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IBD: Issues With Menstruation and Contraception . Menstrual Cycle and Bowel-Pattern Fluctuations. Bowel-pattern fluctuation is common during the menstrual cycle IBD symptoms may increase during the menstrual cycle

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IBD:Issues With Menstruation and Contraception


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Menstrual Cycle and Bowel-Pattern Fluctuations

  • Bowel-pattern fluctuation is common during the menstrual cycle

  • IBD symptoms may increase during the menstrual cycle

  • Suppression of menses via hormonal contraceptive methods may be considered in presence of debilitating symptoms


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Potential IBD-RelatedMenstrual Symptoms

  • Most frequently reported symptoms

    • Pelvic pain 52%

    • Lower back pain 36%

    • Diarrhea 26%

    • Irritability 23%

    • Headache 20%

  • Incidence of any menstrual symptoms significantly higher for IBD patients than for healthy controls (P.01)

Kane SV, et al. Am J Gastroenterol. 1998;93:1867-1872.


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IBD: Issues With Menstruation

  • There is a trend for patients with CD to be affected by IBD symptoms during menstruation to a greater extent than are patients with UC

  • CD patients experienced diarrhea significantly more often than did controls (P=.004)

Kane SV, et al. Am J Gastroenterol. 1998;93:1867-1872.


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OCs and IBD Risk

  • Controversial data

  • Increased incidence of CD with use of OCs?

  • OCs related to flare of CD activity?

  • Newer OCs with lower estrogen content associated with decreasing incidence of CD in women?


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CD Flare and OCs

60

50

40

OC use

No OC use

Patients With Flare (%)

30

20

10

0

0

100

200

300

400

500

Days After Inclusion

Adapted from Cosnes J, et al. Gut. 1999;45:218-222 with permission from BMJ Publishing Group.


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OCs and IBD Risk

2.5

2.0

BaltimoreF:M incidencefor 20-29-year age group

1.5

OlmsteadF:M incidencefor 20-29-year age group

F:M Incidence Ratio

1.0

US OC use(5 million)

0.5

0.0

1960

1965

1970

1975

1980

1985

1990

Adapted from Alic M. Gut. 2000;46:140 with permission from BMJ Publishing Group.


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Contraindications for OCs

  • History of thromboembolic disease

  • Active obstructive liver disease with elevated liver enzymes

  • Breast cancer

  • Smokers over the age of 35

  • Pregnancy


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IBD and Contraception: Conclusions

  • OCs should have lower estrogen content (eg, 35 µg)

  • Avoid for women with known hypercoagulability

  • Avoid for women with IBD-associated liver disease

  • Avoid for women with IBD who smoke


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