My Monthly Trigger: PMS and Crohn’s Disease

My Monthly Trigger: PMS and Crohn’s Disease
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This week, I’ve felt like I’m in my personal version of the 2002 movie “28 Days Later,” an apocalyptic zombie thriller centered around an incurable, rage-inducing virus that spreads across the land.

Instead of my normally laid-back and patient demeanor, I’ve been in a foul mood all week. I’ve lashed out at the people who love me, and I’ve broken down in tears twice.

The isolation caused by COVID-19 isn’t bringing me down. As an introvert, I relish the fact that I don’t have to interact with a lot of people. I have a valid excuse to be antisocial and not leave the house.

I’m frustrated because I have to rely on my sister to buy my groceries. I have to scold my asthmatic mother for risking her health by going to the store and then coming to my house to share her bounty. I’m constantly nagging my husband to wash and sanitize his hands, because he still has to go to work and eats out for lunch. I’m “hangry” because I’m trying to lose weight so I don’t get fatty liver disease, and I go to bed each night with a growling stomach.

My 28 days isn’t the number of days the pandemic has wreaked havoc. My 28 days is my menstrual cycle. It’s making me hormonal and causing mood swings. Being premenstrual on top of the added stress has me on the verge of a flare. I can’t afford to be sick in the middle of a pandemic, when toilet paper is scarce.

I realized my menstrual cycle affected my Crohn’s early on in my diagnosis. In addition to keeping a journal to figure out my dietary triggers, I kept track of my activities and overall health when my symptoms were severe.

After the first few months of keeping a Crohn’s diary, I noticed that, like clockwork, my diarrhea and abdominal pain worsened the week leading up to my period. I mentioned this to both my gynecologist and gastroenterologist, who confirmed this was common in women with inflammatory bowel disease (IBD).

IBD and menses: The connection

Research has shown that female IBD patients experience more noticeable gastrointestinal symptoms during menses. Researchers believe the higher incidence of symptoms is related to fluctuations in prostaglandin levels.

An injury to the body or illness causes a chemical reaction that produces prostaglandins. This, in turn, triggers an inflammatory response as part of the healing process. High levels of prostaglandins can cause acute or chronic inflammation.

In women, prostaglandins stimulate ovulation and cause the muscles in the uterus to contract. Uterine contractions are necessary for giving birth as well as shedding the endometrium — the lining of the uterus — during menstruation. Furthermore, the uterine cavity releases an excess of a certain prostaglandin subtype that increases smooth muscle contractions in the colon. These contractions can lead to urgency and frequent bowel movements.

In the study, both the IBD patients and a non-IBD control group reported changes in their bowel habits leading up to and during menses. However, IBD patients experienced greater abdominal pain, more bowel movements, and frequent diarrhea compared to the control group. A higher number of IBD patients also experienced the premenstrual symptoms of headaches, anxiety, breast tenderness, and depression compared to their counterparts.

This explains my current mood and physical state. It’s a perfect storm. I’m premenstrual. I’m trying to control my building stress and anxiety. I’m fending off a flare as I watch my supply of toilet paper dwindle down.

The bright side is that this too shall pass — at least until next month.

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Note: IBD News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of IBD News Today, or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to IBD.

Emmeline is a 47-year-old Crohn’s warrior and primary sclerosing cholangitis survivor. Her column encourages patients and caregivers to advocate for better healthcare and educates readers about her rare autoimmune diseases. She also freelances as a communication specialist, offering writing, editing, and graphic design services. Emmeline (an Auburn fan) and her husband Patrick (an Alabama fan) enjoy watching SEC football and spending time with loved ones in Austin, Texas. Thanks to a liver transplant in 2017, Emmeline is training for her third-degree black belt in the Korean martial art Mu Sool Won.
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Grace Frank worked as a copy editor, city editor, reporter and news designer for leading American newspapers, including The New York Times and The International Herald Tribune, for many years. She has won numerous journalism awards, and was nominated for a Pulitzer Prize for an investigative series into eye surgeries wrongly conducted outside a clinical trial.
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Emmeline is a 47-year-old Crohn’s warrior and primary sclerosing cholangitis survivor. Her column encourages patients and caregivers to advocate for better healthcare and educates readers about her rare autoimmune diseases. She also freelances as a communication specialist, offering writing, editing, and graphic design services. Emmeline (an Auburn fan) and her husband Patrick (an Alabama fan) enjoy watching SEC football and spending time with loved ones in Austin, Texas. Thanks to a liver transplant in 2017, Emmeline is training for her third-degree black belt in the Korean martial art Mu Sool Won.

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