Crohn’s disease. Ulcerative colitis. They are the most common chronic inflammatory diseases of the intestine. And unfortunately, given that they occur mainly at a young age, between the ages of 20 and 40, they can also have an impact on the reproductive well-being of women. They focused on these aspects at the conference “The female universe in IBD”, held in Padua.
Scholars have confirmed that these pathologies impact women’s life from a young age, and have pointed out the importance of raising awareness of medicine, but also of the population, to grasp the first signs of these diseases to promote early diagnosis and to be able to control them better.
Impact on fertility, pregnancy and lactation
These pathologies are still not very widespread. But they are there, and how. “In Italy we have about 250,000 patients affected by it, with an equal distribution between men and women, and a prevalence of about 0.3 percent of the population – reports Fabiana Castiglione, Associate Professor of Gastroenterology, Director of the UOSD Advanced Therapies of chronic inflammatory bowel diseases – University of Naples Federico II.
Ma their impact, especially on women, it can be very important. Not only because in recent decades there has been a strong increase in the incidence of these diseases in general, but above all because their peak incidence is among the 15 and 40-45 years, therefore precisely in the reproductive age of the woman “. Hence, often, the concern that they may negatively affect fertility, pregnancy, the health of the fetus, breastfeeding.
Many fears that need to be addressed, even in the dialogue between doctor and patient, because – and this is the news – therapies and their correct management can allow the patient who is affected by them to live the various phases of her life as a woman without worry. . In fact, we are faced with chronic pathologies, which can also impact the sexual sphere of women, with difficulties that can be related to the phases of disease activity, psychological factors, and perianal disease.
“The impact is significant, on the one hand for therapies that may require immunosuppressive and biological drugs, and on the other because surgery is often required, especially in the case of Crohn’s disease, with interventions, even at a young age, which concern the abdominal-pelvic area, impacting on fundamental aspects, such as fertility, both on a psychological and anatomical level – points out Castiglione ”.
Medicines and surgery
Surgery it is certainly one of the elements that has the most impact, but there are many factors linked to these pathologies that can affect a woman’s reproductive life. First, the fact of having a chronic disease and the fear of passing the disease on to children. And here is a first important point to dispel: “These diseases are not hereditary: there is a familiarity, which means that in a family there may be a greater risk of contracting them than in the general population, but they are not hereditary diseases – underlines Castiglione. This is a fear that, with adequate counseling, can be eliminated “.
The second important fear that patients have – perhaps the most deeply rooted one – is related to pharmacological therapy and the effect of drugs used for IBD on pregnancy. And on this front, experts report that most of the drugs that are used are absolutely safe during pregnancy and even during breastfeeding. Obviously, case by case, it is necessary to take stock with the doctors who are following the woman, but remembering that the management of drug therapy and the pathology is a fundamental key with respect to various phases and aspects of a woman’s life.
This is true as mentioned for pregnancy, but also for the condition of fertility, with respect to which researches say that there is indeed a reduction, which is however mainly related to the phases of activity of the disease. And here too the message is that if the disease is well controlled, this can have a favorable effect, even with respect to fertility. And this pharmacologically correct management is also useful as age advances and arrives menopause and aging.
“Some drugs, such as cortisone, are extremely active, in the sense that they have an anti-inflammatory power that is expressed quickly and extremely effectively – explains Castiglione. However, cortisone should only be used in the acute phases, and only, in general, in a first phase of the disease, to give way then, in subsequent phases of exacerbation, to drugs that do not have the side effects of cortisone in the long term. This is very important because for example osteoporosis, which generally tends to occur in menopausal women, can be accentuated by prolonged steroid therapy. And precisely for this reason it is important to manage the disease correctly from a pharmacological point of view. Biological drugs help us to avoid dependence on cortisone, thus not prolonging therapies that condition situations in which already at a physiological level there is an increased risk of osteoporosis for women “.