural part of getting older. When a person stops getting their period for an entire year. That’s menopause. The ovaries stop functioning and that leads to having lower estrogen levels. It also means that a person’s fertility is at an end and that they won’t be able to conceive a baby.

Amber Tresca  3:51  

The average age for menopause is 51. But it could occur usually anywhere between the ages of 45 and 55. The age that a person enters into menopause is based on a bunch of different factors that I won’t go into here, but I will include some resources in the show notes.

Amber Tresca  4:11  

Let’s get into how menopause may affect IBD. When perimenopause starts, the changing hormone levels have different effects on the body. One is that there might be bone loss, which means that in perimenopause, people might have a higher risk of fracturing of bone. It also might mean that there’s some weight gain because the body starts to use energy differently.

Amber Tresca  4:37  

There could also be other signs of perimenopause, including mood swings, vaginal dryness, sleep problems, and urinary incontinence. In perimenopause, there may be a change in how often a person gets their period. They could be closer together or further apart.

Amber Tresca  4:55  

Hot flashes could also start in a hot flash means that the body thinks that it’s too hot. It speeds up the heart rate and it starts to sweat, because it’s trying to cool itself down. Hot flashes can last a few minutes, until the body figures out that it’s not actually too hot.

Amber Tresca  5:14  

Having surgery on the ovaries can affect the start of menopause. People who have had surgery to remove their ovaries might go into menopause after surgery. The ovaries aren’t there to make the estrogen anymore. So in some cases, people are given hormone replacement therapy. People who have had surgery to remove their uterus but not their ovaries might go into menopause a little earlier.

Amber Tresca  5:41  

All right post menopause is when a person has gone a whole year without having a period. Postmenopausal people may be at risk for certain health problems, like heart disease, or osteoporosis. For that reason, this is a good time to start thinking about your health differently, and maybe making some changes.

Amber Tresca  6:00  

Okay, now let’s get into how menopause may affect IBD. First is how IBD might change in menopause. And a 2018 study on postmenopausal women, about 65% said that IBD symptoms didn’t change with menopause. Another 18% said symptoms were a bit worse, or even much worse, and 16% said that their IBD symptoms improved. (1)

Amber Tresca  6:31  

The group that said their symptoms of IBD got worse with menopause were women who were first diagnosed in their 40s. Women diagnosed in their 30s or younger, were less likely to say that their IBD symptoms were worse in menopause. (1)

Amber Tresca  6:46  

Second is whether or not women with IBD go into menopause early. There’s a study from Wales, which was published in 1989. I wouldn’t normally use research that’s so old. But the fact that we have so little data to go on is why I’m including it here.

Amber Tresca  7:03  

Anyway, the 196 women in this study had Crohn’s disease, they filled out surveys about the use of birth control and if they smoked, they also gave information about their periods and at what age they went into menopause. (2)

The researchers then compared this with data from women who did not have IBD. What they saw was that women with IBD started menopause at about 46 or 47 years old, and the healthy women were closer to 50 years old. (2)

Amber Tresca  7:34  

Another older study from Chicago, which was done in 2008 looked at 65 women with IBD 20 had ulcerative colitis and 45 had Crohn’s disease. They asked women with IBD about menopause and compared it to healthy women. Both groups in this study entered into menopause at about the same age, which was different from the study that was done in 1989. (3)

Amber Tresca  8:08  

38% of the women with IBD had a flare up within two years of menopause, and about 35% had active disease before menopause. This study also looked at hormone replacement therapy. The women who had hormone replacement therapy were 80% less likely to have a flare up. (3)

What the authors of this study said was that menopause doesn’t seem to change the chances of an IBD flare up. But they did also put it out there that the estrogen in hormone replacement therapy might help prevent active disease in IBD. (3)

And that leads me to hormone replacement therapy and IBD.

Amber Tresca  8:37  

At menopause, the body has less of the hormones estrogen and progesterone. Estrogen we’ve already talked about. Progesterone is the hormone that promotes the growth of breast tissue and maintains pregnancy. It’s also produced by the ovary when an egg is released. If the egg isn’t fertilized, though, the progesterone level falls and that’s when a person gets their period.

Amber Tresca  9:02  

When these hormones aren’t being produced anymore. It can lead to some of the uncomfortable signs and symptoms of perimenopause. Hormone Replacement Therapy is used to try to alleviate these signs and symptoms. You may have already heard that some of the studies on hormone replacement therapy showed that it might increase the risk of some health problems, such as breast cancer and heart disease.

Amber Tresca  9:27  

But more recently, it’s thought that hormone replacement therapy doesn’t carry these extreme risks. The North American menopause society now says that for some people, the benefits might outweigh the risks. They do say that therapy should start within 10 years of menopause starting or before age 60. What they found was that the risks might outweigh the benefits at that point. But this is an individual decision and for some people, it might make sense wants to use hormone replacement therapy for the long term. (4)

Amber Tresca  10:04  

Now, when it comes to IBD and hormone replacement therapy, what is surprised there hasn’t been much research. One older but big study on over 100,000 women showed a connection between hormone therapy and ulcerative colitis. Some women who were previously healthy developed ulcerative colitis.

Amber Tresca  10:25  

After receiving hormone therapy, the risk increased the more time the hormones were being used. After stopping hormone therapy, the risk went down again. There also wasn’t any risk found between hormone therapy and developing Crohn’s disease. (5)

Amber Tresca  10:43  

The study I already mentioned from 2018 looked at how hormones affected women with IBD of all ages. There were 111 women in this study who were postmenopausal, and who are taking hormone replacement therapy. 88% of the women with Crohn’s disease and 91% of the women with ulcerative colitis, said that the hormone therapy didn’t affect their IBD symptoms. There were no women that said their IBD was worse because of hormone therapy. (1)

Amber Tresca  11:14  

That brings us to the last topic, which is how menopause may affect the bones of people who live with IBD. Mainly we want to think about osteopenia and osteoporosis. Osteopenia is when bones are beginning to become weaker, that can advanced to osteoporosis, which is when bones lose mass and become more likely to break. People with IBD already are at higher risk for osteopenia or osteoporosis.

Amber Tresca  11:42  

A 2023 study showed that 33% of people with IBD had osteopenia, and 7% had osteoporosis. Some of the biggest risk factors from this study, were being male, having ulcerative colitis, having serious disease, being less physically active, and having a history of bone fractures. The authors of this study were also very concerned that the IBD patients had really low levels of vitamin D3. (6)

People with IBD are at risk for not having enough vitamin D and calcium, which are both needed for healthy bones.

Amber Tresca  12:20  

It’s usually recommended that people with IBD get screened for osteopenia or osteoporosis with a test called a bone density scan. This test can show if there’s a decrease in bone density. It’s also known that people with IBD are probably not getting this test done often enough. (7)

Amber Tresca  12:40  

The risk of osteoporosis also increases after menopause. A review study of seven other studies showed that people with IBD may have a higher risk of osteoporotic fractures, that’s 32% higher than in people without IBD. (8)

It might be recommended that some people take a type of medication called a bisphosphonate to prevent bone loss.

Amber Tresca  13:04  

There was one study done on women with IBD that compared the use of a bisphosphonate with a placebo. The women who got the bisphosphonate for three years had increased bone density and a lower risk of fractures. (9)

[Music: IBD Dance Party]

Amber Tresca  13:19  

And that’ll do it for IBD and menopause. I know this is not going to answer all of your questions, but I hope that it’s a start. We don’t have a lot of information. So remember to check with your health care team about managing IBD through perimenopause and menopause.

Amber Tresca  13:45  

Hey, super listener.

Amber Tresca  13:47  

Thanks to all the researchers who have studied the effect of menopause on IBD there’s still so much that we don’t know and I hope that we can continue to bring more attention to women’s health and IBD. You can find links to a written transcript, all the citations I used and more information in the show notes and on my episode 139 page on about ibd.com

Amber Tresca  14:10  

You can follow me Amber Tresca across all social media as about IBD

Amber Tresca  14:16  

Thanks for listening. And remember until next time, I want you to know more about IBD.

Amber Tresca  14:22  

About IBD is a production of Mal and Tal Enterprises.

It is written, produced, and directed by me, Amber Tresca.

Mix and sound design is by Mac Cooney.

Theme music is from Cooney Studio. 

Sources:

1. Rolston VS, Boroujerdi L, Long MD, et al. The influence of hormonal fluctuation on inflammatory bowel disease symptom severity—a cross-sectional cohort study. Inflamm Bowel Dis. 2018;24:387–393. doi:10.1093/ibd/izx004

2. Lichtarowicz A, Norman C, Calcraft B, Morris JS, Rhodes J, Mayberry J. A study of the menopause, smoking, and contraception in women with Crohn’s disease. Quarterly Journal of Medicine. 1989;72:623–631.

3. Kane SV, Reddy D. Hormonal replacement therapy after menopause is protective of disease activity in women with inflammatory bowel disease. Am J Gastroenterol. 2008;103:1193–1196. doi:10.1111/j.1572-0241.2007.01700.x

4. “The 2022 Hormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. doi:10.1097/GME.0000000000002028

5. Lungaro L, Costanzini A, Manza F, et al. Impact of Female Gender in Inflammatory Bowel Diseases: A Narrative Review. J Pers Med. 2023;13(2):165. Published 2023 Jan 17. doi:10.3390/jpm13020165

6. Lewandowski K, Kaniewska M, Więcek M, et al. Risk Factors for Osteoporosis among Patients with Inflammatory Bowel Disease-Do We Already Know Everything?. Nutrients. 2023;15(5):1151. Published 2023 Feb 24. doi:10.3390/nu15051151

7. Schüle S, Rossel JB, Frey D, et al. Widely differing screening and treatment practice for osteoporosis in patients with inflammatory bowel diseases in the Swiss IBD cohort study. Medicine (Baltimore). 2017;96(22):e6788. doi:10.1097/MD.0000000000006788

8. Hidalgo DF, Boonpheng B, Phemister J, Hidalgo J, Young M. Inflammatory bowel disease and risk of osteoporotic fractures: A meta-analysis. Cureus. 2019;11:e5810. doi:10.7759/cureus.5810

9. Palomba S, Manguso F, Orio F Jr, et al. Effectiveness of risedronate in osteoporotic postmenopausal women with inflammatory bowel disease: a prospective, parallel, open-label, two-year extension study. Menopause. 2008;15(4 Pt 1):730-736. doi:10.1097/gme.0b013e318159f190

Additional Sources:

Gold EB. The timing of the age at which natural menopause occurs. Obstet Gynecol Clin North Am. 2011;38:425–440. doi:10.1016/j.ogc.2011.05.002

Sheth T, Pitchumoni CS, Das KM. Musculoskeletal manifestations in inflammatory bowel disease: a revisit in search of immunopathophysiological mechanisms. J Clin Gastroenterol. 2014;48:308–317. doi:10.1097/MCG.0000000000000067

Harbord M, Annese V, Vavricka SR, et al. The first European evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease. J Crohns Colitis. 2016;10:239–254. doi:10.1093/ecco-jcc/jjv213

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