Medical research is beginning to realize that celiac disease affects almost every system in the body, including the reproductive system.
There's good evidence that both women and men with celiac disease risk infertility, possibly because of malnutrition or malabsorption of essential nutrients. There's also research showing that women with undiagnosed celiac disease may start menstruating later than average and go through menopause earlier than average.
There's been less medical research on the potential link between celiac disease and chronic menstrual pain, extremely painful periods, and endometriosis. However, a small handful of studies and some anecdotal evidence indicate there's likely a connection there, too. In fact, a comprehensive study of reproductive problems in celiac women found that nearly 5% of the women cited "menstrual cycle disorders" as their main celiac disease symptoms.
Many Celiac Women Report Painful Periods
Dysmenorrhea technically means severe menstrual cramps, and the American Congress of Obstetricians and Gynecologists (ACOG) notes that these cramps can last one or two days per cycle. According to ACOG, these cramps may be caused by prostaglandins, or chemicals made by the uterus that cause uterine contractions.
The cramps, which seem to occur most frequently on the first day of a woman's period, can be so painful that some teenagers and women vomit or pass out. In some cases, extremely heavy menstrual bleeding accompanies the cramps.
Although there's little research on the incidence of this type of menstrual pain in women with celiac disease, one published case study showed relief from painful period cramps and pelvic pain in a woman who was diagnosed with celiac disease and began to follow a gluten-free diet.
Anecdotally, there have been multiple accounts of women who suffered from extremely painful menstrual cramps that improved or disappeared once they were diagnosed with celiac disease and implemented the diet. In fact, some naturopathic physicians have begun suggesting gluten-free diet trials to women who complain of extremely painful periods. However, it should be noted that there is not yet extensive research supporting this.
Endometriosis Also Potentially Linked with Celiac Disease
Endometriosis, a condition in which uterine cells grow outside the uterus, also causes chronic pelvic pain. It also can cause heavy menstrual bleeding, pain during sexual intercourse, and even sleep disturbances. However, in some cases, endometriosis does not have any obvious symptoms at all, and it's often discovered during testing for infertility.
Again, there's little medical research on potential links between celiac disease and endometriosis, but the research that does exist, and anecdotal reports from women with celiac disease, indicate that endometriosis may be more common in celiac women than it is in the general population.
In a study conducted in 2009, researchers sought to determine the incidence of celiac disease in a population of infertile women who had been diagnosed with endometriosis. They compared 120 women whose endometriosis diagnosis had been confirmed by laparoscopy with 1,500 healthy women.
Study: Celiac Four Times More Common in Women with Endometriosis
In the study, both groups were tested for celiac disease with celiac disease blood tests that included both screening for anti-tissue transglutaminase (tTG-IgA) and a screen for anti-endomysium (anti-EMA) antibodies. The EMA-IgA test is considered the most specific for celiac disease.
Nine of the 120 women in the study group were positive on the tTG-IgA test, and five of them also turned up positive on the EMA-IgA test. Of these five, four agreed to an intestinal biopsy, which confirmed celiac disease in three cases (a 2.5% prevalence).
Meanwhile, in the control group, the researchers found celiac disease in one out of every 136 women, for an incidence rate of 0.66%. The researchers concluded that celiac disease appears commonly in women with endometriosis, "and may be clinically relevant."
F.M. Aguiar et al. Serological testing for celiac disease in women with endometriosis. A pilot study. Clinical and Experimental Obstetrics & Gynecology. 2009;36(1):23-5.
M.G. Porpora et al. Celiac disease as a cause of chronic pelvic pain, dysmenorrhea, and deep dyspareunia. Obstetrics and Gynecology. 2002 May;99(5 Pt 2):937-9.
D. Martinelli et al. Reproductive life disorders in Italian celiac women. A case-control study. BMC Gastroenterology. 2010 Aug 6;10:89.
Chronic Pelvic Pain. American Congress of Obstetricians and Gynecologists. Accessed Jan. 5, 2011.