The reality is, celiac disease and women’s health are heavily connected. And with 60-70% of the celiac population being women, it’s important we talk about the impacts of celiac disease and women’s health.
A quick note for my non-binary and transitioned celiac friends, this post applies to the health of those assigned female at birth (AFAB) too.
First, before we talk about the connection between celiac disease and women’s health (and the health of those assigned female at birth), a quick primer on what celiac disease is. Celiac disease is an autoimmune disease that causes an abnormal immune response when gluten is eaten.
This immune response to gluten causes damage to the small intestine and a wide-array of symptoms (learn about unusual symptoms of celiac here). Symptoms like nutrient deficiencies, headaches, bloating, diarrhea, constipation, fatigue, and brain fog.
To protect the body from this damaging response to gluten, celiacs need to follow a strict gluten-free diet.
As we discuss AFAB and women’s health with celiac disease, it’s important we understand how celiac disease can impact the health of those who were assigned female at birth.
According to current data, women are diagnosed with celiac disease more often than men, with about 60-70% of total diagnoses in most populations being female or AFAB.
While there are many similarities in celiac symptoms between the sexes, it can be different depending on the individual due to the genetic variations of autoimmune diseases, especially compared between males and females.
In fact, a study done by Jansson-Knodell and others, results showed that symptoms were more unalike than alike in males and females who had celiac disease. Those assigned female at birth were shown to have more cases of constipation, bloating, hyperthyroidism, and anemia than their male counterparts.
Common symptoms that present in those who were AFAB are:
These are the symptoms that can raise red flags for doctors to suspect and test for celiac disease in those who ovulate.
Other symptoms that are not as well-known but can still be complications of celiac disease in those AFAB are:
And while a lot of these symptoms can be present in both sexes, in this context their are either more prevalent or are relevant to the conversation of health for those with a uterus.
Now that we understand the impact of celiac on women and those assigned female at birth, let’s quickly get on the same page on what I mean by women’s health.
Women’s health is the sector of medicine that deals only with the health, diagnoses, diseases, and conditions that pertain to those with a uterus. Some of the specific sectors of women’s health include:
Essentially, women’s health applies to that of which specifically impacts those who’s anatomy include a uterus. However, the term women’s health excludes those who need the care but do not identify as women.
Celiac disease affects women’s health and the health of those assigned female at birth, because nutrition is directly tied to our hormones. This in turn can impact a woman’s fertility, period, bone health, menopause status, and more.
Nutrition for celiac disease and women (and those AFAB) is so important to the optimal functioning of our endocrine and reproductive systems. These systems are where the production of many vital hormones takes place.
Specific nutrients can impact the production, release, and efficacy of many hormones such as the relationship of selenium and iodine to thyroid health.
Varying levels of nutrients, ranging from inadequate to excess amounts, can impact your hormonal health and, thus, your overall health. This can be a major issue as it relates to celiac disease because going gluten-free can cause imbalances in our diet.
For example, removing gluten from the diet initially and without proper guidance can eliminate food groups that contain nutrients essential for optimal hormone production and function.
Additionally, consistent “glutening” can damage your gut lining and prevent the digestion and absorption of essential nutrients for hormone health, worsening the issue.
Thus, it is essential that you are maintaining a strict gluten-free diet to prevent gluten exposure. Additionally, it’s important you are appropriately balancing your diet to make sure you’re getting the nutrients needed to support hormone health.
However, I also want to note, as you live gluten-free your hormone activity should normalize. If it doesn’t it’s time to consider other autoimmune diseases linked to celiac.
Untreated celiac disease in women (and those AFAB) can impact fertility. Additionally, if undiagnosed or unmanaged, celiac can impact pregnancy: it impacts a person’s ability to get pregnant, remain pregnant for the full term, and have a safe delivery.In a study done by Moleski and others in 2015, results showed that women with celiac disease had higher rates of spontaneous abortion compared to non-celiac participants.
Celiac can further impact fertility if a person is malnourished due to intestinal damage. This is because nutrition is essential to support a healthy pregnancy and delivery for both herself and the baby.
Some key nutrients to monitor while pregnant or trying to get pregnant, especially with celiac, include:
Thus, gluten-free foods for fertility and pregnancy should include foods rich in those nutrients.
Common fertility issues in women with celiac most likely arise from nutrient deficiencies, low progesterone, low thyroid hormone, and high prolactin. This is tying us back to our discussion on celiac and hormone health
If we are getting enough nutrients from a balanced gluten-free diet or because of small intestinal damage, then we can’t properly support our hormones.
All of this is to say however, that as you heal and eat gluten-free with celiac, infertility and rate of birth complications drop.
However, those who are assigned female at birth that go untreated and undiagnosed with celiac can be at a higher risk of fetal abnormalities, preterm births, and miscarriages. Study correlations indicate that the gluten proteins, when present in celiac mothers, interact and can disrupt the placenta in the developing fetus so a gluten-free diet should be followed.
But don’t take this and freak out if you’ve been glutened while pregnant. 1 accidental exposure is not going to ruin your pregnancy.
Celiac disease can impact those AFAB and women’s health by affecting periods. Celiac, especially when undiagnosed, can cause skipped and irregular periods and can even cause amenorrhea (3 missed periods in a row).
In fact, in a study comparing people who ovulate with celiac disease to those with out celiac, amenorrhea was 3x more likely to show up in people who have celiac than in non-celiacs. In another study, ~25% of those who ovulate reported a history of missing periods compared to 10% of non-celiac study participants.
However, women starting and adhering to a gluten-free diet is shown to greatly lessen or eliminate many amenorrhea cases.
Other period complications found in that study included very light periods, infrequent periods, strange spotting, or very heavy periods. Additionally, delayed menarche can also be a sign of celiac disease but cases show that beginning and adhering to a gluten-free diet will also improve and potentially eliminate complications.
Celiac disease can impact women’s health by causing early menopause in those with a uterus with undiagnosed or mismanaged celiac.
In fact, a 2011 study on menopause development in celiac and non-celiac women found that celiacs developed menopause earlier. This is likely related to inadequate nutrition impacting proper hormone functioning in celiac women.
However in this study, they determined that diagnosis and treatment of celiac 10 years before menopause prolongs fertility of celiacs that have a uterus.
Meaning, swift diagnosis and adaptation to a gluten-free diet is imperative to fertility and the prevention of early menopause.
Celiac disease impacts women’s health by putting strain on the bones. Low bone mineral density resulting in osteopenia and osteoporosis is common in people assigned female at birth with celiac disease.
Celiac bone health complications are due to calcium, magnesium, and vitamin D absorption being impaired due to small intestinal damage from gluten in those still undiagnosed or still healing from a celiac diagnosis.
When people receive their initial celiac diagnosis, part of proper celiac testing should include a DEXA scan to check bone mineral density. This is so celiacs can either take precautions to prevent these conditions from occurring or slow their progression.
Celiacs are also recommended to keep a close eye on their calcium, vitamin D, and magnesium levels and ensure that they are getting enough of them via the diet or from supplementation.
The general recommendations for daily consumption of these nutrients are:
Here’s an example of a gluten-free supplement that has all of these nutrients that can help supplement a balanced diet in supporting bone health. When considering any supplement though, please be sure to consult your doctor to make sure they are safe for you to take.
A common question about celiac and women’s health I get is “does celiac put you are higher risk for UTIs (urinary tract infections)”. If you have a uterus and celiac, the answer is complicated.
There is no conclusive evidence showing that celiac disease causes an increase in frequency of UTIs. Most studies are either done in a small sample size, done on a single case in a single patient, or do not show a strong correlation or causation.
It is thought to be a tertiary symptom of celiac disease, caused by symptoms caused by the celiac itself. For example, a possible explanation is that the malnutrition and dehydration that is a result of the celiac disease causes the presence of the UTI, not that celiac disease directly causes a UTI to occur.
Additionally, if you’re spending a lot of time on the toiled with celiac diarrhea, bacteria could end up in the urinary tract and cause an infection.
Another impact of celiac disease on women’s health is the higher frequency of anemia in celiac disease patients.
Iron deficiency anemia can be common in those who ovulate, especially those with celiac disease. Even in people who have not fully developed iron deficiency anemia, many are still deficient or at risk of developing this condition.
This is because the damage to the small intestine from eating gluten with celiac can impair iron, folate, and B12 absorption. A deficiency in any of these nutrients can lead to anemia.
It is important that people with celiac disease get a complete blood count and iron panel to monitor for anemia. Additionally, it’s vital that celiacs consume a balanced gluten-free diet, and supplement if needed to prevent anemia and related symptoms from occurring.
What can we do about celiac disease impacting women’s health? There are a lot of approaches that can be taken.
There’s a lot you can do to support your health with celiac. If you’re feeling stuck, always discuss your plan of care with your healthcare team.
Celiac disease impacts women’s health and those who were assigned female at birth in unique ways compared to those who were assigned male at birth. From impacting periods, bone health, fertility, pregnancy, and menopause, there’s a lot to consider.
One of the best ways to support your health with celiac disease is to avoid cross-contact and gluten while balancing a gluten-free diet (in the order).