Impact of Menopause and Clinical Considerations in Patients With Inflammatory Bowel Disease.

Menopause is marked by a natural decline in estrogen and progesterone that alters gut barrier integrity, immune regulation, and systemic inflammation. In women with inflammatory bowel disease (IBD), this interplay may result in increased symptoms and worse clinical outcomes. Women with IBD face diagnostic delays, distinct disease phenotypes, higher rates of extraintestinal manifestations, and greater treatment burden. In menopausal women with IBD, specific guidance remains scarce. Beyond gut-specific effects, menopausal women are at an increased risk of osteoporosis, cardiovascular disease, and mood disorders. Lacking is a framework that promotes individualized, multidisciplinary care for menopausal women with IBD, focusing on the alterations in the immune system, gut microbiome, clinical presentations, multisystem risks, and therapeutic considerations. This article aims to synthesize the current evidence and research gaps around the impact of menopause in IBD, evaluate the safety and effectiveness of menopausal hormone therapy in this context, and propose a practical, patient-centered management framework for clinicians.