Celiac Disease
in Women
Celiac disease occurs more frequently in women than in men, with a diagnosis ratio of approximately 2-2.5:1.1
Compared with men, women living with celiac disease reported a poorer health-related quality of life, related to:2
- The permanence of bowel symptoms despite following a gluten-free diet
- Depressive and anxious behaviours related to feeling different
- A passive-adaptive attitude towards accepting the disease
As well as typical celiac disease symptoms, women may also experience an impaired reproductive life, including delayed puberty, infertility and early menopause due to celiac disease.3-5 Women with celiac disease are also at a higher risk of osteoporosis due to malabsorption and indirect hormonal effects.2,6
Undiagnosed celiac disease may be an underlying cause of unexplained subfertility and recurrent miscarriage.3 The National Institute for Health and Care Excellence (NICE) recommends considering serological testing for coeliac disease in people with unexplained subfertility or recurrent miscarriage.7
Celiac disease and female reproductive system dysfunction
In a case-control study of 288 females with celiac disease and 586 controls, women with celiac disease experienced more reproductive impairment throughout their lives compared with the controls.3
| Measure | Women with celiac disease | Women without celiac disease | Statistical result |
|---|---|---|---|
| Impact on menarche and menstruation | |||
| Mean age at menarche3 | 14.6 ± 2.0 years | 13.6 ± 1.5 years | p=0.001 |
| Delayed menarche3 | 30.8% (n=86/279) |
11.4% (n=65/569) |
OR: 3.4 (95% CI: 2.4-4.9); p=0.001 |
| Overall menstrual abnormality3 | 39.7% (n=123/279) |
25.8% (n=147/569) |
OR: 2.2 (95% CI: 1.6-3.0); p=0.001 |
| Impact on fertility and conception | |||
| Involuntary delay in conception of more than 1 year3 | 33.8% (n=46/136) |
11.8% (n=41/346) |
OR: 3.8 (95% CI: 2.3-6.1); p=0.01 |
| Infertility rate3 | 10.5% (n=16/152) |
5.2% (n=19/365) |
OR: 2.1 (95% CI: 1.0-4.2); p=0.028 |
| Impact on pregnancy and birth | |||
| Pregnancy with poor outcome3* | 46.1% (n=172/373) |
22.2% (n=206/927) |
OR: 3.0 (95% CI: 2.3-3.8); p=0.001 |
| Pre-term live birth3 | 16.3% (n=45/276) |
3.7% (n=30/795) |
OR: 4.9 (95% CI: 3.0-8.0); p=0.001 |
| Abortion3 | 23.5% (n=89/378) |
12.8% (n=120/935) |
OR: 2.0 (95% CI: 1.5-2.8); p=0.0001 |
*Poor outcome: abortion, still-birth, pre-term birth, low birth weight
The pathogenesis of reproductive system dysfunction in female patients with celiac disease is not fully understood. Proposed reasons for reproductive dysfunction in women with celiac disease who are not following a gluten-free diet include:3
- Compromised nutrition
- Deficiency of micronutrients
- Hormonal imbalance
- Ovarian factors
The role of the gluten-free diet
A gluten-free diet has been shown to completely or partially reverse the reproductive dysfunction of female patients with celiac disease.3
Compared with a gluten-containing diet, a gluten-free diet in women with celiac disease has been shown to:2,5
Lengthen the reproductive period
Lower the incidence of spontaneous abortions
Regulate the age of menarche
Correct markers of infertility
Improve bone mass density
- Galli G, Amici G et al. Sex-gender differences in adult coeliac disease at diagnosis and gluten-free-diet follow-up. Nutrients 2022;14:3192
- Manza F, Lungaro L et al. Gluten and wheat in women's health: beyond the gut. Nutrients 2024;16
- Prasad S, Singh P et al. Reproductive functions and pregnancy outcome in female patients with celiac disease. J Gastroenterol Hepatol 2024;39:1310-1317
- Bold J, Rostami K. Non-coeliac gluten sensitivity and reproductive disorders. Gastroenterol Hepatol Bed Bench 2015;8:294-297
- Freeman H J. Reproductive changes associated with celiac disease. World J Gastroenterol 2010;16:5810-5814
- Lungaro L, Manza F et al. Osteoporosis and celiac disease: updates and hidden pitfalls. Nutrients 2023;15:1089
- National Institute for Health and Care Excellence (NICE). NICE guideline 20. Coeliac disease: recognition, assessment and management, September 2015. Available at: https://www.nice.org.uk/guidance/ng20/resources/coeliac-disease-recognition-assessment-and-management-pdf-1837325178565. Accessed January 2025
© NICE 2015 Celiac disease: recognition, assessment and management. Available from www.nice.org.uk/guidance/ng20. All rights reserved. Subject to Notice of rights.
NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/ publication.