Celiac disease is an autoimmune disorder in which the ingestion of gluten triggers an immune response that damages the small intestine. While it affects people of all genders, a large proportion of diagnosed cases are found in women. Interestingly, women often do not experience the classic digestive symptoms early on but instead show a range of non-digestive signs that may go unrecognized for years.

Why Celiac Disease Is More Frequently Diagnosed in Women

Estimates suggest that women make up around 70% of those diagnosed with celiac disease. There are two primary reasons for this disparity: firstly, celiac disease genuinely occurs more often in women, and secondly, women are generally more likely to seek medical attention when they notice changes in their health, leading to more diagnoses overall.

Another significant observation is that women often report symptoms that are not gastrointestinal in nature before any digestive issues emerge. These signs can include hormonal imbalances, reproductive health concerns, and symptoms associated with nutrient deficiencies.

Early Signs in Women: More Than Just Digestive Trouble

While digestive symptoms such as bloating, diarrhea, constipation, and abdominal pain are commonly associated with celiac disease, many women experience other issues first. Irregular menstrual cycles, difficulties conceiving, and persistent fatigue are often early indicators of an underlying gluten-related problem.

Hormonal symptoms such as missed periods, unusually heavy or painful periods, or early menopause have been linked to undiagnosed celiac disease. These may appear before any digestive complaints and could lead healthcare providers to overlook celiac as a possible cause.

Fertility and Reproductive Health

One of the more impactful areas celiac disease can affect is reproductive health. Women dealing with unexplained infertility are sometimes later diagnosed with celiac disease, despite not having typical digestive symptoms. Several studies have explored the connection between gluten-triggered autoimmunity and fertility, with some suggesting that undiagnosed celiac may interfere with conception or increase the risk of miscarriage.

Pregnancy-related complications are also more common among women with unrecognized celiac disease. These can include anemia during pregnancy, poor fetal growth, preterm delivery, and even pregnancy loss. In such cases, diagnosis and adherence to a gluten-free diet can significantly improve outcomes.

In younger women, celiac disease may delay the onset of menstruation. It is also associated with menstrual irregularities such as amenorrhea and has been linked to endometriosis and chronic pelvic pain.

Anemia and Nutrient Deficiencies

Iron-deficiency anemia is one of the most frequent symptoms seen in women with undiagnosed celiac disease. In many cases, it is the first noticeable sign of trouble, especially in women of childbearing age. The chronic inflammation and damage to the small intestine in celiac disease impair nutrient absorption, especially iron, folate, and vitamin B12.

This deficiency can lead to fatigue, weakness, pale skin, and shortness of breath. Often, iron supplementation alone does not resolve the issue, and celiac disease is considered as a possible cause when anemia remains unexplained.

Bone Health and Osteoporosis

Another common concern among women with celiac disease is reduced bone density. The impaired absorption of calcium and vitamin D can lead to osteopenia or osteoporosis, conditions where bones become brittle and prone to fractures.

Women are already at higher risk of developing bone diseases due to hormonal changes, especially after menopause. When celiac disease goes undetected, it further accelerates bone loss. The good news is that once the disease is managed through a gluten-free diet, bone health can gradually improve.

Thyroid and Autoimmune Conditions

Celiac disease often coexists with other autoimmune disorders, and thyroid conditions are among the most common. Women with autoimmune thyroid diseases such as Hashimoto’s thyroiditis or Graves’ disease may have an increased risk of also developing celiac disease.

Symptoms of thyroid dysfunction—like fatigue, weight changes, mood fluctuations, and temperature sensitivity—can overlap with those of celiac disease, making diagnosis challenging without targeted testing. In some individuals, a gluten-free diet helps reduce inflammation and stabilize thyroid hormone levels.

Other Autoimmune and Neurological Issues

Celiac disease has been observed more frequently in women diagnosed with other autoimmune disorders such as lupus, rheumatoid arthritis, and type 1 diabetes. Additionally, conditions like multiple sclerosis have been loosely linked to gluten sensitivity, though more research is needed to clarify this relationship.

Some women with undiagnosed celiac disease report neurological symptoms including migraines, numbness or tingling in the limbs, or even balance issues. While not always directly tied to gluten, many of these symptoms lessen or resolve on a gluten-free diet.

Digestive Symptoms in Women

Although non-digestive symptoms may present first, many women with celiac disease do experience classic gastrointestinal symptoms eventually. These can include:

  • Persistent bloating

  • Chronic diarrhea or constipation

  • Abdominal discomfort or pain

  • Excessive gas

  • Nausea or vomiting

However, because these issues are often mistaken for irritable bowel syndrome (IBS)—a condition more common in women—many cases of celiac disease are initially misdiagnosed.

The Silent Nature of Celiac Disease

Some women may not display any noticeable symptoms at all, a form known as silent or asymptomatic celiac disease. In such cases, the damage to the intestine is still happening despite the absence of discomfort. This highlights the importance of testing, especially for women with family history or coexisting autoimmune diseases.

Diagnosis and Treatment

If celiac disease is suspected, testing involves a blood panel to detect specific antibodies. If results suggest gluten sensitivity, an upper endoscopy with a biopsy of the small intestine may be recommended to confirm the diagnosis.

It is crucial that gluten remains in the diet until testing is complete, as removing it prematurely can cause test results to be inaccurate.

Once diagnosed, the only effective treatment is strict adherence to a gluten-free diet for life. Eliminating gluten helps the intestinal lining heal, reduces symptoms, and prevents long-term complications.

Conclusion

Celiac disease in women often manifests through a variety of symptoms that go beyond digestive issues. Hormonal irregularities, fertility challenges, anemia, thyroid dysfunction, and bone loss are among the many ways this condition can present. Because women are more likely to seek medical attention, they are also more frequently diagnosed—but even so, many still go undiagnosed for years.

Understanding the full spectrum of symptoms, particularly non-gastrointestinal ones, can help in identifying celiac disease earlier. For women experiencing unexplained reproductive or metabolic symptoms, persistent fatigue, or nutrient deficiencies, testing for celiac disease may be a valuable step toward restoring health and improving quality of life.