General Conclusions:General Conclusions:Special Considerations for Special Considerations for

Women With IBDWomen With IBD

Women have more severe symptoms, more disease Women have more severe symptoms, more disease concerns than menconcerns than men

Menstrual symptoms may be more severeMenstrual symptoms may be more severe

OCs may be related to disease-activity flaresOCs may be related to disease-activity flares

IPAA improvement may be accompanied by feelings IPAA improvement may be accompanied by feelings of decreased attractivenessof decreased attractiveness

Most women experience postoperative improvement Most women experience postoperative improvement in sexual activityin sexual activity

General Conclusions:General Conclusions:Special Considerations for Special Considerations for Women With IBD (cont’d)Women With IBD (cont’d)

FertilityFertility

– Normal or near normal Normal or near normal in UCin UC

– May be affected in CDMay be affected in CD

– IPAA reduces fertilityIPAA reduces fertility

– Voluntary Voluntary childlessness makes childlessness makes data difficult to data difficult to interpretinterpret

PregnancyPregnancy

– IBD has minimal effect on IBD has minimal effect on pregnancy outcomespregnancy outcomes

– Conception during Conception during remission preferableremission preferable

– Some IBD drugs safe in Some IBD drugs safe in pregnancy and breast- pregnancy and breast- feedingfeeding

– Disease activity is greater Disease activity is greater threat to pregnancy than threat to pregnancy than treatment treatment

General Conclusions:General Conclusions:Special Considerations for Special Considerations for Women With IBD (cont’d)Women With IBD (cont’d)

MenopauseMenopause

– Bone loss, especially Bone loss, especially in CD, is greatest risk, in CD, is greatest risk, leads to osteoporosisleads to osteoporosis

– Cardiovascular risk Cardiovascular risk increases, equal to increases, equal to risk in men by age 75risk in men by age 75

– Benefits of HRT are Benefits of HRT are increasingly increasingly questioned as risks questioned as risks are observedare observed

OsteoporosisOsteoporosis

– Common in Common in postmenopausal women, postmenopausal women, aggravated by CD and aggravated by CD and steroid therapysteroid therapy

– Active plan to prevent bone Active plan to prevent bone loss and osteoporosis is loss and osteoporosis is vitalvital

– Nonsteroidal IBD drugsNonsteroidal IBD drugs

– Treatment options to Treatment options to preserve bone masspreserve bone mass

General Conclusions: General Conclusions: Special Considerations forSpecial Considerations forWomen With IBD (cont’d)Women With IBD (cont’d)

Adherence improves outcomes; nonadherence Adherence improves outcomes; nonadherence leads to relapseleads to relapse

Patient must understand nature of disease, goals Patient must understand nature of disease, goals of treatmentof treatment

Treatment plan tailored to patient’s life and needsTreatment plan tailored to patient’s life and needs

Adherence improved by good physician-patient Adherence improved by good physician-patient communicationcommunication