Menopause and Ulcerative Colitis: What to Know
Digestive HealthUlcerative Colitis
Explore This Topic

How Does Menopause Affect Ulcerative Colitis?

How Does Menopause Affect Ulcerative Colitis?
iStock
By
Published on September 10, 2025
by
Although more research is needed to understand how menopause may affect ulcerative colitis (UC), some studies suggest the rapid decline of hormones in menopause may worsen UC symptoms for some women.

“There is a significant need for more sex- and gender-specific research in inflammatory bowel disease [IBD], especially examining hormonal transitions like menopause,” says Ekta Gupta, MD, the chief of gastroenterology at the University of Maryland Medical Center in Baltimore. One reason is because menopause and UC have some overlapping symptoms and shared complication risks, including issues with bone, cardiovascular, and mental health.

That’s why it’s so important to take a holistic approach to managing UC during menopause, Dr. Gupta says. “We must listen carefully to women who report symptom changes during perimenopause and menopause, validating their concerns and tailoring care accordingly,” says Gupta.

Here’s what to know about menopause, how it may affect UC, and how to manage both conditions.

What Is Menopause?

Menopause means your periods have stopped for 12 months in a row, signaling the end of your reproductive years.

 The average age of menopause in the United States is 51, but the transition can start anywhere from age 45 to 55 and last for two to eight years.

As you transition into menopause, your ovaries produce fewer hormones like estrogen and progesterone, which can lead to the following symptoms:

How Does Menopause Affect Ulcerative Colitis?

Some people with UC report worsened symptoms during menopause, which improve with estrogen therapy, a form of hormone replacement therapy (HRT), but research hasn’t consistently confirmed this link.

“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.

In addition, menopause and UC symptoms can overlap. These may include bloating, abdominal pain, gas, nausea, indigestion, constipation, and diarrhea.

 “It is often difficult to discern which condition is causing symptoms, and they should be evaluated by a gastroenterologist,” says Adalberto Gonzalez, MD, a gastroenterologist with Cleveland Clinic in Florida.

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

Experts believe hormones like estrogen help manage inflammation in the gastrointestinal tract, and a healthy gut microbiome helps with estrogen metabolism — how your body breaks down the hormone.

“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.

Estrogen plays a big role in how neurotransmitters (brain messengers) function, and declining levels can cause shifting moods.

 Anxiety and depression often accompany both IBD and menopause.

“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

Beyond mental health concerns, menopause and UC share some risks for other medical conditions, including osteoporosis.

 “UC patients, especially those with a history of corticosteroid use or malabsorption, are already at risk of osteoporosis — a risk further amplified by menopause,” says Gupta.

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.

The Takeaway

  • Menopause and ulcerative colitis (UC) can cause similar gastrointestinal symptoms and together may increase the risk for complications like osteoporosis and heart disease.
  • Some treatment add-ons for menopause can help lessen shared symptoms, like vitamin D for bone strength and hormone-replacement therapy (HRT) for hot flashes, although research results on HRT are mixed.
  • You can help keep UC and menopause symptoms at bay with healthy lifestyle habits like exercise, a nutritious diet, getting plenty of sleep, and avoiding alcohol and smoking.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Guo Y et al. Facilitation of Mucosal Healing by Estrogen Receptor β in Ulcerative Colitis Through Suppression of Branched-Chain Amino Acid Transport and Subsequent Triggering of Autophagy in Colonic Epithelial Cells. Acta Pharmaceutica Sinica B. November 26, 2024.
  2. Moktan VP et al. A Cohort Study of the Age at Menopause in Female Patients With and Without Inflammatory Bowel Disease. Crohn's & Colitis 360. August 4, 2022.
  3. What Is Menopause? NIH National Institute on Aging. October 16, 2024.
  4. Menopause. MedlinePlus. September 13, 2024.
  5. Peacock K et al. Menopause. StatPearls. December 21, 2023.
  6. Symptoms & Causes of Crohn’s Disease. National Institute of Diabetes and Digestive and Kidney Diseases. July 2024.
  7. Im E et al. Gastrointestinal Symptoms in Four Major Racial/Ethnic Groups of Midlife Women: Race/Ethnicity and Menopausal Status. Menopause. December 6, 2021.
  8. Rolston VS et al. The Influence of Hormonal Fluctuation on Inflammatory Bowel Disease Symptom Severity—A Cross-Sectional Cohort Study. Inflammatory Bowel Diseases. February 2018.
  9. Freeman M et al. Hormone Replacement Therapy Is Associated with Disease Activity Improvement among Post-Menopausal Women with Inflammatory Bowel Disease. Journal of Clinical Medicine. 2024.
  10. Kim GW et al. Altered Brain Morphology and Functional Connectivity in Postmenopausal Women: Automatic Segmentation of Whole-Brain and Thalamic Subnuclei and Resting-State fMRI. Aging (Albany NY). March 23, 2024.
  11. Hu S et al. Depression and Anxiety Disorders in Patients With Inflammatory Bowel Disease. Frontiers in Psychiatry. October 8, 2021.
  12. Alblooshi S et al. Does Menopause Elevate the Risk for Developing Depression and Anxiety? Results From a Systematic Review. Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists. April 2023.
  13. Nitkin K. Crohn’s and Ulcerative Colitis Pose Special Concerns for Women. Johns Hopkins University. May 11, 2020.
  14. Ryczkowska K et al. Menopause and Women’s Cardiovascular Health: Is It Really an Obvious Relationship? Archives of Medical Science. December 10, 2022.
  15. Biondi RB et al. Cardiovascular Risk in Individuals with Inflammatory Bowel Disease. Clinical and Experimental Gastroenterology. April 24, 2020.
  16. Fasero M et al. Cardiovascular Disease Risk in Women with Menopause. Journal of Clinical Medicine. May 23, 2025.
  17. Exercise for Your Bone Health. National Institute of Arthritis and Musculoskeletal and Skin Diseases. May 2023.
  18. Axelrad JE et al. Hormone Therapy for Cancer is a Risk Factor for Relapse of Inflammatory Bowel Diseases. Clinical Gastroenterology and Hepatology. 2021.
  19. Tseng YT et al. Association of Hormone Replacement Therapy with Inflammatory Bowel Disease Risk in Women with Menopausal Disorders: A Population-Based Retrospective Cohort Study. Healthcare. 2025.
  20. Peifer R. IBD Risk Factors: What Causes Crohn’s & Colitis? Crohn’s & Colitis Foundation. July 21, 2025.
  21. Lifestyle Changes for Menopause. NYU Langone Health.
Meet Our Experts
See Our Editorial PolicyMeet Our Health Expert Network

Yuying Luo, MD

Medical Reviewer

Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.

Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.

She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.

See full bio

Abby McCoy, RN

Author

Abby McCoy is an experienced registered nurse who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She is a married mother of four and loves the circus — that is her home! She has family all over the world, and loves to travel as much as possible.

McCoy has written for publications like Remedy Health Media, Sleepopolis, and Expectful. She is passionate about health education and loves using her experience and knowledge in her writing.

See full bio
See Our Editorial PolicyMeet Our Health Expert Network