Use of contraceptives and risk of inflammatory bowel disease: a nested case–control study

• Published in: Alimentary pharmacology & therapeutics Vol. 55; no. 3; pp. 318 - 326
• Main Authors: Pasvol, Thomas Joshua, Bloom, Stuart, Segal, Anthony Walter, Rait, Greta, Horsfall, Laura
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.02.2022
• Subjects: Adolescent; Adult; Birth control; Case-Control Studies; Colitis, Ulcerative - chemically induced; Colitis, Ulcerative - epidemiology; Contraception; Contraceptive Agents; Contraceptives; Crohn Disease - chemically induced; Crohn Disease - diagnosis; Crohn Disease - epidemiology; Crohn's disease; Crohns disease; Estrogens; Female; Humans; Inflammatory bowel disease; Inflammatory Bowel Diseases; Intestine; Medical research; Middle Aged; Oral contraceptives; Ulcerative colitis; Young Adult
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.16647

Summary 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 six controls by age, practice and year. Odds ratios (OR) and 95% confidence intervals (95% CI) 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 [1.41‐1.82] and 1.30 [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% (5.1%‐7.7%) and ulcerative colitis by 3.3% (2.1%‐4.4%). Progestogen‐only pills had no effect on Crohn's disease risk (OR 1.09 [0.84‐1.40]) but there was a modest association with ulcerative colitis (OR 1.35 [1.12‐1.64]). Parenteral contraception was not associated with the development of Crohn's disease or ulcerative colitis (OR 1.15 [0.99‐1.47] and 1.17 [0.98‐1.39], respectively). Conclusions We observed an increase in the risk of IBD with increasing duration of exposure to COCPs. 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 oestrogen component of contraception may drive IBD pathogenesis. Nested case‐control study including 4932 IBD cases matched to 29 340 controls. Use of oestrogen‐containing contraception was associated with development of both CD and UC. Progestogen‐only pills were not associated with CD but there was a modest association with UC. Parenteral progestogen‐only methods were not associated with IBD. The oestrogen component of contraception may drive IBD pathogenesis.