Recognising coeliac disease symptoms in women

In women, coeliac disease rarely shows up as a classic belly complaint. More often it starts with a low iron that will not recover, with persistent fatigue, or with an irregular cycle. About 1 in 100 women have coeliac disease, and many do not know it (PMID 29551598).

That is exactly the problem. These complaints do not look like a gut disease, so no one thinks of it. A woman gets iron tablets or the label irritable bowel sooner than a gluten test.

In this article I line up the symptoms that are overlooked most often in women. What coeliac disease is exactly is in the overview on coeliac disease: symptoms, testing and gluten-free living.

What are the first symptoms of coeliac disease in women?

The first symptoms in women are often vague and not gut-related. Think of fatigue, a low iron, paleness, headaches or a slightly bloated feeling. Gut complaints like belly pain and diarrhoea do occur, but are not always the first or the clearest clue.

That vagueness is what makes it hard. Fatigue and a low iron fit dozens of things, from a busy stretch to heavy periods. Coeliac disease is rarely top of the list, while it can sit among them.

A recurring pattern is telling: complaints that persist despite iron tablets, or that return after a while. That stubbornness is often the real signal.

Which complaints outside the gut belong to coeliac disease?

In women, coeliac disease often causes complaints outside the gut, the so-called atypical symptoms. They arise because your damaged gut absorbs fewer nutrients, and because the autoimmune reaction plays elsewhere in your body too. Below are the signals missed most often.

That itchy rash, dermatitis herpetiformis, is almost proof of coeliac disease. Nearly everyone with this rash has gut damage too, even without belly complaints (PMID 27499257). Yet it is often treated as eczema first.

If your iron keeps running down, look beyond the tablets. What a low ferritin means and how coeliac disease fits in is in coeliac disease, iron deficiency and unexplained fatigue.

Why is coeliac disease missed so often in women?

Coeliac disease is missed often in women because the complaints fit so many other things. Fatigue, a low iron and belly complaints become separate problems, each with its own explanation. So the underlying pattern drops out of view, sometimes for years.

A classic scenario: a woman with heavy periods gets iron tablets for her anaemia. Reasonable, because those periods explain a lot. But if the iron stays low despite tablets, a second cause may be playing that no one has tested yet.

The irritable bowel label falls quickly too. The complaints resemble it, and without a targeted test coeliac disease stays hidden underneath. The difference between coeliac disease, a wheat allergy and gluten sensitivity is explained in the gluten intolerance test.

When should you think of a coeliac test?

Think of a coeliac test when your complaints are stubborn or occur together: a low iron that will not recover, unexplained fatigue, recurring gut complaints or an itchy rash. A relative with coeliac disease is also reason to consider it, because the predisposition is partly hereditary.

Important: keep eating gluten until your blood is drawn. Go gluten-free first, and the antibodies drop, so the test can read normal when it should not. Which blood values to measure exactly is in coeliac disease blood test: which values say enough.

If you recognise yourself in this, discuss it with your GP. If you want to have your antibodies measured already, you can test for coeliac disease while you are still eating bread. Thuisarts and the NHG always look at the whole picture with such a result, never one value alone.

References

1. Lebwohl B, Sanders DS, Green PHR. Coeliac disease. Lancet. 2018;391(10115):70-81. PMID 28760445.
2. Singh P, Arora A, Strand TA, et al. Global Prevalence of Celiac Disease: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2018;16(6):823-836. PMID 29551598.
3. Reunala T, Salmi TT, Hervonen K, et al. Dermatitis herpetiformis: a cutaneous manifestation of coeliac disease. Ann Med. 2017;49(1):23-31. PMID 27499257.
4. Roy A, Laszkowska M, Sundström J, et al. Prevalence of Celiac Disease in Patients with Autoimmune Thyroid Disease: A Meta-Analysis. Thyroid. 2016;26(7):880-890. PMID 27256300.
5. NHG and Thuisarts. Information on coeliac disease and blood testing. Available via thuisarts.nl.

Every blood test result at Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.