Women with untreated celiac 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 celiac 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 gynecology at Upstate Medical University in Syracuse, New York.
"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 Badawy, who was not involved in the new study.
Combined with other studies that have also shown reproductive problems in women with untreated celiac disease, "it's a really important finding," he told Reuters Health.
In people with celiac disease - about one percent of Americans - the immune system reacts to a protein called gluten, which is found in wheat, barley, and rye. Eating foods with gluten damages the small intestine and keeps it from absorbing nutrients.
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 celiac disease, may be the reason for the earlier menopause they observed.
"When people have celiac disease, they have really chronic diarrhea, for example," Badawy said. "With this, they lose much of the necessary amino acids, vitamins, (and) minerals, and all these certainly have their importance in the function of the vital endocrine organs."
Estrogen levels are generally lower in women with celiac disease, said Ciacci. Both reduced body fat and inflammation stemming from the celiac disorder itself can contribute to hormonal disruption, she explained.
The new study included a group of about 100 postmenopausal women. Twenty-five of them had been diagnosed with celiac disease and followed a gluten-free diet for at least 10 years before menopause. Another 33 had celiac disease that wasn't diagnosed until after menopause, and 45 celiac-free women served as a comparison group.
Researchers asked all the women how old they were when they got their first period and when they stopped having periods. They also found out how many times they had been pregnant, about any pregnancy complications -- such as miscarriages or premature births -- they had experienced, and about symptoms they had during menopause, including hot flashes.
On average, women with and without celiac 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 celiac 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 celiac disease than in the comparison group - a pattern that also followed, but to a lesser extent, in women with treated celiac disease.
Ciacci's team also noted that women in the untreated celiac group reported more menopause-associated problems, such as hot flashes, irritability, and muscle and joint symptoms than non-celiac women.
They concluded that diagnosing celiac disease early, and preventing some of the nutritional and hormonal differences in celiac women, might delay an otherwise early menopause. It's likely, Ciacci said, that many people go their whole lives with celiac 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 celiac disease, she told Reuters Health. "One is anemia, 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 celiac disease."
But women - who are more at risk for celiac 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 celiac disease. It's probably too late to gain anything about fertility but it's probably important for her quality of life," Ciacci said. "This is the same for people experiencing multiple (spontaneous) abortions or preterm birth -- it's just a blood test."
SOURCE: http://bit.ly/ja9XY2 Menopause, online June 3, 2011.
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