This project has two objectives: 1) to provide training to enhance the principle investigator's research skills and knowledge and 2) to study the interrelationships between the menstrual cycle and ulcerative colitis (UC), and the possible influence on the change in symptoms of UC. Forty patients with UC and twenty control subjects with normal bowel function will be studied during the 3 phases of the menstrual cycle: menstruation, the follicular phase, and the luteal phase. The hypotheses to be tested are: 1) There are biochemical mediators which significantly increase numbers of colonic mast cell between the menstruation phase and the follicular phase which will be followed by increased degranulation of the mast cells just prior to ovulation. 2) The symptoms and severity of UC a) worsen at ovulation when estrogen is at a peak and mast cells degranulate releasing histamine and activate prostaglandin (PG)D2 synthesis and b) worsen in the luteal phase just prior to menstruation because of an increased release of PGF2a. 3) The daily activity level and quality of life will decrease during the follicular phase due to symptoms and worsening of UC, and will decrease again in the luteal phase due to symptoms prior to menses. 4) Signs and symptoms of UC will be more pronounced during ovulation and in the luteal phase during a relapse compared to the signs and symptoms in remission. The subjects will determine their menstrual cycle phases after attending classes in charting changes in vaginal mucus secretion and will use LH surge home urine kits to determine ovulation. During menstruation (day 1-30, the follicular phase (day 12-14, just prior to ovulation) and the luteal phase (day 20-24) women with UC and controls will have evaluation of their colonic function and mucosa by clinical, sigmoidoscopic and histologic criteria. They will also have evaluation of estrogen, progesterone, PGF2a, and active mast cell products histamine, tryptase, and PGD2. Gastrointestinal and non-gastrointestinal symptoms will be assessed by detailed diaries which will also record daily level of functioning. Subjects will be followed monthly for determination of relapse. Those who relapse will repeat the one month data collection procedure. The importance of this study is to demonstrate cyclical changes on symptoms and colonic inflammation in women with UC. With the exception of fertility, the unique aspects of gender in IBD have been neglected. Findings from this study will provide better understanding of the course of inflammatory bowel disease in women, both UC and Crohn's disease. Knowledge of the interrelationships of IBD and the menstrual cycle would impact on symptomatic treatment and patient education regarding the IBD as well as fertility issues.
