Perimenopause and Coeliac Disease: Gut Health, Nutrition, and Hormones
Coeliac disease and perimenopause interact in important ways around nutrition, bone health, and gut symptoms. Here is what women managing both conditions need to know.
Why Coeliac Disease Makes Perimenopause More Complex
Coeliac disease is an autoimmune condition in which gluten triggers an immune response that damages the small intestine's lining. This damage impairs the absorption of key nutrients including calcium, vitamin D, iron, and B vitamins. During perimenopause, the body's need for these nutrients increases, particularly for calcium and vitamin D to protect bone density as estrogen declines. When absorption is compromised by coeliac disease, women face a double disadvantage. Even women who follow a strict gluten-free diet may have some lasting gut damage affecting nutrient absorption, making nutritional monitoring especially important.
Bone Health: A Priority for Both Conditions
Both coeliac disease and perimenopause increase the risk of reduced bone density. Coeliac disease does this through malabsorption of calcium and vitamin D; perimenopause does it through estrogen-driven changes in bone turnover. Together, they make osteoporosis a genuine concern that deserves proactive attention. Women with coeliac disease should have their bone density monitored regularly, and a GP or endocrinologist can advise on supplementation targets. Calcium from dietary sources, ideally gluten-free fortified foods, combined with vitamin D supplementation and regular weight-bearing exercise, form the foundation of bone protection in this situation.
Bloating and Gut Symptoms: Coeliac, Perimenopause, or Both?
Bloating, bowel changes, abdominal discomfort, and nausea are symptoms of coeliac disease, particularly if gluten exposure has occurred. They are also common perimenopause symptoms, driven by hormonal effects on gut motility and the gut microbiome. When symptoms worsen during perimenopause, it can be difficult to know whether gluten contamination has occurred, whether hormones are driving gut changes, or whether coeliac disease is simply becoming more symptomatic. A clear food and symptom diary can help you correlate episodes with specific foods or hormonal patterns, which is useful information for both your gastroenterologist and your GP.
Iron Deficiency and Fatigue
Iron malabsorption in coeliac disease is common and causes fatigue that is sometimes the first symptom that brings women to a diagnosis. Perimenopause can bring heavier or more frequent periods in the years before cycles stop, which adds to iron loss. This combination means that iron deficiency anaemia is a real risk for perimenopausal women with coeliac disease. Fatigue in this context often goes investigated for one cause and misses the other. If you are experiencing significant tiredness, ask your doctor to check full blood count, ferritin, B12, and vitamin D as a routine panel.
Gluten-Free Eating During Perimenopause
The gluten-free diet can sometimes be lower in fibre, certain B vitamins, and fortified grains than a conventional diet. During perimenopause, when the gut microbiome is already shifting and constipation becomes more common for many women, fibre intake matters. Prioritising naturally gluten-free high-fibre foods, such as legumes, vegetables, fruit, and gluten-free whole grains, supports gut health, blood sugar stability, and weight management. Working with a dietitian who understands both coeliac disease and perimenopause is worth seeking out; the combination is specific enough that general dietary advice may not address all the relevant considerations.
Medical Monitoring and Coordination
Women with coeliac disease are typically monitored by a gastroenterologist or at minimum reviewed periodically by their GP. Adding perimenopause to this context means ensuring that your hormonal health is also being reviewed. A blood panel that includes hormonal markers alongside the standard coeliac monitoring tests gives a fuller picture. If you are considering hormone therapy, your gastroenterologist does not need to be involved in that decision, but your GP should have a complete picture of your coeliac status, current absorption levels, and bone density before making recommendations about hormonal support.
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