Use of contraceptives and risk of inflammatory bowel disease: A nested case-control study

Background: How contraceptive formulation, dose, duration of therapy and mode of delivery affects the risk of inflammatory bowel disease (IBD) is poorly described.
Aim: To examine associations between types of hormonal contraception and development of IBD.
Methods: This was a nested case-control study using IQVIA Medical Research Data. Women aged 15–49 years with a new diagnosis of IBD were matched with up to 6 controls by age, practice and year. Odds ratios (ORs) and 95% confidence intervals (CIs) for incident IBD and use of contraception were calculated.
Results: 4932 incident cases of IBD were matched to 29,340 controls. Use of combined oral contraceptive pills (COCPs) was associated with the development of Crohn’s disease and ulcerative colitis (OR = 1.60 [95% CI: 1.41–1.82] and 1.30 [95% CI: 1.15–1.45], respectively). Each additional month of COCP exposure per year of follow-up increased risk of Crohn’s disease by 6.4% (95% CI: 5.1–7.7%) and ulcerative colitis by 3.3% (95% CI: 2.1–4.4%). Progestogen-only pills had no effect on Crohn’s disease risk (OR = 1.09 [95% CI: 0.84–1.40]) but there was a modest association with ulcerative colitis (OR = 1.35 [95% CI: 1.12–1.64]). Parenteral contraception was not associated with the development of Crohn’s disease or ulcerative colitis (OR = 1.15 [95% CI: 0.99–1.47] and 1.17 [95% CI: 0.98–1.39], respectively).

Conclusions: The authors observed an increase in the risk of inflammatory bowel disease (IBD) with increasing duration of exposure to combined oral contraceptive pills. Progestogen-only pills were not associated with Crohn’s disease but there was a modest association with ulcerative colitis. There was no association between parenteral progestogen-only contraception and IBD. These findings are broadly consistent with a hypothesis that the estrogen component of contraception may drive IBD pathogenesis.

Dr. T.J. Pasvol, The Research Department of Primary Care and Population Health, University College London, London, UK,
E-Mail: thomas.pasvol@nhs.net

DOI: DOI: 10.1111/apt.16647

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