Key takeaways
- Hormonal changes, such as those occurring during menstruation, can worsen ulcerative colitis (UC) symptoms in females.
- Females with UC may experience sexual dysfunction, fertility issues, iron deficiency anemia, osteoporosis, and body image issues.
- While most UC medications are safe during pregnancy, consulting a doctor about potential risks is essential when planning to conceive.
UC is a form of inflammatory bowel disease (IBD). This long-term condition causes prolonged inflammation of the colon.
Learn more about how UC can affect females, the additional risks it poses, associated conditions, when to consult a doctor, and the general outlook for the condition.
The use of binary terms such as “male” and “female” or “men” and “women” in this article reflects the language of the sources we’ve used. Unless otherwise noted, it’s unclear whether the research we reference included participants with expansive gender identities.
People with IBD may go through periods where they experience no symptoms (remission). Or they may experience periods of remission and periods of active disease (flares). Symptoms can range from mild to severe.
Common symptoms include:
- diarrhea
- bloody stool due to rectal bleeding
- abdominal pain
- urgent need to go to the bathroom
A person may also experience general symptoms, such as:
- weight loss
- fatigue
- fever
- loss of appetite
For more information on IBD, visit our dedicated hub.
Hormonal factors
Hormonal fluctuations during different periods of a female’s life may impact their IBD symptoms.
A
Pregnancy may also affect disease activity. In turn, UC and treatments or procedures may impact fertility and pregnancy outcomes.
Postmenopausal females reported no change in symptoms due to menopause itself. Females with worsened symptoms after menopause were older when receiving an IBD diagnosis.
Treatment aims to maintain periods of remission or help manage a flare of symptoms.
Depending on the degree of symptoms, a doctor may recommend mesalamine, immunomodulators such as methotrexate, or biologics such as adalimumab (Humira).
In periods of flares, doctors may prescribe a short course of steroids to help quickly bring down inflammation until other medications can take effect.
Remedies
Alternative remedies are available for colitis, such as avoiding certain foods, consuming fruits and vegetables as juices, drinking probiotics, and following specific diets. People may wish to experiment with home remedies alongside their treatments.
Although these remedies may provide some benefit, there is no evidence to suggest that they replace traditional therapies.
Surgical
If nonsurgical treatments do not provide relief for symptoms, doctors may suggest surgery as an option. These may involve removing all or part of the colon (colectomy), connecting the small intestine to an external pouch (ileostomy), or connecting the intestine to the muscles around the anus (J-pouch).
Certain factors may affect females with UC. These include their genes, environment, and hormones.
These factors may affect the course of the disease and, in turn, impact the person’s quality of life. Alongside worsened menstrual symptoms, a female with UC may have an increased chance of developing the following conditions:
Sexual dysfunction
A 2025 article notes that sexual dysfunction was high in females with IBD and appeared to become more common with increased disease activity.
Those with IBD may experience:
- a lack of sexual desire
- inability to achieve orgasm
- pain during sexual activity (dyspareunia)
Contributing factors included:
- psychological factors related to having UC
- changes in body image
- vaginal discomfort
- rectovaginal fistulas
Fertility and pregnancy
According to the Crohn’s and Colitis Foundation, those with UC or Crohn’s disease in remission are as likely to conceive as those without the condition. However, conceiving during a flare-up can lead to difficulties and a higher risk of complications, such as:
- pregnancy loss
- low birth weight
- premature birth
Surgery may also affect pregnancy. A
However, a 2020 study examined fertility rates in females who underwent surgery for colitis as a child. It found that
Iron deficiency anemia
Research recognizes that iron deficiency anemia (IDA) is a common complication with IBD, as a result of bleeding in the inner lining of the intestine. IDA may also result from the decreased absorption of iron due to inflammation.
In some people, heavy periods can lead to excessive blood loss and may cause anemia. If a person has UC or Crohn’s and experiences heavy periods, this could further increase their risk of IDA.
Osteoporosis
Females with IBD are at an increased risk of having osteoporosis, as their bone density is lower than average.
Osteoporosis and bone loss may result from multiple factors:
- Inflammation: Inflammation affects the rate at which the body removes old bone and forms new bone (typical bone metabolism).
- Corticosteroid use: Corticosteroids may decrease the amount of calcium absorbed by the intestines and reduce the production of the hormone estrogen, which contributes to strong bones. They can also affect cells associated with bone formation, called osteoblasts and osteocytes.
- Vitamin D deficiency: People with IBD, particularly those who have had sections of their small intestine removed, are at increased risk of vitamin D deficiency, as this is the part of the body that absorbs most nutrients.
Body image issues
Taking corticosteroids can cause weight gain during flares, while malabsorption and a lack of nutrition due to dietary changes may lead to weight loss. These fluctuations in weight can cause body image issues.
A
Females who had elevated scores on the eating attitude test as part of the study experienced the following:
- low weight
- a diagnosis of IBD in childhood
- psychological distress
- body image disturbance
Fistulous tracts
Fistulous tracts are holes or tunnels on the intestinal walls or other organs. Fistulas may develop after a person undergoes bowel surgery or as a complication of IBD.
These tracts are more common in Crohn’s disease, with 1 in 3 people with Crohn’s disease developing a fistula.
People with UC usually develop fistulous tracts as a result of bowel surgery.
Doctors prescribe medications as the first line of treatment for UC. Corticosteroids such as prednisone are anti-inflammatory drugs that suppress the immune system. This type of drug may lead to fungal infections such as yeast infections in the mouth and vagina or urinary tract infections (UTIs).
Those looking to conceive should also stop taking methotrexate 3 to 6 months before conception. This is because it can increase the risk of congenital abnormalities.
Most medications for UC are safe to continue taking during pregnancy, but a person should always speak with a doctor to discuss risks and medications when pregnant or trying to conceive.
Flares can range in intensity. While a person may be able to manage mild flares at home, severe flares may need urgent attention, as they may be a sign of a complication that could be life threatening.
The following symptoms warrant immediate medical attention:
- constant, severe abdominal pain lasting more than 24 hours
- abdominal pain with high fever
- heavy rectal bleeding or bleeding with clots
- heavy diarrhea
UC is a form of IBD that causes symptoms such as diarrhea, bloody stools, and abdominal pain. Treatments range from taking long-term prescription medications to making lifestyle and dietary changes, and in severe cases, having surgery.
Females with IBD may experience challenges, including worsened menstrual symptoms, osteoporosis, and fertility issues due to UC inflammation or its treatments.
A person should speak with a doctor to discuss the complications related to UC, and they may wish to explore alternative treatments to reduce risks.