Colon to Rectum
J Clin Gastroenterol. 2024;58(3):271–6
Hormonal contraceptives reduce active symptomatic disease but may increase intestinal inflammation in IBD
Background: Among women of reproductive age with inflammatory bowel disease (IBD), the authors aimed to assess the relationship of hormonal contraceptives (HCs) with IBD-related symptoms, and intestinal inflammation.
Methods: A nested cohort of women in the longitudinal Manitoba Living with IBD Study, ages 18 to 49, were followed for 1 year, with bi-weekly online surveys. This included a validated measure of disease activity; IBD Symptom Inventory (IBDSI), and stool samples obtained at 3 time-points for assessment of fecal calprotectin (FC). Use of HC included oral and vaginal intrauterine devices. Logistic regression analysis was used to assess the association between HC and IBD-related symptoms (IBDSI > 14 for Crohn’s disease, > 13 for ulcerative colitis), or inflammation (FC > 250 µg/g) at any measurement point in the study.
Results: Of 71 women, 17 (24%) reported taking HC in the 1-year period. Adjusting for age, disease type, disease duration, and smoking status, the odds of having increased IBD-related symptoms (IBDSI) during the year were lower for women using HC compared with women not using HC (adjusted odds ratio [aOR] = 0.16, 95% confidence interval [CI]: 0.02–0.90). Conversely, women using HC were more likely to have inflammation during the year (aOR = 5.7, 95% CI: 1.23–43.6).
Conclusions: Hormonal contraceptive (HC) use among women with inflammatory bowel disease (IBD) was associated with a lower likelihood of IBD-related symptoms but a higher likelihood of experiencing intestinal inflammation (fecal calprotectin > 250 µg/g) over 1 year. Further work is needed to examine this dichotomous result, potentially examining aspects such as duration of HC use, and the types of HC.