Celiac Disease and Women’s Health

The reality is, celiac disease can impact women’s health. 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 too. Though for the sake of brevity and so this post is able to be found on the internet, I will be referring to the health of those assigned female at birth as “women’s health” for the rest of the post.

Holding space for the lack of inclusivity in SEO and celiac research.

Table of Contents

What is Celiac

First, before we talk about the connections, 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. Symptoms like nutrient deficiencies, 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. 

Celiac Disease Symptoms in Women - Celiac and Women's Health - Celiac Dietitian - Tayler Silfverduk

Celiac Disease Symptoms in Women

As we discuss women’s health and celiac disease, it’s important we understand how celiac disease can impact women.

Women are diagnosed with celiac disease more often than men, with about 60-70% of total diagnoses in most populations being female.

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 when researched. Women were shown to have more cases of constipation, bloating, hyperthyroidism, and anemia than their male counterparts. 

Common symptoms that present in celiac women are:

  • Abdominal pain
  • Bloating
  • Bowel changes

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 women are:

  • Iron deficiency anemia
  • Bone health complications
  • Dysfunctions of the liver
  • Hypersplenism
  • Asthma
  • Weight loss
  • Fatigue
  • Menstrual irregularities
  • Infertility
  • Adverse pregnancy outcomes

Defining Women's Health

Now that we understand celiac and how it impacts women, 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 the female population. Some of the specific sectors of women’s health include:

  • Birth control 
  • STIs
  • Mammograms
  • Gynecology
  • Menopause
  • Hormone therapy
  • Pregnancy and birth
  • Osteoporosis

Essentially, women’s health applies to that of which specifically impacts women.

Celiac Disease and Women's Health - Celiac Dietitian - Tayler Silfverduk - Celiac disease impacts fertility, celiac disease impacts periods, celiac disease impacts bone health

How Does Celiac Disease Affect Women’s Health?

Celiac disease affects women’s health because nutrition is directly tied to our hormones. This in turn can impact a woman’s fertility, period, bone health, menopause status, and more.

Celiac Nutrition and Hormones

Nutrition for celiac disease 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 our hormonal health and, thus, our 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 our 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.

Fertility and Celiac Disease

Untreated celiac disease can impact fertility. Additionally, if undiagnosed or unmanaged, celiac can impact pregnancy: it impacts a woman’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 women 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:

  • Iron
  • Folate
  • Zinc
  • Copper

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, a woman with celiac that goes untreated 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.

Periods and Celiac Disease

Celiac disease can impact 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 women with celiac disease to those without it, amenorrhea was 3x more likely to show up in celiac women than non-celiacs. In another study, ~25% of women 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.

Menopause and Celiac

Celiac disease can impact women’s health by causing early menopause in women 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 celiac women.

Meaning, swift diagnosis and adaptation to a gluten-free diet is imperative to fertility and the prevention of early menopause in celiac women.

Bone Disease and Celiac

Celiac disease can impact women’s health by affecting bone health. Low bone mineral density resulting in osteopenia and osteoporosis is common in women 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 women 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.

Celiac women 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 women for daily consumption of these nutrients are:

  • 1200 mg of calcium per day for menstruating women, 1500 mg for menopausal and post-menopausal women either from gluten-free calcium-foods or supplements.
  • 600 IU of vitamin D per day to meet needs but a doctor may recommend more if you are already vitamin D deficient with celiac.
  • 320 mg of magnesium per day for women, 400 mg per day if pregnant or lactating 

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.

UTIs and Celiac Disease

A common question about celiac and women’s health I get is “does celiac put you are higher risk for UTIs (urinary tract infections)”.

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.

Anemia and Celiac Disease

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 women, especially those with celiac disease. Even in women 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 women with celiac disease get a complete blood count and iron panel to monitor for anemia. Additionally, it’s vital that celiac women consume a balanced gluten-free diet, and supplement if needed to prevent anemia and related symptoms from occurring.

How to Support Women's Health with Celiac Disease - Celiac Dietitian - Tayler Silfverduk

How to Support Women’s Health with Celiac

  1. Consume a balanced gluten-free diet containing all necessary micronutrients and macronutrients needed for your body’s unique requirements. Consuming enough calories overall will greatly aid you in also consuming adequate amounts of necessary micronutrients for optimal bodily & hormonal functioning. Not to mention it will help you repair your small intestine to prevent any further celiac women’s health complications.
  2. Pay attention to your vitamin and mineral levels. Get regular blood work as needed & evaluate your diet every so often to ensure that you are getting in key nutrients such as calcium, magnesium, iron, and vitamin D.
  3. Engage in weight-bearing exercise. This will help to overload the bones and cause bone remodeling which can strengthen them to boost bone mineral density!
  4. Get in the sun! Show your wrists and ankles in the sun for 15 minutes every day during peak sun hours to maximize vitamin D synthesis.
  5. Eat your iron! Eat heme iron sources regularly for the most bioavailable form of the mineral. These sources mainly come from meats and poultry, especially red meats! If you are unable to consume heme sources, you can get non-heme iron from sources such as beans and legumes and fortified grain products. Be sure to pair your iron sources with vitamin C to boost absorption! Don’t forget to read my post on iron-rich gluten-free foods for more help.
  6. Adhere to a celiac diet as much as possible. This will greatly reduce any symptom flare-ups and long-term health complications that can result from persistent gluten exposure.
  7. Work with a celiac dietitian to make sure your current gluten-free lifestyle is supporting all aspects of health.