Background: Coeliac disease (CD) is a systemic immune-mediated disorder whose manifestations extend beyond the gastrointestinal tract. Women with CD may experience reproductive and menstrual abnormalities, yet these associations may receive limited attention during routine clinical assessment. Recognising extraintestinal manifestations may provide opportunities for earlier diagnosis and management.
Objective: To examine the evidence linking CD with female reproductive and menstrual health and highlight implications for clinical recognition and patient management.
Methods: Published evidence examining CD and female reproductive health was reviewed, with particular attention to menstrual abnormalities, reproductive function, fertility and pregnancy outcomes. Recent systematic reviews, meta-analyses and observational studies were considered.
Results: Evidence indicates that reproductive manifestations may occur across the female life course. A 2026 systematic review and meta-analysis found that women with CD had higher risks of abnormal uterine bleeding and amenorrhea and a modestly later age at menarche, although biochemical reproductive hormone concentrations were not significantly different from controls. Evidence concerning infertility is less consistent: a systematic review found no clear increase in biopsy-confirmed CD among infertile women, while other studies have reported associations between CD and adverse reproductive or pregnancy outcomes. Nutritional deficiencies and the systemic effects of untreated disease may further complicate reproductive health.
Conclusion: Female reproductive and menstrual manifestations should be recognised as part of the broader clinical spectrum of CD. Rather than recommending indiscriminate screening for infertility alone, clinicians should maintain diagnostic awareness when reproductive or menstrual abnormalities coexist with nutritional deficiencies, gastrointestinal symptoms or other features suggestive of CD. A multidisciplinary approach involving primary care, nursing, gastroenterology, nutrition and reproductive health services may support earlier recognition and comprehensive care.