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Women with untreated coeliac disease may hit menopause earlier, and have a higher risk of some pregnancy complications, than women without the disease, suggests a small study.
However, if women with coeliac disease are diagnosed early, and follow a strict diet as treatment, the findings suggest they won't go through menopause any earlier than disease-free women.
Celiac disease affects "the whole spectrum of the reproductive career of women," said Dr Shawky Badawy, the head of obstetrics and gynaecology at Upstate Medical University in Syracuse, New York.
Early diagnosis
"It's very interesting that when this disease is diagnosed early and corrected by (a) gluten-free diet, you find that these people improved significantly and their reproductive function improved significantly," added Dr Badawy, who was not involved in the new study.
Combined with other studies that have also shown reproductive problems in women with untreated coeliac disease, "it's a really important finding," he said.
The authors of the new study, led by Dr Carolina Ciacci from Federico II University of Naples, Italy said that nutrient deficiencies, plus lower levels of some key hormones in women with coeliac disease, may be the reason for the earlier menopause they observed.
Oestrogen levels are generally lower in women with coeliac disease, said Dr Ciacci. Both reduced body fat and inflammation stemming from the coeliac disorder itself can contribute to hormonal disruption, she explained.
The study
The new study included a group of about 100 postmenopausal women. Twenty-five of them had been diagnosed with coeliac disease and followed a gluten-free diet for at least 10 years before menopause. Another 33 had coeliac disease that wasn't diagnosed until after menopause, and 45 coeliac-free women served as a comparison group.
On average, women with and without coeliac disease had gotten their periods at age 12 or 13. Both women without the disease and those who had followed a gluten-free diet hit menopause around age 50, according to the findings, published in the journal Menopause.
But women with untreated coeliac disease went through menopause between age 47 and 48, on average - making their fertile life span shorter than other women's.
And while all three groups of women had gotten pregnant an average of two to three times, the combination of miscarriages and premature births was more common in women with untreated coeliac disease than in the comparison group - a pattern that also followed, but to a lesser extent, in women with treated coeliac disease.
The findings
Dr Ciacci's team also noted that women in the untreated coeliac group reported more menopause-associated problems, such as hot flashes, irritability, and muscle and joint symptoms than non-coeliac women.
They concluded that diagnosing celiac disease early, and preventing some of the nutritional and hormonal differences in coeliac women, might delay an otherwise early menopause. It's likely, Dr Ciacci said, that many people go their whole lives with coeliac symptoms, but are never diagnosed.
She said that one important way to change that is education of primary care doctors.
"There are big signs" of coeliac disease, she said. "One is anaemia, or iron deficiency. If you couple that with gastrointestinal symptoms or with fatigue, then you have three symptoms that all together must tell a doctor: check for coeliac disease."
But women - who are more at risk for coeliac disease than men - can also be aware of the disease themselves, she added, especially since, if they have symptoms, getting tested can be very simple.
"When a woman has early menopause, she should think of coeliac disease. It's probably too late to gain anything about fertility but it's probably important for her quality of life," Dr Ciacci said. "This is the same for people experiencing multiple (spontaneous) abortions or pre-term birth - it's just a blood test." (Reuters Health/ June 2011)
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