“Higher levels during the reproductive years are thought to offer some protective effect against flares. However, nothing can be conclusively established with available evidence, and we may need additional studies to further investigate,” says Gupta.
Women With UC May Experience Menopause Earlier
Some evidence suggests menopause may take place earlier in women with UC than those without UC, though more studies are needed to confirm this. One small study of 171 women found that those with IBD completed menopause at age 50, on average, while those without IBD reached the same milestone about a year and a half later.
Whether this affects UC symptoms isn’t fully clear. “Some women report a worsening of symptoms postmenopause, while others experience improvement or no change,” says Gupta.
Estrogen May Influence How Your Intestines Function
“The relationship between estrogen and ulcerative colitis is complex and not fully understood,” says Asma Khapra, MD, a gastroenterologist in Fairfax, Virginia. Estrogen acts through various receptors in the gut, influencing intestinal inflammation, the epithelial barrier, and the immune system. “Depending on how it interacts, estrogen can have both positive and negative effects,” says Dr. Khapra.
But evidence remains mixed, says Gupta. Some studies suggest a slight increase in UC symptom risk postmenopause, while others find no significant effect. The impact likely varies based on individual factors including genetic predisposition, disease severity, and hormone receptor sensitivity, says Gupta.
Menopause May Worsen Mental Health in People With Ulcerative Colitis
“Menopause-related changes in sleep, stress levels, and metabolism can indirectly affect disease activity and quality of life in women with UC, being part of the brain-gut connection as well,” says Gupta.
“Supportive care, including psychological counseling or referral to women’s health specialists, is key in managing both the health conditions with a wholesome integrated approach,” says Gupta.
Ulcerative Colitis and Menopause Can Both Affect Bone and Heart Health
Both menopause and UC also increase the risk of heart disease. Chronic inflammation from UC can be hard on blood vessels, and during the menopausal transition, cholesterol increases, which can add to the risk for heart issues.
Does Ulcerative Colitis Treatment Change During Menopause?
Core treatments for UC, like medication, don’t change with menopause, but additional treatments may be added to address bone health and potential hormone replacement, says Gupta. “[For strong bones,] I recommend DEXA scans (bone imaging), ensuring adequate calcium, vitamin D supplementation, and strength training exercise,” says Gupta.
Some people choose to try hormone replacement therapy to boost their estrogen levels postmenopause, but this treatment has conflicting evidence regarding its effect on UC, says Dr. Gonzalez. “However, HRT does seem to decrease the risk of colorectal cancer, which women with UC are at increased risk for,” notes Gonzalez.
Some studies have shown improved UC symptoms with HRT, while others suggest this therapy could increase the risk for UC relapse. “If considered, HRT should be discussed collaboratively with gynecology,” says Gupta. “The benefits and risks should be assessed on a case-by-case basis and need to be individualized.”
Lifestyle Changes May Help Manage Ulcerative Colitis and Menopause
No matter your menopause status, Gonzalez recommends making protective lifestyle changes for UC, like limiting or avoiding nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and maintaining a healthy weight.
“I advise following a healthy Mediterranean diet, exercising regularly (especially strength training), getting adequate sleep, and managing stress — all of which are important during menopause,” says Khapra, who also recommends getting plenty of protein to help prevent muscle loss.
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