Coeliac disease is known for affecting the gut, causing symptoms such as diarrhoea, stomach pain and bloating. But without management, it can also change menstrual cycles, fertility and pregnancy.
This condition causes your immune system to react to gluten, a protein in wheat, barley and rye.
If you eat something containing gluten, the disease can cause a range of gut-related symptoms, along with more general symptoms, such as tiredness.
Following a strict, lifelong gluten-free diet allows people to manage coeliac disease and avoid long-term complications.
Around 60–70% of people with coeliac disease are female. And among this group, female health conditions develop at a higher rate than in females without coeliac disease.
Read on for more information about the symptoms of coeliac disease and how it can affect menstruation, pregnancy and fertility.
General symptoms of coeliac disease
If you have coeliac disease, the symptoms arise after you consume gluten. Your immune system sees the gluten as a threat and launches an attack.
In the process, it damages healthy tissue, and this prevents your body from absorbing nutrients properly – an issue called malabsorption.
Over time, this can lead to nutrient deficiencies. For people with untreated coeliac disease, the most common nutrient deficiencies involve iron, vitamin D, calcium, vitamin B12, folic acid and zinc.
The characteristic symptoms of coeliac disease relate to your digestive system. But this condition can affect other parts of your body, too.
Coeliac disease symptoms include:
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Diarrhoea: You may have frequent, loose or watery poos, usually three or more times a day. This happens when your intestines can’t absorb nutrients as they usually would.
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Fatty, smelly poo: If your intestines aren’t absorbing nutrients, your poos may contain high levels of fat. They may smell worse, appear oily or frothy, and be difficult to flush.
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Stomach pain: As your immune system attacks the lining of your gut, you may feel pain or cramping in your abdomen.
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Bloating: This feeling of tightness or pressure can cause your abdomen to look bigger. Gas builds up when your intestines aren’t fully absorbing nutrients.
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Flatulence: A buildup of gas causes you to pass wind more than usual.
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Constipation: You may poo less often, and with more difficulty, than is normal for you.
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Nausea and vomiting: Eating gluten may make you feel sick and throw up, as your body tries to get rid of what it sees as a harmful substance.
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Tiredness: If your intestines aren’t fully absorbing nutrients, you can miss out on some that are key for energy metabolism. This can lead to fatigue.
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Unexpected weight loss: This can also result from not fully absorbing nutrients and digesting food.
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An itchy rash: Some people with coeliac disease develop dermatitis herpetiformis, a rash with blisters, after they eat gluten. This tends to appear on the elbows, knees and buttocks, though it can develop elsewhere.
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Numbness and tingling: Less often, coeliac disease affects the nervous system. This can lead to numbness and tingling in the hands and feet.
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Problems with movement and speech: If coeliac disease affects your nervous system, it could lead to changes in your coordination, balance and ability to speak.
It’s worth keeping in mind that coeliac disease is just one reason why females might feel bloated, sick and tired.
Many other conditions, including inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), can lead to gut symptoms similar to those of coeliac disease. We do know that the symptoms of IBD and IBS appear more frequently in females than males.
But it’s important not to assume that you have IBS. Because of the overlap in symptoms, it's crucial to get tested for coeliac disease if you’re experiencing gut-related symptoms.
A correct diagnosis is key to optimising the management of your symptoms. The best approaches for coeliac disease, IBS and IBD are very different, and without treatment, coeliac disease leads to long-term health complications.
It’s also worth noting that IBS is more common in people with coeliac disease.
You can learn more about IBS and IBD here.
Coeliac disease and menstruation
As we’ve seen, coeliac disease doesn’t just affect your gut. Your immune system’s response to gluten can affect other areas of your body and the way your body works.
If you have coeliac disease, eating gluten can sometimes affect the regularity of your menstrual cycle.
This could result in:
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a delay in your first period arriving
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a missed or late period
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early menopause, which means that your periods stop before you turn 45
Having a strict, lifelong gluten-free diet usually resolves the symptoms for most people.
However, up to 30% of people continue to experience symptoms, have gut inflammation or both. This issue is called non-responsive celiac disease.
Coeliac disease and pregnancy
Without diagnosis and management, coeliac disease is associated with several pregnancy complications.
Possible effects on pregnancy include:
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low birth weight
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slowed growth in the womb
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increased risk of miscarriage and stillbirth
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preterm birth
Experts don’t currently know why coeliac disease can have these effects. One theory is that the body produces certain antibodies, called anti-tissue transglutaminase antibodies, in response to untreated celiac disease.
These antibodies are thought to negatively affect the formation and function of the placenta.
However, the evidence suggests that early diagnosis of coeliac disease and a strict gluten-free diet reduces the risk of these outcomes.
Coeliac disease and fertility
Undiagnosed and untreated coeliac disease could be causing some cases of unexplained infertility.
Some research suggests that 4–8% of females with unexplained infertility may have coeliac disease. This is striking, considering that the condition affects an estimated 0.6% of all females.
Still, it’s unlikely that infertility can be fully explained by missing out on certain nutrients. Some researchers have studied cases of infertility in females with untreated coeliac disease and found no nutritional deficiency.
Age may be a key factor. One investigation into coeliac disease and infertility found that only females aged 25–29 with coeliac disease seemed to have a higher risk of infertility. People in other age groups had the same risk as those without coeliac disease.
Again, research suggests that following a gluten-free diet means that females with coeliac disease have the same risk of fertility problems as those without this condition.
What happens if coeliac disease goes untreated?
If you have coeliac disease and don’t remove gluten from your diet, several complications can eventually arise, on top of the symptoms we’ve already mentioned.
These complications include:
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iron deficiency anaemia
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vitamin B12 deficiency anaemia
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malnutrition
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lactose intolerance
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increased risk of some cancers
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osteoporosis
Osteoporosis causes your bones to weaken, which can make them more prone to break or fracture. In general, females are more at risk of osteoporosis than males.
To support bone health, experts suggest that people with coeliac disease get 1,000 milligrams of calcium a day. They also recommend a daily vitamin D supplement, especially between September and March.
Overall, the symptoms and complications of coeliac disease may seem a bit overwhelming. But following a gluten-free diet is enough to reduce your risk.
When someone with coeliac disease avoids barley, wheat and rye, their life is similar to someone who doesn’t have the condition.
Summary
Coeliac disease often causes gut-related symptoms, such as diarrhoea, stomach pain and bloating. Without a diagnosis and management, the condition may also affect periods, pregnancy and fertility, among other complications.
Coeliac disease can have a significant effect on your health and quality of life. But adjusting your diet to remove gluten – found in barley, wheat and rye – takes care of the symptoms for most people and reduces the risk of long-term complications.
You can find further support from Coeliac UK, including an online assessment tool.
To learn more about other gut health topics, visit Symprove’s Gut Hub.
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Non-responsive coeliac disease: A comprehensive review from the NHS England National Centre for Refractory Coeliac Disease. Nutrients. (2020). Link.
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Women with celiac disease present with fertility problems no more often than women in the general population. Gastroenterology. (2014). Link.
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