1. General Conclusions: Special Considerations for Women With IBD Women have more severe symptoms, more disease concerns than men Women have more severe symptoms, more disease concerns than men Menstrual symptoms may be more severe Menstrual symptoms may be more severe OCs may be related to disease-activity flares OCs may be related to disease-activity flares IPAA improvement may be accompanied by feelings of decreased attractiveness IPAA improvement may be accompanied by feelings of decreased attractiveness Most women experience postoperative improvement in sexual activity Most women experience postoperative improvement in sexual activity

2. General Conclusions: Special Considerations for Women With IBD (contd) Fertility Fertility –Normal or near normal in UC –May be affected in CD –IPAA reduces fertility –Voluntary childlessness makes data difficult to interpret Pregnancy Pregnancy –IBD has minimal effect on pregnancy outcomes –Conception during remission preferable –Some IBD drugs safe in pregnancy and breast- feeding –Disease activity is greater threat to pregnancy than treatment

3. General Conclusions: Special Considerations for Women With IBD (contd) Menopause Menopause –Bone loss, especially in CD, is greatest risk, leads to osteoporosis –Cardiovascular risk increases, equal to risk in men by age 75 –Benefits of HRT are increasingly questioned as risks are observed Osteoporosis Osteoporosis –Common in postmenopausal women, aggravated by CD and steroid therapy –Active plan to prevent bone loss and osteoporosis is vital –Nonsteroidal IBD drugs –Treatment options to preserve bone mass

4. General Conclusions: Special Considerations for Women With IBD (contd) Adherence improves outcomes; nonadherence leads to relapse Adherence improves outcomes; nonadherence leads to relapse Patient must understand nature of disease, goals of treatment Patient must understand nature of disease, goals of treatment Treatment plan tailored to patients life and needs Treatment plan tailored to patients life and needs Adherence improved by good physician-patient communication Adherence improved by good physician-patient communication