Can biologics improve my UC flare quickly?

Question

Hello doctor,

I have had ulcerative colitis for five years and have been on Mesalamine and Prednisone on and off, but my symptoms became much worse after I had my daughter 18 months ago. I am having eight to 10 bloody bowel movements a day with severe cramping, and my gastroenterologist wants to start me on Infliximab. However, I am still breastfeeding, and I am worried about the medication passing to my baby through breast milk.

My colonoscopy last month showed extensive inflammation throughout my colon and rectum. I am also having heavy periods since delivery that last seven to eight days, and my iron level dropped to 8.5, which is causing severe fatigue. The combination of ulcerative colitis symptoms and heavy menstrual bleeding is making me feel weak all the time.

My OB-GYN suggested a Mirena IUD to reduce the bleeding, but my gastroenterologist is concerned about doing any procedures while my colitis is flaring. I have also developed perianal skin tags that are painful during bowel movements. Is it safe to take biologic medications for ulcerative colitis while breastfeeding, and can the IUD help with both conditions?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

It sounds like you are dealing with a very challenging situation, managing both active ulcerative colitis and heavy menstrual bleeding while still breastfeeding.

Infliximab and other biologic medications are often used when ulcerative colitis becomes severe or does not respond well to standard treatments. Available research shows that very little of the drug passes into breast milk, and it is generally considered safe for breastfeeding mothers, with major gastroenterology and lactation guidelines supporting its use.

Treating your colitis aggressively is important not only for your own health but also for your ability to care for your baby. Your heavy periods and low iron levels are likely contributing significantly to your fatigue, and a Mirena IUD (intrauterine device) can be very effective in reducing menstrual bleeding and improving anemia over time. It does not directly affect ulcerative colitis, but it can help improve your overall energy and quality of life.

The concern about procedures during a flare is valid, but an IUD insertion is usually a minor and safe procedure. Your doctors can coordinate the timing once your colitis is better controlled. Managing your iron deficiency with supplements or iron infusions may also be necessary.

I recommend staying in close communication with both your gastroenterologist and your gynecologist so that your treatment plan supports both your colitis and your reproductive health.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.