The names don’t exactly roll off the tongue: Crohn’s disease and ulcerative colitis. But these two types of inflammatory bowel disease (IBD) are common, painful and serious, affecting more than 3 million Americans. While equal numbers of men and women suffer, these conditions are particularly tough on women, says Ramona Rajapakse, MD, a Mather Hospital gastroenterologist specializing in IBD.

The good news: There are very effective treatments for these conditions. But understanding the gender effect is key to proper diagnosis and effective treatment — and unfortunately, many women don’t recognize that they’re carrying an extra burden from the disease. Even doctors may not focus on it, which is why Dr. Rajapakse says it’s important to know that Crohn’s disease and ulcerative colitis pose five unique challenges for women:

IBD occurs when the body’s immune system mistakenly attacks cells in the gastrointestinal tract, leading to inflammation. Symptoms depend on how severe the inflammation is and where in your GI tract it occurs, but you may have diarrhea, rectal bleeding, abdominal pain and cramping, fatigue and weight loss. “These can be exhausting, debilitating illnesses,” says Dr. Rajapakse. “Severe cases can be life-threatening, but even a mild version can have a big impact on your quality of life.” Women often find that their symptoms worsen during menstruation, says Dr. Rajapakse. Adding insult to injury, women with IBD are more likely than other women to suffer from premenstrual headaches and cramps.

You probably already know that menstrual bleeding increases the odds of becoming anemic. That’s because blood loss during your period carries iron out of your body, which leaves red blood cells less able to deliver oxygen to tissues from your head to your toes. The result: You feel tired and short of breath. Iron-deficiency anemia is even more likely for women with IBD, because it can cause digestive tract bleeding; the disease can also impair your body’s ability to absorb iron. Symptoms of IBD, like diarrhea and cramping, also may make it harder for you to eat and get the nutrients you need to function at your peak.

3. Trouble getting and staying pregnant

Uncontrolled inflammation can make it harder for sperm to reach the egg — and if IBD flares during pregnancy, it may increase the risk of complications. “When young women with active disease tell me they want to get pregnant, the first thing I tell them is that they have got to get their inflammation under control,” says Dr. Rajapakse. “That’s when their fertility will improve.” Fortunately, she says, most medications used to treat inflammation are safe for pregnant women.