Colorectal cancer in women: Could you be mistaking your abdominal discomfort for premenstrual syndrome (PMS)?

Both women and men are at risk of developing colorectal cancer. Although men have a slightly higher risk than women (38.2% chance in men and 27.2% chance in women), it is harder to detect colon cancer in women as the symptoms are often dismissed as gynaecological or menstrual issues. These include abdominal bloating, discomfort and gas. As a trained specialist, it is relatively easy for me to distinguish between some colorectal and gynaecological symptoms, but many female patients tend to overlook those warning signs and avoid going to the doctor entirely.

I cannot emphasise enough that early detection is key and no symptom is considered too minor. In this article, I will explore some issues revolving around colorectal cancer in women and give some tips on how women can better distinguish gynaecological and colorectal problems.

What are the symptoms of colorectal cancer in women? 

The symptoms of colorectal cancer are the same in women and men. They include: 

  • Changes in bowel habits that last for more than a few days, including constipation and diarrhoea 
  • The feeling that your bowel is not emptied completely after a bowel movement 
  • Blood in your stool or dark, tarry stool
  • Constant fatigue 
  • Ongoing abdominal pain, cramps, gas or bloating 
  • Vomiting 
  • Unexplained weight loss 

Please take note that in its early stages, colorectal cancer may carry no noticeable symptoms. 

Why are the symptoms of colon cancer often mistaken for gynaecological issues? 

For many women, the less jarring symptoms of colon cancer may be easily mistaken and related to their menstrual cycle. An example would be feeling unusually tired or lacking energy, which is commonplace when women experience premenstrual syndrome (PMS). Symptoms of anaemia are also not abnormal, especially if you lose a lot of blood during your period.

In the same vein, abdominal cramps associated with colon cancer may be mistaken for menstrual cramps, something a lot of women experience during their period. Even if the cramps were to be severe, the possibility of colon cancer wouldn’t be the first thing to come to mind, but rather a gynaecological issue like endometriosis. 

I would advise women to take note of the frequency and timing of their symptoms; the biggest difference and indicator of menstrual symptoms is their cyclical nature, whereas colon cancer symptoms may not follow the same pattern. Even if you’re experiencing symptoms that are aligned with your menstrual cycle, as long as they’re relatively recent, I would recommend speaking to a doctor. You should also speak to a doctor if symptoms that you normally experience around your menstrual period feel different.

Do women carry extra risk factors for colorectal cancer? 

Many of the risk factors of colon cancer for women are the same for women. They include: 


The risk of developing colon cancer increases significantly after the age of 50. For women, the median age of diagnosis is 71. However, the number of patients diagnosed with colon cancer under 50 is increasing. Studies show that between 2012 and 2016, the number of colon cancer patients younger than 50 increased by 2% every year. I should also add that after a woman hits menopause, her risk for all cancers increases. 

Personal or family history of polyps 

If you’ve had benign polyps before, your risk of developing cancerous polyps is much higher. Likewise, if you have a family history of colon cancer or polyps, then your chance of colon cancer increases as well. 

Sedentary and unhealthy lifestyle 

Being sedentary, obese and indulging in lifestyle habits like smoking and drinking puts you at risk of many cancers, including colon cancer. I regularly advise my patients to consume a balanced diet filled with lean protein and plenty of fruits and vegetables, and lead an active lifestyle starting with 150 minutes of physical activity a week. 

Lynch syndrome

Women with Lynch syndrome or hereditary non-polyposis colorectal cancer (HNPCC) face a higher risk of developing cancers like colorectal cancer, ovarian cancer and endometrial cancer. Likewise, women with a history of ovarian, uterine or endometrial cancer may be more prone to developing colon cancer. 

Does Hormonal Replacement Therapy (HRT) reduce a woman’s risk of colorectal cancer? 

Studies show that women who use HRT after menopause have a lower risk of colon cancer, reason being estrogen receptors help with DNA repair. An inability to repair defective DNA is one of the biggest reasons why colon cancer occurs in the first place. By this logic, it also explains why the rate of colon cancer is higher in men. 

With that said, the decision to start HRT should not be solely based on preventing colon cancer. In addition, taking extra estrogen and progesterone after menopause can increase a woman’s risk of lung and breast cancer, heart disease and blood clots. If you’re considering starting HRT for whatever reason, I suggest discussing the advantages and risks with a doctor first. 


  1. Murphy, N., Xu, L., Zervoudakis, A., Xue, X., Kabat, G., Rohan, T. E., Wassertheil-Smoller, S., O’Sullivan, M. J., Thomson, C., Messina, C., Strickler, H. D., & Gunter, M. J. (2017). Reproductive and menstrual factors and colorectal cancer incidence in the Women’s Health Initiative Observational Study. British journal of cancer, 116(1), 117–125.
  2. Siegel, R., Desantis, C., & Jemal, A. (2014). Colorectal cancer statistics, 2014. CA: a cancer journal for clinicians, 64(2), 104–117. 

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