Crohn's Disease Symptoms in Females: What You Need to Know

The curious thing about an autoimmune disease is that it doesn’t look the same on everyone. Crohn’s disease symptoms in females can differ from males, affecting their well-being when living with the disease and impacting future health risks. And while the standard treatment for Crohn’s is medication, there’s good evidence that taking a functional medicine approach to treatment can improve inflammation in the disease and help you live a healthier, fuller life.

Crohn’s disease symptoms in those assigned female at birth are similar to those assigned male at birth. However, the disease can affect females in key ways due to hormonal influences, gynecological complications, influences on fertility, and impact on bone health.

A disease where there is chronic inflammation in the gastrointestinal tract, Crohn’s affects about one million people in the U.S. Along with ulcerative colitis, Crohn’s is one of two of the main types of inflammatory bowel disease (IBD).

The disease can affect any part of your digestive tract, from your mouth to your anus, but it most often affects your small intestine and the beginning portion of your large intestine, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Note that IBD is different from irritable bowel syndrome, or IBS, another condition that causes GI symptoms but does not cause damage to the GI tract.

Considered an autoimmune disorder, Crohn’s disease moves through flares (periods of increased disease activity/inflammation and symptoms) and remission (where the disease has quieted down) that greatly affect quality of life. Flares, for example, can cause severe GI symptoms, as well as fatigue, stress, and disruptions in daily life and social relationships. Ahead, you’ll find info on how to fight those flares, plus lifestyle strategies that keep symptoms at bay.

Common symptoms of Crohn’s disease

While we think of Crohn’s as a digestive condition, it causes symptoms in other parts of the body, too. Everyone who experiences Crohn’s will do so in their unique way, but here are some common symptoms:

Digestive symptoms

Due to GI tract inflammation, according to the Crohn’s & Colitis Foundation, symptoms can include:

• Abdominal cramping and pain
• Constipation
• Diarrhea
• Rectal bleeding
• The sensation of having an incomplete bowel movement
• Urgency to have a bowel movement

Non-digestive symptoms

Crohn’s also affects other parts of the body, and up to half of people with IBD may have what’s called “extra-intestinal manifestations” (not to be confused with extraterrestrial manifestations). While the majority of patients have one, more than one-third have two or more. In fact, research suggests that those assigned female more commonly experience extraintestinal manifestations, especially arthritis, erythema nodosum (a condition featuring red, tender bumps under the skin), and manifestations related to the eyes, says Elena Ivanina, DO, a triple board-certified integrative gastroenterologist and founder of the Center for Integrative Gut Health. Overall, here’s what can occur:

• Anemia
• Eye inflammation
• Fatigue
• Fever
• Joint pain and inflammation
• Kidney stones
• Liver inflammation and damage
• Low bone density
• Oral lesions
• Pain
• Skin inflammation
• Weight loss

Crohn’s disease in women vs. men

Although the symptoms of Crohn’s disease are similar between men and women, the disease can affect those assigned female at birth in unique ways, with specific hormonal, gynecological, bone, and cancer risks.

Hormonal influences

“Hormone fluctuations are associated with IBD flares and changes in disease activity,” says Ivanina. Crohn’s may be appearing at earlier ages: “There is also a shift to female predominance of Crohn’s in Western countries around puberty, which may be related to sex hormone-dependent mechanisms,” she says.

If you are menstruating, your periods might be irregular and your Crohn’s symptoms might worsen before or during your period. “A large survey of female patients found that over half of women with IBD had worsening symptoms around their menses,” says Ivanina. Interestingly, symptoms of Crohn’s may improve during pregnancy for half of pregnant people, that same survey found. Differing intensity of symptoms during the month or life stage may be due to hormonal fluctuations.

Gynecological and reproductive symptoms

There are specific complications for individuals born female who have Crohn’s. One of those is genital fistulas. A fistula is an abnormal passageway that develops between two tissues or organs. Genital fistulas can form between the rectum and vagina (rectovaginal), anal canal and vagina (anovaginal), or vagina and small intestine (enterovaginal) for example. Depending on where the fistula is located, you can have symptoms like vaginal discharge of stool or gas.

In addition, there is a link between IBD and endometriosis, research shows. Complicating matters is that the two conditions can share symptoms like abdominal pain, irregular periods, diarrhea, and constipation. This can lead to receiving the wrong diagnosis. Since you can have both conditions at once, a diagnosis of endometriosis, for example, may be missed entirely.

Finally, research also finds that women with Crohn’s may have reduced fertility and birth rate, with more severe disease having a greater impact on reproductive health, according to the Journal of Crohn’s and Colitis. Inflammation can play a role in decreasing fertility, but women with Crohn’s may be having fewer children because they engage in sexual activity less (symptoms of Crohn’s can lower one’s libido). They may also simply choose not to have children (or to have fewer) out of factors like fear of worsening symptoms, passing IBD onto their children, or worry about their ability to take care of children.

According to the Crohn’s & Colitis Foundation, if you are planning a pregnancy, getting pregnant during remission is ideal, since pregnancy during active disease may make symptoms worse. From a functional medicine perspective, clinicians also recommend improving your gut health prior to pregnancy. This is important for everyone, but especially if you have Crohn’s. Because being pregnant with Crohn’s is associated with some complications for both the pregnant person and the baby, such as gestational diabetes and preterm delivery, you ‘ll want to optimize your health as much as possible before pregnancy.

Higher risk for osteoporosis and colon cancer

If you are a woman with Crohn’s, it’s also important to have your eye on potentials for chronic disease in the future. Females are already at a higher risk for developing osteoporosis (low bone mass) and bone fracture. Having Crohn’s increases that risk further due to inflammation, possible steroid use, and nutrient deficiencies that are common in the disease.

In addition, colorectal cancer is the fourth leading cause of cancer death in females. Unfortunately, the inflammation in Crohn’s disease also makes you more likely to develop this cancer. The American Gastroenterology Association recommends getting a colonoscopy eight to 10 years after an IBD diagnosis if your disease affects your colon. Talk to your doctor about when you should start colorectal cancer screenings.

When to seek medical attention

It can take longer for women to get a diagnosis of Crohn’s disease compared to men, whose disease is diagnosed in 4.5 months on average. For women, it takes longer than a year on average to get a Crohn’s diagnosis, according to a study published in 2023 in Inflammatory Bowel Diseases. So, if you’re experiencing persistent digestive issues like diarrhea, constipation, abdominal pain, bowel urgency, or other symptoms like fatigue, arthritis, unexplained weight loss, or general pain, make an appointment with a clinician. If you are diagnosed with Crohn’s, there are good lifestyle changes and medical treatments that can help you get control of the disease and feel better.

Causes and risk factors of Crohn’s Disease

Autoimmune diseases are multifaceted in nature and the result of a combination of the following, according to the NIDDK:

• Immune system dysregulation. Autoimmune disease is where the immune system overreacts and attacks its own tissues. In Crohn’s, it is the gastrointestinal tract that’s damaged.
• Environmental triggers, such as smoking, poor dietary habits, living in an urban environment, and living in a Northern climate.
• Genetics, since Crohn’s, IBD, and autoimmune disease can run in families. Crohn’s may also be more prevalent in those who are of eastern European descent.
• Changes to the gut microbiome that affect the immune system and inflammation.

Diagnosis and testing

If your clinician suspects Crohn’s disease, you’ll have a combination of a doctor's exam and testing to confirm (or rule out) IBD. Here’s what you might expect:

• A doctor-patient chat: This is where you’ll talk about your symptoms (including what they are, how long they’ve been going on, and if anything makes them better or worse), as well as your medical and family history. Has anyone else in your family been diagnosed with Crohn's, IBD, or another autoimmune disease?
• A physical exam: Your doctor might physically touch and listen to your abdomen and take your weight and vital signs.
• Lab testing: Blood or stool tests may be used to look for inflammatory markers.
• Diagnostic procedures: Doctors will recommend an upper endoscopy (to look at the upper part of your GI system) or a colonoscopy (to look at your large intestine). A camera endoscopy may also be used, which involves swallowing a tiny camera, as this can reach areas of the intestines an endoscopy or colonoscopy can’t.
• Biopsy: If there is evidence of inflammation, a doctor can take a biopsy of the tissue.
• Imaging tests: Imaging scans like a CT scan or MRI may be needed to create images of what’s going on in the GI tract.

Treatment and Management of Crohn’s Disease

Honestly, this is where things start looking up because you have many options for treatment, including shifts to your eating, activity, and mental health habits that make a difference.  It can take a while to get to the right treatment plan for you, which often involves medical care plus lifestyle adjustments. If necessary, surgical treatment may also be recommended.

Early research suggests that a functional medicine “whole body” approach can benefit your health and wellness as you live with IBD, research in Crohn’s & Colitis 360 shows. Addressing your needs for nutrition, sleep, stress, exercise, and social connections will improve your well-being. “We know that IBD causes other symptoms outside of what most would consider ‘GI symptoms,’” says gastroenterologist Thomas Strobel, MD, one of the authors on that research. “Fatigue is a notoriously difficult symptom to treat in patients with IBD. High-quality sleep regulates cardiovascular and endocrine function, promotes healthy digestion, and reduces stress. Stress is important because we know that stress can actually trigger IBD flares by stimulating the release of neurotransmitters, fueling immune dysregulation, and exacerbating GI symptoms.”

So, beyond medications, here’s a list of things you can start doing today to improve your health and help manage your symptoms.

Medications

Some medical providers may be quick to jump to a medication-only plan, whereas a functional medicine provider will take a whole-body approach to assess your treatment needs. For many people, medications are recommended for their Crohn’s disease. These medications can reduce inflammation, allowing your GI tract to heal and reduce or eliminate symptoms. The goal is to put your disease into remission and help you stay there. Several types of medications are used in Crohn’s disease treatments, according to the Crohn’s & Colitis Foundation, including:

• Aminosalicylates like mesalamine, which reduce intestinal inflammation.
• Corticosteroids like prednisone, which are steroids that are used short-term to bring down inflammation quickly.
• Immunomodulators like azathioprine (Azasan), which suppress the immune system to turn down inflammation.
• Antibiotics, which are used to treat infections.
• Biologics like adalimumab (Humira), which are antibodies that target specific inflammatory proteins in the body.
• Targeted synthetic small molecules like upadacitinib (Rinvoq), which are used for moderate-to-severe disease and target parts of the immune system to decrease inflammation.

Each of these has their risks and benefits, so be sure to have a clear understanding of what is recommended for you, why, and what you can expect while taking it. Some of these medications can also take several months to work, which is why lifestyle adjustments, no matter if or what medication you’re taking, are so important.

Lifestyle adjustments

From a functional medicine perspective, the following holistic approach is needed to best care for Crohn’s, says Ivanina:

• Optimize nutrition, which may include nutritional testing and supplementation.
• Improve lifestyle habits, such as exercising, avoiding smoking, and prioritizing sleep.
• Manage stress, which can include practices such as yoga, mindfulness/meditation, or gut-directed hypnotherapy.
• Explore mental health therapy, such as cognitive behavioral therapy (CBT).
• Pursue microbiome optimization, such as taking prebiotics, probiotics, or postbiotics.
• Consider herbs and supplements like curcumin/turmeric, which can help with inflammation.

Dietary changes

“Diet plays a really big role in Crohn’s disease management. We’ve learned a lot about this with good, solid research from the last 10 years,” says Sophie Dolan, RD, a registered dietitian who specializes in GI conditions, including Crohn’s. The goal with nutritional therapy is to decrease inflammation, lessen symptoms, and ensure adequate nutrition, she says. “As always, nutrition is extremely individualized and personalized.”

Because people find that eating itself is connected to their symptoms, it’s common to see a lot of dietary restrictions in hopes of feeling better, but food avoidance can cause malnutrition. Sometimes, elimination diets are recommended to pinpoint individual food triggers, but it’s best to meet with a dietitian, ideally one specializing in GI health, to do this safely and effectively, says Dolan.

Another tenet of dietary management in Crohn’s is eating a diet with as much variety of foods as possible, which not only gets you more access to foods high in nutrition and fiber to benefit your overall and gut health, but can also make eating more enjoyable. Dolan recommends focusing on whole foods as much as possible, limiting highly processed products, and improving the digestibility of plant foods by cooking them well or blending. (Try eating stews and curries or making a smoothie.) Eating a variety of plant foods also benefits your gut microbiome, the ecosystem in your intestines of live bacteria, viruses, and other pathogens, which is related to inflammation in Crohn’s.

Surgical treatments

Surgery may be recommended to address complications of Crohn’s disease, such as fistulas, abscesses (a pocket of pus), or obstructions (an intestinal blockage). You may have surgery to remove part of your small or large intestine, depending on where the problem is located. In certain situations, surgery to remove the entire colon and rectum (proctocolectomy) or ileostomy (a surgical procedure that creates a pouch to collect waste from your body) may be needed if other treatments have been ineffective.

Complications and related conditions

Crohn’s disease is a chronic illness that affects your entire body. Unfortunately, females with IBD also tend to have a worse quality of life, more psychological distress, and reduced sexual activity compared to males with the disease, says a review in the Journal of Personalized Medicine. This is due, in part, to the many possible complications and other related diseases you can experience with Crohn’s:

• Fistulas, abscesses, obstructions
• Reduced fertility
• Increased symptoms in pregnancy if your disease is not well controlled prior to conception
• Potential links with reproductive conditions like endometriosis
• Increased and more severe Crohn’s disease symptoms around menstruation
• Higher risk of osteoporosis and colorectal cancer. (Make sure you receive specific guidance from your clinician for when to begin screenings.)
• Increased side effects from drug therapy compared to males

Living with Crohn’s disease as a woman

With unique challenges (hello, hormones), living with Crohn’s disease can be a real struggle sometimes. There’s often uncertainty and even shame and stigma about what you can or cannot control about your health. But it is possible to get back to a place of feeling good.

“People with Crohn’s disease live long fulfilling and successful lives,” says Ivanina. “As long as you are getting regular care with a gastroenterologist who is monitoring your nutrition, complications, and flares, and assessing cancer risk and implementing preventive protocols, then you are on top of it,” says Ivanina.

Managing symptoms daily

Identifying symptom triggers, whether that’s specific foods, monthly hormonal changes, or lifestyle challenges like stress will help you create a plan to mitigate their impact on your health.

In addition, how you eat can also be as important as what you eat. Dolan recommends eating regularly every three to five hours, which helps manage hunger to decrease the likelihood of overeating (something that can trigger GI discomfort) slowing down the eating rate, and chewing slowly with mindful eating to improve digestion.

Emotional and mental health support

Clinicians must examine the root cause of your Crohn’s disease. “The root cause is so often removed from the process, but that’s important to consider for effective treatment,” says Alexandra Shustina, DO, an integrative board-certified gastroenterologist. She often asks patients what was going on in their lives right before a diagnosis, and often finds there was a significant life stressor, such as a divorce or death of a family member. Honoring the mind-body connection by treating stress and trauma can significantly affect the course of your disease, she says.

Even if you don’t have a significant trauma, your clinician should screen you for depression and anxiety, since these disorders are incredibly common among people with IBD, suggests research in Frontiers in Psychiatry. Therapy, support groups, and other mental health support will be an invaluable tool in managing Crohn’s disease.

Support and advocacy

Support comes from both doctors and community resources. “Talking about bowel movements is not super comfortable. But I’d love for that to be more normalized. Working with providers who have experience in GI health can improve outcomes and quality of life when you have Crohn’s,” says Dolan. In addition to finding a provider that you trust and can be open with, know that there is a larger Crohn’s and IBD community you can connect with, too. Look at resources like those offered at the Crohn’s & Colitis Foundation to identify community and support groups that are right for you.

Frequently Asked Questions (FAQs)

What are the early warning signs of Crohn's?

The three most common symptoms of Crohn’s to be on the lookout for are diarrhea, abdominal cramping and pain, and weight loss.

What is the life expectancy of someone with Crohn's disease?

Fortunately, you can have the same life expectancy as someone who does not have Crohn’s disease.

What is the best thing to do for Crohn's disease?

Work with your clinician to create a comprehensive plan that treats you as a whole. Treatment may include medication, but it should also focus on healthy lifestyle habits, including diet, exercise, sleep, and stress management, all of which will help decrease inflammation and improve your quality of life.

What can be mistaken for Crohn's disease?

Certain GI conditions, especially irritable bowel syndrome and celiac disease, can be mistaken for IBD since they can have overlapping symptoms. In addition, diverticulitis, other autoimmune conditions, viral, bacterial, fungal, and parasitic infections, and certain cancers can mimic the symptoms of Crohn’s.

Can you live a normal life with Crohn's disease?

Absolutely. Living with a chronic disease can be really tough, but people go on to live really rich, full, and healthy lives with Crohn’s disease.

Conclusion

If you’re female and have symptoms of Crohn’s disease, including gastrointestinal changes, unexplained weight loss, relentless fatigue, joint pain and inflammation, or any other perplexing symptom, see a clinician for a thorough workup. If you are diagnosed with Crohn’s, talk to your clinician about how your hormones may affect your symptoms, how Crohn’s may affect a pregnancy, and the future health threats to have on your radar. While medication is the right treatment for many females, experts stress the importance of viewing your body and mind as a whole through functional treatment for Crohn’s. That means optimizing nutrient intake through the proper diet, improving sleep habits, finding stress reduction strategies that work for you, and practicing regular physical activity. Working with a clinician  like one at Parsley Health who understands these pillars of well-being and can tailor them in a targeted treatment plan for your Crohn’s disease will help you live well in light of your diagnosis.

Key Takeaways

• Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract.
• Typical symptoms can include diarrhea/constipation, abdominal pain, and weight loss. Extraintestinal symptoms, like fatigue, pain, arthritis, and eye and skin manifestations may be more prevalent in females who have Crohn’s.
• Females and other menstruating people who have Crohn’s may experience worsening of symptoms around their period. The condition can also increase the risk of pregnancy complications, as well as certain diseases that those assigned female at birth may be predisposed to, such as osteoporosis.
• Effective treatment requires a whole-body approach. While medications or even surgery may be recommended in some cases, lifestyle measures like sleep, stress management, proper diet and eating habits, and physical activity can reduce inflammation in the disease and lower the risk of flares while improving energy and a sense of well-being.