Hormonal contraceptives ease IBD symptoms but may induce intestinal inflammation in women

Women with inflammatory bowel disease (IBD) who use hormonal contraceptives (HCs) appear to be less likely to experience IBD-related symptoms but are more likely to have intestinal inflammation over a year, reports a study.

A team of investigators followed a nested cohort of women, aged 18‒49 years, in the longitudinal Manitoba Living with IBD Study for 1 year, with bi-weekly online surveys. They used a validated measure of disease activity, IBD Symptom Inventory (IBDSI), and obtained stool samples at three time-points to assess the faecal calprotectin (FCAL). Use of HC consisted of oral and vaginal intrauterine devices.

Finally, logistic regression analysis was performed to explore the relationship between HC and IBD-related symptoms (IBDSI >14 for Crohn’s disease, >13 for ulcerative colitis), or inflammation (FCAL >250 ug/g) at any measurement point in the study.

Seventy-one women were included in the analysis, of whom 17 (24 percent) reported using HC in the 1-year period. After adjusting for age, disease type, disease duration, and smoking status, women using HC were found to have lower odds of experiencing increased IBD-related symptoms during the year than those not using HC (adjusted odds ratio [aOR], 0.16, 95 percent confidence interval [CI], 0.02‒0.90).

In contrast, women using HC had a higher likelihood of having inflammation during the year (aOR, 5.7, 95 percent CI, 1.23‒43.6).

“Further work is needed to examine this dichotomous result, potentially examining aspects such as duration of HC use, and the types of HC,” the investigators said.