Maurice Cerulli, MD
Maurice Cerulli, MD, program director of gastroenterology, hepatology and nutrition at the North Shore-Long Island Jewish Health System, New Hyde Park, New York.
The 5.5 million women in North America who have endometriosis—an inflammatory disorder of the female reproductive system that often leads to abdominal pain and infertility—already endure a lot. Now, a new study is telling us that women with endometriosis also have a higher-than-normal risk of developing inflammatory bowel disease (IBD), an umbrella term for two horrid conditions, Crohn’s disease and ulcerative colitis. I’m not going to sugarcoat this. For any woman, endometriosis and IBD together can be a tough, tough challenge. But it’s good that we know there’s a connection now—and perhaps that can lead to earlier detection and better treatments.
Previous studies had suggested an association between endometriosis and autoimmune diseases such as multiple sclerosis. With that in mind, researchers at the Statens Serum Institut in Copenhagen decided to investigate the possibility of an association between endometriosis and IBD, another autoimmune disease. They gathered the medical records of 37,661 women who had been diagnosed with endometriosis between 1977 and 2007 and looked through these records to answer this question—during that 30-year span, how many of these women went on to develop IBD?
The results: 228 of the women had developed Crohn’s disease and 92 had developed ulcerative colitis. Now, those numbers might seem small, but that’s only because IBD in the general population is rare. Compared with the general population, these women were, on average, 50% more likely to develop IBD.
Another interesting finding: Endometriosis occurs when the uterine lining abnormally grows outside the uterus. Having a hysterectomy or going through menopause can make endometriosis symptoms either disappear completely or lessen. So the researchers were curious to know whether women who had undergone menopause would still be at greater risk for IBD. It turns out that, unfortunately, they were. The mean age of endometriosis diagnosis in the study was 39, and the findings showed that even 20 years after diagnosis (when women were 59, on average, and likely past menopause), they still had a 50% higher risk for IBD.
To discuss all these findings—and what they might mean for my readers—I called Maurice Cerulli, MD, program director of gastroenterology, hepatology and nutrition at the North Shore-Long Island Jewish Health System in New Hyde Park, New York, who had carefully reviewed the study.
Although no one knows for sure why endometriosis raises the risk for IBD, Dr. Cerulli did bring up one intriguing possibility. Having endometriosis (or having had it in the past) can cause scarring that makes bowel movement more difficult. This, in turn, can lead to bacterial overgrowth that could contribute to the development of IBD, he said. Drinking lots of fluids, said Dr. Cerulli, may make your bowel movements softer and easier and, therefore, potentially limit bacterial overgrowth. So if you have endometriosis, try to sip on water throughout the day. And ask your doctor if taking probiotics is a good idea.
He also said that it’s extremely important for women with endometriosis to be aware of the connection between endometriosis and IBD because many IBD symptoms are strikingly similar to those of endometriosis—so it would be all too easy for both a doctor and a patient to not realize that a woman has both health problems. Two symptoms in particular are common among endometriosis, Crohn’s disease and ulcerative colitis—chronic abdominal pain and diarrhea. But some distinguishing features of both Crohn’s disease and ulcerative colitis include rectal pain, bleeding, bloody diarrhea, an urgent need to have a bowel movement and an inability to move the bowels.
So if you have or have had endometriosis, note your symptoms carefully—and tell your doctor if you start experiencing any IBD-like symptoms. If testing reveals IBD, then your physician may help you find relief with treatment.
