Understanding Inflammatory Bowel Disease in Women From Puberty to Menopause

Women with inflammatory bowel disease (IBD) experience distinct physiologic and clinical challenges across their lifespan. In childhood and adolescence, early exposure to corticosteroids, chronic inflammation, and malnutrition may impair pubertal development, disrupt hormonal regulation, and reduce peak bone mass accrual. During puberty, fluctuating levels of estrogen and progesterone can exacerbate gastrointestinal symptoms and IBD activity. In adult women, gynecologic comorbidities such as endometriosis and uterine fibroids may mimic or worsen IBD-related symptoms, contributing to diagnostic complexity, pelvic pain, and sexual dysfunction. As women transition into menopause, declining estrogen can further affect gastrointestinal motility and immune regulation, confounding IBD symptoms. Postmenopausal women with IBD are also at an increased risk for osteoporosis and may face elevated cardiovascular risk owing to systemic inflammation and hormonal changes. This article focuses on women with IBD beyond the years of pregnancy and lactation, emphasizing the impact of hormonal transitions, dysmenorrhea, sexual health concerns, and menopause.