title: The impact of hormonal contraception on disease-related cyclical symptoms in women with inflammatory bowel diseases.
abstract: BACKGROUND
  Women with inflammatory bowel diseases (IBD) commonly report an increase in their IBD symptoms related to their menstrual cycle. Hormonal contraceptives are safe for women with IBD and frequently used for reproductive planning, but data are lacking on their effect on IBD-related symptoms.
  
  
  METHODS
  We completed a cross-sectional phone survey of 129 women (31% response rate), aged 18 to 45 years, with IBD in an academic practice between March and November 2013. An electronic database query identified eligible women, and we sent an opt-out letter before contact. Questions included demographics, medical and reproductive history, and current/previous contraceptive use. Women were asked if/how their menses affected IBD-related symptoms and if/how their contraceptive affected symptoms. We calculated descriptive statistics and made comparisons by Crohn's disease versus ulcerative colitis on Stata V11.
  
  
  RESULTS
  Participants were predominately white (85%) and college educated (97%), with a mean age of 34.2 (SD 6.2, range 19-45) years. Sixty percent had Crohn's disease, and 30% had IBD-related surgery previously. Half of the participants were parous, and 57% desired future pregnancy. Of the participants, 88% reported current or past hormonal contraceptive use and 60% noted cyclical IBD symptoms. Symptomatic improvement in cyclical IBD symptoms was reported by 19% of estrogen-based contraceptive users and 47% of levonorgestrel intrauterine device users. Only 5% of all hormonal method users reported symptomatic worsening.
  
  
  CONCLUSIONS
  In a subset of women with IBD, 20% of hormonal contraception users reported improved cyclical menstrual-related IBD symptoms. Health care providers should consider potential noncontraceptive benefits of hormonal contraception in women with cyclical IBD symptoms.
authors.affiliation: *Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; †Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and ‡Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Lori M
authors.initials: LM
authors.lastname: Gawron
authors.forename: Adina
authors.initials: A
authors.lastname: Goldberger
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gawron
authors.forename: Cassing
authors.initials: C
authors.lastname: Hammond
authors.forename: Laurie
authors.initials: L
authors.lastname: Keefer
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000503:physiopathology*; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage*; D003424:Crohn Disease / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008597:Menstrual Cycle / Q000187:drug effects / Q000502:physiology*; D008875:Middle Aged; D011247:Pregnancy; D011379:Prognosis; D055815:Young Adult
chemical_list: D003278:Contraceptives, Oral, Hormonal
references.citation: Aliment Pharmacol Ther. 2013 Sep;38(5):501-12
references.pmid: 23855425
references.citation: Aliment Pharmacol Ther. 2012 Jul;36(2):135-44
references.pmid: 22621660
references.citation: Neurology. 1986 Dec;36(12):1607-10
references.pmid: 3785677
references.citation: Aliment Pharmacol Ther. 2013 Oct;38(7):761-71
references.pmid: 23957526
references.citation: Am J Gastroenterol. 1998 Dec;93(12):2426-30
references.pmid: 9860403
references.citation: Am J Gastroenterol. 2006 Jul;101(7):1539-45
references.pmid: 16863558
references.citation: Am J Gastroenterol. 1998 Oct;93(10):1867-72
references.pmid: 9772046
references.citation: Inflamm Bowel Dis. 2014 Jan;20(1):92-102
references.pmid: 24193152
references.citation: Am J Gastroenterol. 2010 Sep;105(9):1994-2002
references.pmid: 20372115
references.citation: Am J Gastroenterol. 2000 Nov;95(11):3165-70
references.pmid: 11095336
references.citation: Gastroenterology. 2012 Jan;142(1):46-54.e42; quiz e30
references.pmid: 22001864
references.citation: CMAJ. 2007 Mar 27;176(7):953-61
references.pmid: 17389445
references.citation: Headache. 2008 Sep;48(8):1186-93
references.pmid: 18819179
references.citation: Turk J Gastroenterol. 2003 Dec;14(4):250-6
references.pmid: 15048600
references.citation: Inflamm Bowel Dis. 2014 Mar;20(3):534-40
references.pmid: 24451220
references.citation: Cochrane Database Syst Rev. 2007 Jul 18;(3):CD001019
references.pmid: 17636650
references.citation: Contraception. 2014 May;89(5):419-25
references.pmid: 24486008
references.citation: Inflamm Bowel Dis. 2007 May;13(5):591-9
references.pmid: 17206690
references.citation: Gut Liver. 2013 Jan;7(1):51-7
references.pmid: 23423645