Menopause and Inflammatory Bowel Disease: A Systematic Review

Background Research is limited on the impacts of menopause, defined as the permanent cessation of ovarian function and decline of reproductive hormones, on gastrointestinal symptom severity and disease progression in women with inflammatory bowel disease (IBD). This review synthesizes current evidence on the impact of menopause, menopause transition, and hormonal therapy (HT) on disease activity, IBD and menopause symptom severity, and disease progression among individuals with IBD.

A systematic literature review was reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and preregistered at PROSPERO (CRD42024564901). Five databases were searched without date restrictions. Data extraction and risk-of-bias assessment were performed independently by multiple reviewers. Results were qualitatively synthesized.

Of 1667 records, 15 studies met inclusion criteria (5 cohort, 3 case-control, 7 cross-sectional) with IBD sample sizes from 37 to 1367. Evidence on HT and IBD risk was mixed: some studies linked HT to increased ulcerative colitis risk while others found no significant association after adjusting for confounders. Women with IBD experience earlier menopause than healthy control subjects. While most women reported no change in IBD symptoms postmenopause, a minority reported symptom worsening. HT may reduce flare severity. Women with IBD reported more severe vulvovaginal symptoms and had distinct vaginal microbiome profiles compared with healthy control subjects.

Few studies have explored the relationship between menopause and IBD. There is a need for continued research on the relationship between IBD disease activity and menopause symptoms to create tailored interventions to improve women’s health with IBD across the lifespan.

menopause, inflammatory bowel disease, hormone replacement therapy Key Messages. What is already known? Women with inflammatory bowel disease (IBD) may experience changes in IBD-related symptom severity during hormonal transitions. What is new here? Women with IBD tend to experience earlier menopause and more severe vulvovaginal symptoms compare to healthy control subjects; the use of hormonal therapy may reduce disease activity. How can this study help patient care? Understanding the connection between menopause and IBD can enhance personalized care strategies including the use of hormonal therapy to manage IBD-related symptoms and improve quality of life of women during the hormonal transition.

Inflammatory bowel diseases (IBDs), including ulcerative colitis and Crohn’s disease, impact almost 5 million individuals worldwide. Although IBD is typically diagnosed between 20 and 30 years of age, the highest peak in IBD prevalence is at 50 to 54 and 60 to 64 years of age.1 This peak prevalence coincides with the time in which female IBD patients typically undergo menopause transition. Menopause is the permanent cessation of ovarian function that usually occurs between 45 and 55 years of age.2–5 Perimenopause, the time of variable menstrual cycles leading up to menopause, is often when symptoms of menopause start such as vasomotor (eg, hot flashes, night sweats), vaginal dryness, sleep disturbances, and mood symptoms.6,7 Hormonal therapy (HT) is indicated to treat bothersome menopausal symptoms, prevention of osteoporosis fractures, and premature ovarian insufficiency.7,8 HT can help manage hot flashes and vaginal dryness and prevent bone loss with established benefits but may carry some risks depending on individual health factors.8 However, minimal IBD research has focused on the impact of menopause transition in female patients with IBD. During the menopause transition, levels of estradiol and progesterone decrease. The decreasing estradiol may decrease gut motility and increase permeability via regulation of tight junction expressions.9–11 Progesterone has been noted to slow gastric motility and may decrease gastric emptying.12 In the general population, postmenopausal women report changes in bowel function, greater symptoms of gas and heartburn, and more laxative use when compared with premenopausal females.13,14 However, minimal attention has been given to midlife females and the impact of menopause and its relationship to IBD and if these changes in the gastrointestinal tract related to hormone changes in menopause further exacerbate existing increased gut permeability, alterations in gut motility, and dysbiosis in IBD and, in turn, influence IBD-related symptoms or disease activity.10 Additionally, IBD pathophysiology and treatment may impact the age when women enter menopause transition. Moktan et al15 reported that the age of menopause may be earlier among those with IBD compared with healthy control subjects, indicating the potential impacts of IBD treatment and disease processes on menopause onset. The purpose of this study was to systematically review the existing literature on the impact of menopause, menopause transition, and HT among individuals with IBD.

A systematic literature review was conducted, and results were reported based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The review was preregistered at PROSPERO (CRD42024564901). During the conduct of the review, we identified multiple published reviews regarding bone mineral density and osteoporosis.16–18 Thus, we modified our exclusion criteria and aims to exclude studies focused on solely on the outcomes of osteoporosis or bone mineral density. Search strategy The literature search was performed by a medical librarian using 5 databases: PubMed, Web of Science, Embase, PsycInfo, and CINAHL. Databases were searched with no publication date restrictions, and only English-published articles were included. Databases were searched from their inception until March 27, 2025. The search consisted of keywords related to IBD and menopause. See the Supplemental Materials for the full search strategies for each database. Study selection Inclusion criteria were cross-sectional, longitudinal, quasi-experimental, or randomized controlled trial studies, consisting of individuals with IBD (Crohn’s disease or ulcerative colitis). We excluded reviews, case studies, opinions, or studies in which only the abstract was available. Studies focused only on osteoporosis or bone mineral density and those that did not capture any menopause outcomes were also excluded. Study selection occurred using Covidence (Veritas Health Innovation), an online systematic review manager. Two reviewers (TK, KK) independently screened the titles and abstracts. Disagreements were reviewed by a third reviewer (SC). Next, full-text review was conducted by 2 reviewers, and disagreements were resolved by consensus and, if necessary, a third reviewer. Data extraction Relevant data were manually extracted from studies in tabular form by a single author. Data extracted included: study characteristics (ie, design, method of recruitment, sample size), patient demographics (eg, age, race/ethnicity), characteristics of IBD (ie, type of IBD, disease activity, disease activity measurement, disease activity results in relation to IBD), characteristics of menopause (ie, menopause measurement methods, age of menopause onset, menopause symptoms), and other related findings. Extracted data were checked independently by 2 authors. Risk-of-bias assessment The quality of studies was assessed using the National Heart, Lung, and Blood Institute’s Study Quality Assessment Tools.19 The tool was selected based on study design to include Cohort and Cross-Sectional Studies (14 domains) as well as Case-Control Studies (12 domains). Each domain is answered as yes, no, not reported, cannot be determined, or not applicable. Two reviewers scored the quality of each study, and disagreements were resolved by consensus. Data synthesis A narrative synthesis approach was used to summarize the findings from the study. We were unable to conduct a meta-analysis, as 3 studies did not report the same outcome and due to the variability in how menopause was measured and reported.

Study characteristics A total of 1667 records were identified in the search. After removing duplicates (n = 476), 1191 records were screened for title/abstract. A total of 113 records were included in the full-text review. A total of 15 studies met the inclusion/exclusion criteria (see Figure 1 for PRISMA flow diagram). About half of the studies were published in the past 5 years (47% [n = 7]). The majority of studies used a cross-sectional design (47% [n = 7]), followed by cohort studies (33% [n = 5]), and case-control studies (20% [n = 3]). Risk of bias All studies clearly stated their research questions and patient populations. The majority of cohort study designs did not report the time from IBD diagnosis to menopause onset, making it difficult to determine the timeframe between the exposure and outcome. Additionally, many studies did not report if IBD onset occurred before menopause. It was often unclear how menopause was defined. Few studies reported a power analysis or sample size justification. Most studies did not report if the outcome assessors were blinded to the exposure status of participants. Risk-of-bias findings are reported in Supplemental Table 1. Sample characteristics See Supplemental Table 2 for a summary of the studies included. Sample sizes ranged from 65 to 108 844 participants across the 15 studies, with a total of 135 629 participants (IBD and healthy control subjects) across all the studies. IBD participant sample sizes ranged from 37 to 1250, with a total of 4250 participants with IBD. Participants were recruited from a variety of settings, including outpatient IBD clinics, electronic medical records, larger cohort studies, and national health insurance claims database. Most studies (n = 8) were conducted in the United States, with additional studies from the United Kingdom (n = 2), Canada (n = 2), Iran (n = 1), Ireland (n = 1), and Taiwan (n = 1). The proportion of participants in menopause ranged from 14% to 100%. Participant age at the time of the study ranged from 12 to 90 years and the mean or median age ranged from 36.6 to 62.5 years. Race and ethnicity data were reported in 6 studies, with the majority of participants being White, ranging from 89% to 97.6%. Black, Asian, and other racial groups were underrepresented, comprising 2.4% to 11% of studies. Six studies reported IBD clinical disease activity levels, with those in remission ranging from 9% to 85%. Eleven studies had IBD participants with both Crohn’s disease and ulcerative colitis, while 3 only had participants with either Crohn’s disease or ulcerative colitis. There were a total of 2892 participants with Crohn’s disease and 1319 participants with ulcerative colitis. One study did not report participants’ type of IBD. Studies used a variety of methods to measure menopause, including participant self-report, medical record review, 6 consecutive months of amenorrhea, 12 consecutive months of amenorrhea, and STRAW (Stages of Reproductive Aging Workshop). Three studies did not report how menopause was measured. Surgical menopause refers to those who had their ovaries removed prior to natural menopause; 5 studies included those in both surgical and nonsurgical menopause, whereas the remaining studies did not report data on surgical menopause. Articles did not differentiate between early and late postmenopausal patients. No studies examined perimenopause. Table 1 provides an overview of studies and findings. Table 1. | Theme | Results | Reference(s) | |---|---|---| | Menopause and risk of IBD diagnosis | Postmenopausal hormonal therapy was not significantly associated with IBD risk in a multivariate model. | 22 , 23 | | Postmenopausal hormone use and genetically predicted age at last hormonal therapy use were associated with an increased risk of ulcerative colitis but not Crohn’s disease. | 21 | | | Primary ovarian insufficiency (defined by onset of menopause at the <40 y of age) associated with an increased risk of IBD. | 20 | | | Age of menopause in established IBD | Women with IBD experience early menopause. | 15 , 24 , 25 | | Ulcerative colitis is not associated with early menopause. | 26 | | | A younger age of IBD diagnosis has a positive association with a younger age at last missed period (r = 0.70). | 27 | | | Menopause and IBD disease activity | Around 16%-18% reported improvements in IBD symptoms during and after menopause. | 28 , 29 | | HT treatment was associated with a 5.6 times increase in the odds of an improvement in post-HT Physician Global Assessment score compared with those who did not use HT treatment. | 30 | | | Women taking HT were 80% less likely to experience a flare within the first 2 y following menopause onset compared with those not taking HT. | 31 | | | Of participants using HT, 61% reported no change in IBD symptoms and 31% stated they “didn’t know” whether HT influenced symptoms. | 28 | | | 85% of postmenopausal women reported no change in their symptoms due to HT. | 29 | | | Menopause symptoms in IBD | Women with IBD are more likely to report moderate-severe vulvovaginal symptoms (ie, itching, burning, irritation, dryness, pain, and discharge) compared with healthy control subjects. Vulvovaginal symptoms did not differ based on disease activity. | 32 | | Postmenopausal women with IBD were more likely to report vulvovaginal symptoms (ie, vulvar discomfort, vaginal discomfort, vaginal dryness, vulvovaginal pain) compared with premenopausal women with IBD. | 33 | | | Postmenopausal women had lower menopause-related quality of life compared with premenopausal women. The specific domains differed based on disease activity. For those with active disease, they were psychosocial and sexual domains. For those in clinical remission, it was the vasomotor domain (eg, hot flushes, night sweats). | 27 | Abbreviations: HT, hormone therapy; IBD, inflammatory bowel disease. Menopause and risk of IBD No studies compared the risk of developing IBD before and after menopause. Kirubarajan et al20 reported that women with primary ovarian insufficiency (defined by onset of menopause at <40 years of age) had an increased risk of developing IBD compared with those with menopause onset after 40 years of age (21.2% vs 9.8%; odds ratio, 1.6; 95% confidence interval, 1.2-2.0). Three studies focused on the use of HT and the risk of developing IBD with mixed results. Khalili et al21 reported that postmenopausal hormone use was associated with an increased risk of developing ulcerative colitis but not Crohn’s disease. The type of HT regimen (estrogen only, combination estrogen + progesterone) did not impact this relationship; however, dose was not reported (see Supplemental Table 3). Riahi et al22 found a relationship between HT and risk of IBD in a univariate model. However, in a multivariate model examining other environmental factors including sleep quality, oral contraception, age, and marital status, HT was not significantly associated with risk of developing IBD. Notably, participants 12 to 80 years of age were included in the multivariate model, potentially diluting the impact of HT. Tseng et al23 used a National Health Insurance Claims Database from Taiwan. With 1:1 propensity score matching, they found no significant association between HT use and IBD risk among postmenopausal women. Age of menopause Five studies examined the age of menopause onset in individuals with IBD. 15,24–27 Four articles compared the age of menopause onset among those with IBD with healthy control subjects (Table 2).15,24–26 Three studies reported earlier age (<50 years of age) of menopause onset in Crohn’s disease and ulcerative colitis compared with healthy control subjects.15,24,25 One study by Lichtarowicz et al26 did not report a difference in the age of menopause between those with ulcerative colitis compared with healthy control subjects (see Table 2 for age of menopause). One article examined the relationship between age at IBD diagnosis and age of menopause, reporting that a younger age of IBD diagnosis was significantly associated with a younger age of menopause.27 Table 2. | Age of menopause in IBD patients (y) | Age of menopause in healthy control subjects (y) | Sample size (n) | Measure | Reference | |---|---|---|---|---| | 47.6 (CD) | 49.6 | IBD: 146 HC: 103 | Median | 24 | | 50.3 ± 5.8 (UC) | 48.1 ± 4.4 | IBD: 96 HC: 62 | Mean | 26 | | 50.0 (CD and UC) | 51.5 | IBD: 83 HC: 88 | Median | 15 | | 41.9 ± 2.4 (CD), 43.2 ± 2.1 (UC) | 46.8 ± 3.3 | IBD: 66 HC: 35 | Mean | 25 | Values are mean ± SD or n, unless otherwise indicated. Abbreviations: CD, Crohn’s disease; IBD, inflammatory bowel disease; UC, ulcerative colitis. Menopause, HT, and IBD disease activity, and IBD symptoms No studies reported the impact of perimenopause or early postmenopause on IBD disease activity. In a retrospective study by Rolston et al,28 16% of IBD patients self-report an improvement in IBD symptoms, 65% self-report no change, and 19% self-report more severe IBD symptoms due to menopause itself. In another retrospective study by Zutshi et al,29 menopause changed IBD symptoms in 17.6% of postmenopausal women, although the study did not indicate if change meant symptoms were improving or worsening. No studies prospectively examined disease activity and IBD symptoms or IBD disease activity in perimenopause. Four studies examined the impact of HT on IBD symptoms or IBD disease activity.28–31 Two studies using self-report questionnaires reported no relationship between HT and IBD symptoms. Two studies (case-control and cohort designs) reported a decreased likelihood of an IBD flare. Additionally, for those taking HT who had a flare, medical management was more conservative (ie, patients could be treated with a dosing change and did not require treatment class escalation). No studies reported that HT increased the risk of IBD disease activity. Most studies did not report data on HT dose or route. Menopause symptoms in IBD Three studies examined menopause symptoms in IBD.27,32,33 Women with IBD were nearly 3 times more likely to report moderate-severe vulvovaginal symptoms compared with healthy control subjects (33% vs 12%). Two studies indicated that vulvovaginal symptoms, such as itching, burning, irritation, dryness, pain, and discharge, do not differ based on IBD disease activity. However, women with active IBD were more bothered by and had reduced quality of life from menopause symptoms than women in remission. Additionally, the vaginal microbiome differed between postmenopausal women with IBD compared with healthy control subjects. Postmenopausal women with ulcerative colitis had a non–Lactobacillus-dominant vaginal microbiome compared with all postmenopausal healthy control subjects who had Lactobacillus-dominant vaginal microbiome. Studies did not examine symptoms commonly experienced in menopause that also impact quality of life, including vasomotor symptoms, depression, anxiety, difficulty concentrating, or changes in sleep.

Despite the growing population of individuals with IBD entering menopause, minimal research has focused on the impacts of perimenopause and menopause on IBD and vice versa. We report the findings from 15 studies focused on the relationship between menopause and IBD. The most consistent finding was that individuals with IBD may have an earlier age of menopause compared with those without IBD. Individuals with IBD may have an earlier age of menopause compared with control subjects; particularly those with longer disease duration. Other autoimmune conditions such as diabetes, rheumatoid arthritis, and lupus are also associated with an earlier age of menopause.15,34 Inflammatory mediators such as cytokines may impact female hormone level, accelerate the decline in ovarian function, and lead to an earlier age of menopause.10 Additionally, individuals with primary ovarian insufficiency had an increased risk of IBD compared with those entering menopause at the average age of menopause.20 However, the majority of studies which examined the age of menopause did so before the introduction of new IBD medications (ie, 1989, 1991, and 1996). Moktan et al15 was the only recent study to examine differences in age at menopause, using data from the Rochester Epidemiology Project; however, participants were diagnosed with IBD between 1970 to 2010. Thus, additional research regarding the impact of newer medications and surgical treatments on the age of menopause is needed. An earlier age of menopause (≤45 years of age) has been associated with increased risk of osteoporosis, dementia, cardiovascular disease, and diabetes.5,8,35 As the risk of ischemic stroke may be higher among postmenopausal women with IBD compared with those without IBD.36 Identification of those at risk for early menopause is key to prevention and early detection of these potential sequalae. Most studies focused on menopause and IBD disease activity examined HT. The two studies that reported IBD symptoms before and after menopause relied on retrospective reports from patients with IBD.28,29 With retrospective reports, only 16% of participants self-reported that IBD symptoms changed during menopause.28,29 Notably, no studies prospectively examined disease activity and IBD symptoms or used objective disease activity markers, limiting our understanding of the dynamic relationships that may exist. Thus, there is a need for longitudinal studies to fully characterize menopause (including accurate and comprehensive menopause staging) and IBD symptom and disease progression as women with IBD progress through the reproductive stages of premenopause, perimenopause, and postmenopause and in people with and without surgical menopause. Our findings highlight the need for further research to understand how HT affects the risk of developing IBD and outcomes among those with established IBD. Furthermore, there is a need to robustly characterize HT including type and route as the majority of studies did not report this data. Only 1 study reported HT route. Among those without IBD, it remains unclear whether HT increases the risk of developing IBD. For women already diagnosed with IBD, HT appears to be associated with improved disease activity as measured by physician global assessment and clinical disease activity measures, but it does not appear to impact self-reported IBD symptoms.30,31 Notably, we did not find any studies which focused on menopause symptoms, such as hot flashes, night sweats, or sleep disturbances, among those with IBD. Bar et al32 examined vulvovaginal symptoms finding that women with IBD were more likely to report moderate-to-severe vulvovaginal symptoms compared with healthy control subjects. Furthermore, it is already known that those with IBD report greater sleep disturbances than healthy control subjects.37 Thus, it is likely the menopausal transition may be different for those with IBD. However, based on available evidence, we cannot anticipate what will occur during menopause. Furthermore, no studies explored the difference between IBD treatment (eg, corticosteroids, surgery) and IBD diseases processes (eg, inflammation) and menopause. Thus, more robust characterization of HT, objective disease activity, and symptoms is needed to guide treatment and provide patients with information about the impact of HT on IBD during midlife. This lack of empiric evidence prevents healthcare providers from adequately meeting the menopause health needs for those with IBD. Strengths of our study include a systematic review of the literature developed in consultation with an expert medical research librarian. Weaknesses and limitations of this review include the small number of studies, which results in a limited dataset to draw conclusions about the relationship between menopause and IBD. Additionally, the studies disproportionately represented White participants, so findings may not accurately reflect trends in minority Asian, Hispanic, and Black populations. Another limitation is the reliance of studies on retrospective reporting of menopause status and IBD symptoms, which may be inconsistent and potentially biased. The variation in measurement of menopause including self-report, 6 months of amenorrhea, 12 months of amenorrhea, and STRAW guidelines impacts the interpretation. Future studies should incorporate well-established guidelines for menopause measurement. Clinical implications There is a need for coordination between IBD providers and women’s health providers. Early and premature menopause can lead to increased risk of osteoporosis, dementia, cardiovascular disease, and diabetes.5,8,35 Prompt and early identification of those women at risk and counseling them on HT risks and benefits may protect women from these consequences. IBD providers can engage in conversations with their female IBD patients regarding if they are having menstrual-related concerns and/or experiencing menopause symptoms, and make referrals as needed.

Few studies have examined menopause, menopause transition, or HT among those with IBD. Inconclusive results were found for the relationship between menopause and disease activity. No studies reported the impact of IBD on vasomotor symptoms. However, there is a need for continued research on the relationship between IBD disease activity and menopause symptoms to create tailored interventions to improve women’s health in IBD across the lifespan. Supplementary Material Contributor Information Tanvi Kale, Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, United States. Linda Yoo, Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, United States. Ellie Kroeger, Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, United States. Arwa Iqbal, Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, United States. Sunanda Kane, Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Clinic, Mayo Clinic, Rochester, MN, United States. Sara Shihab, Department of Internal Medicine, Division of Women’s Health, Mayo Clinic, Phoenix, AZ, United States. Samantha Conley, Department of Nursing, Division of Nursing Research, Mayo Clinic, Rochester, MN, United States. Kendra Kamp, Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, United States. Supplementary Data Supplementary data is available at Inflammatory Bowel Diseases online. Funding L.Y. is supported by the National Institute of Nursing Research (F31 NR020426). K.K. is funded, in part, by the National Institute of Nursing Research (K23 NR020044). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Conflicts of Interest S.S. has served as a consultant for LASA health. The other authors have no conflicts of interest to disclose. Data Availability Articles used in this review have been cited and data extracted from the articles are in the tables.

- 1. Park J, Jeong GH, Song M, et al. The global, regional, and national burden of inflammatory bowel diseases, 1990–2019: a systematic analysis for the global burden of disease study 2019. Dig Liver Dis. 2023;55:1352-1359. 10.1016/j.dld.2023.04.003 [DOI] [PubMed] [Google Scholar] - 2. Morabia A, Costanza MC. International variability in ages at menarche, first livebirth, and menopause. World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives. Am J Epidemiol. 1998;148:1195-1205. 10.1093/oxfordjournals.aje.a009609 [DOI] [PubMed] [Google Scholar] - 3. InterLACE Study Team. Variations in reproductive events across life: a pooled analysis of data from 505 147 women across 10 countries. Hum Reprod. 2019;34:881-893. 10.1093/humrep/dez015 [DOI] [PMC free article] [PubMed] [Google Scholar] - 4. Harlow SD, Gass M, Hall JE, et al. ; STRAW + 10 Collaborative Group. Executive summary of the stages of reproductive aging workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97:1159-1168. 10.1210/jc.2011-3362 [DOI] [PMC free article] [PubMed] [Google Scholar] - 5. Davis SR, Baber RJ. Treating menopause—MHT and beyond. Nat Rev Endocrinol. 2022;18:490-502. 10.1038/s41574-022-00685-4 [DOI] [PubMed] [Google Scholar] - 6. Santoro N, Epperson CN, Mathews SB. Menopausal symptoms and their management. Endocrinol Metab Clin North Am. 2015;44:497-515. 10.1016/j.ecl.2015.05.001 [DOI] [PMC free article] [PubMed] [Google Scholar] - 7. Santoro N, Roeca C, Peters BA, Neal-Perry G. The menopause transition: signs, symptoms, and management options. J Clin Endocrinol Metab. 2021;106:1-15. 10.1210/clinem/dgaa764 [DOI] [PubMed] [Google Scholar] - 8.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;29:767-794. 10.1097/gme.0000000000002028 [DOI] [PubMed] [Google Scholar] - 9. Meleine M, Matricon J. Gender-related differences in irritable bowel syndrome: potential mechanisms of sex hormones. World J Gastroenterol. 2014;20:6725-6743. 10.3748/wjg.v20.i22.6725 [DOI] [PMC free article] [PubMed] [Google Scholar] - 10. Xu L, Huang G, Cong Y, Yu Y, Li Y. Sex-related differences in inflammatory bowel diseases: the potential role of sex hormones. Inflamm Bowel Dis. 2022;28:1766-1775. 10.1093/ibd/izac094 [DOI] [PubMed] [Google Scholar] - 11. Looijer-van Langen M, Hotte N, Dieleman LA, Albert E, Mulder C, Madsen KL. Estrogen receptor-β signaling modulates epithelial barrier function. Am J Physiol Gastrointest Liver Physiol. 2011;300:G621-G626. 10.1152/ajpgi.00274.2010 [DOI] [PubMed] [Google Scholar] - 12. Coquoz A, Regli D, Stute P. Impact of progesterone on the gastrointestinal tract: a comprehensive literature review. Climacteric. 2022;25:337-361. 10.1080/13697137.2022.2033203 [DOI] [PubMed] [Google Scholar] - 13. Triadafilopoulos G, Finlayson M, Grellet C. Bowel dysfunction in postmenopausal women. Women Health. 1998;27:55-66. 10.1300/J013v27n04_04 [DOI] [PubMed] [Google Scholar] - 14. Infantino M. The prevalence and pattern of gastroesophageal reflux symptoms in perimenopausal and menopausal women. J Am Acad Nurse Pract. 2008;20:266-272. 10.1111/j.1745-7599.2008.00316.x [DOI] [PubMed] [Google Scholar] - 15. Moktan VP, Daoud ND, Tremaine WJ, et al. A cohort study of the age at menopause in female patients with and without inflammatory bowel disease. Crohns Colitis 360. 2022;4:otac027. 10.1093/crocol/otac027 [DOI] [PMC free article] [PubMed] [Google Scholar] - 16. Kärnsund S, Lo B, Bendtsen F, Holm J, Burisch J. Systematic review of the prevalence and development of osteoporosis or low bone mineral density and its risk factors in patients with inflammatory bowel disease. World J Gastroenterol. 2020;26:5362-5374. 10.3748/wjg.v26.i35.5362 [DOI] [PMC free article] [PubMed] [Google Scholar] - 17. Bernstein CN, Leslie WD. Review article: osteoporosis and inflammatory bowel disease. Aliment Pharmacol Ther. 2004;19:941-952. 10.1111/j.1365-2036.2004.01876.x [DOI] [PubMed] [Google Scholar] - 18. Schulte CM. Review article: bone disease in inflammatory bowel disease. Aliment Pharmacol Ther. 2004;20 Suppl 4:43-49. 10.1111/j.1365-2036.2004.02057.x [DOI] [PubMed] [Google Scholar] - 19. National Heart Lung and Blood Institute. Study Quality Assessment Tools 2013. Accessed April 1, 2025. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools - 20. Kirubarajan A, Sohel N, Mayhew A, Griffith LE, Raina P, Shea AK. The association between primary ovarian insufficiency and increased multimorbidity in a large prospective cohort (Canadian Longitudinal Study on Aging). Fertil Steril. 2025;123:289-299. 10.1016/j.fertnstert.2024.08.345 [DOI] [PubMed] [Google Scholar] - 21. Khalili H, Higuchi LM, Ananthakrishnan AN, et al. Hormone therapy increases risk of ulcerative colitis but not Crohn’s disease. Gastroenterology. 2012;143:1199-1206. 10.1053/j.gastro.2012.07.096 [DOI] [PMC free article] [PubMed] [Google Scholar] - 22. Riahi R, Abdi S, Ashtari S, Malekpour H. Evaluating the influence of environmental risk factors on inflammatory bowel diseases: a case-control study. Gastroenterol Hepatol Bed Bench. 2023;16:307-318. 10.22037/ghfbb.v16i2.2576 [DOI] [PMC free article] [PubMed] [Google Scholar] - 23. Tseng YT, Chen II, Wang CH. Association of hormone replacement therapy with inflammatory bowel disease risk in women with menopausal disorders: a population-based retrospective cohort study. Healthcare (Basel). 2025;13:578. 10.3390/healthcare13050578 [DOI] [PMC free article] [PubMed] [Google Scholar] - 24. 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. Q J Med. 1989;72:623-631. [PubMed] [Google Scholar] - 25. Wu JJ, Yakoob J, Norris LA, Keeling PWN. Is the fertile period reduced in patients with inflammatory bowel disease? Ir J Med Sci. 1996;165:35-36. [DOI] [PubMed] [Google Scholar] - 26. Lichtarowicz A, Srivastava E, Norman C, et al. A study of the menopause in women with ulcerative colitis. J Obstet Gynaecol. 1991;11:361-364. [Google Scholar] - 27. Donaldson EK, Huang V, Ross S, Sydora BC. Experience of menopause in women with inflammatory bowel disease: pilot study. Climacteric. 2017;20:545-551. 10.1080/13697137.2017.1360861 [DOI] [PubMed] [Google Scholar] - 28. 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. 10.1093/ibd/izx004 [DOI] [PMC free article] [PubMed] [Google Scholar] - 29. Zutshi M, Hull TL, Hammel J. Crohn’s disease: a patient’s perspective. Int J Colorectal Dis. 2007;22:1437-1444. 10.1007/s00384-007-0332-9 [DOI] [PubMed] [Google Scholar] - 30. Freeman M, Lally L, Teigen L, Graziano E, Shivashankar R, Shmidt E. Hormone replacement therapy is associated with disease activity improvement among post-menopausal women with inflammatory bowel disease. J Clin Med. 2023;13:88. 10.3390/jcm13010088 [DOI] [PMC free article] [PubMed] [Google Scholar] - 31. 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. 10.1111/j.1572-0241.2007.01700.x [DOI] [PubMed] [Google Scholar] - 32. Bar O, Sudhof LS, Yockey LJ, et al. Comparison of vaginal microbiota between women with inflammatory bowel disease and healthy control subjects. PLoS One. 2023;18:e0284709. 10.1371/journal.pone.0284709 [DOI] [PMC free article] [PubMed] [Google Scholar] - 33. Ona S, James K, Ananthakrishnan AN, et al. Association between vulvovaginal discomfort and activity of inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2020;18:604-611.e1. 10.1016/j.cgh.2019.05.018 [DOI] [PubMed] [Google Scholar] - 34. Motta F, Di Simone N, Selmi C. The impact of menopause on autoimmune and rheumatic diseases. Clin Rev Allergy Immunol. 2025;68:32. 10.1007/s12016-025-09031-8 [DOI] [PMC free article] [PubMed] [Google Scholar] - 35. Peycheva D, Sullivan A, Hardy R, Bryson A, Conti G, Ploubidis G. Risk factors for natural menopause before the age of 45: evidence from two British population-based birth cohort studies. BMC Womens Health. 2022;22:438. 10.1186/s12905-022-02021-4 [DOI] [PMC free article] [PubMed] [Google Scholar] - 36. Greywoode R, Larson J, Peraza J, et al. Risk of adverse cardiovascular outcomes in postmenopausal women with inflammatory bowel disease. Dig Dis Sci. 2024;69:2586-2594. 10.1007/s10620-024-08348-2 [DOI] [PMC free article] [PubMed] [Google Scholar] - 37. Ballesio A, Zagaria A, Baccini F, Micheli F, Di Nardo G, Lombardo C. A meta-analysis on sleep quality in inflammatory bowel disease. Sleep Med Rev. 2021;60:101518. 10.1016/j.smrv.2021.101518 [DOI] [PubMed] [Google Scholar] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Supplementary Materials Data Availability Statement Articles used in this review have been cited and data extracted from the articles are in the tables.