P677 Hormonal contraceptive use is not associated with increased disease activity in IBD women - Results from an online survey
A. de Lima*1, L. de Groot2, C.J. van der Woude1
1Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands, 2ErasmusMC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
The effect of hormonal contraception (HC) on disease activity in women with inflammatory bowel disease (IBD) is still unclear. The primary aim of this study was to assess the effect of HC on IBD activity. Secondary aims included (1) the efficacy of oral hormonal contraceptives (OHC) in IBD women in terms of unplanned pregnancies and (2) the occurrence of venous thromboembolism (VTE) in IBD women using HC.
We conducted an online survey between October 2014 and November 2014 at the patient panel of the Dutch IBD patient association (CCUVN). IBD women between 15 and 45 years of age were eligible. Data on demographics, disease characteristics, contraception use, disease activity and the occurrence of VTE were collected. Past year prednisone use, hospital admittance for IBD, inflammation at endoscopy were used to assess disease activity.
The survey was completed by 194 out of 282 (69% response) women (122 CD (62.9%), 67 UC (34.6%), 5 IBDU (2.6%)). Median age was 32 yrs (IQR: 26-38) and median disease duration 5 yrs (IQR: 2-10). In the past year 142 women (73.2%) used any form of contraceptives (44 (31.0%) barrier contraceptives, 72 (50.7%) OHC and 37 (26.1%) other HC or intrauterine device). Between HC users and non-HC users in the past year, there was no difference in prednisone use (19 (9.8%) vs 33 (17.0%), p=0.32), hospital admittance for IBD flares (13 (6.7%) vs 19 (9.8%), p=0.85) or inflammation seen at endoscopy (24 (12.4%) vs 41 (21.1%), p=0.66) in the past year. Abdominal complaints during menses less often occurred in IBD women using HC versus non-HC users (53 (27.3%)vs 93 (47.9%), p=0.04). Out of the past year OHC users, 18 (25%) reported use of extra barrier contraceptives in times of active disease. Six women (3.6%) reported an unplanned pregnancy ever despite OHC use. These conceptions did not occur in periods of self-reported active disease. VTE occurred in 9 (4.6%) women of which 3 women had confirmed underlying thrombophilia. VTE without thrombophilia was not significantly associated with ever OHC use (p=1.00). VTE occurred in times of active disease in 4 women (66.7%).
This study shows HC is not associated with increased risk of disease activity over the course of one year. Furthermore, unplanned pregnancies despite OHC use in this study were not associated with IBD disease activity at time of conception. VTE was not associated with ever OHC use in this study. However, to adequately assess the efficacy and safety of HC in IBD women a controlled study will be needed to put these data into perspective.