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The Impact of Menstruation on IBD Symptoms and Contraceptive Considerations

This article explores the relationship between menstruation, inflammatory bowel disease (IBD), and contraception. It highlights how bowel-pattern fluctuations are common during the menstrual cycle, with IBD symptoms often intensifying during this time. Key symptoms reported by patients include pelvic pain, lower back pain, and diarrhea. The article also discusses the potential implications of hormonal contraceptives on IBD, noting the controversial data surrounding the use of oral contraceptives and their potential effects on Crohn's disease. Recommendations for contraceptive use in IBD patients are provided.

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The Impact of Menstruation on IBD Symptoms and Contraceptive Considerations

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  1. IBD:Issues With Menstruation and Contraception

  2. 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

  3. 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.

  4. 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.

  5. 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?

  6. 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.

  7. 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.

  8. Contraindications for OCs • History of thromboembolic disease • Active obstructive liver disease with elevated liver enzymes • Breast cancer • Smokers over the age of 35 • Pregnancy

  9. 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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