Contraceptive use among women with inflammatory bowel disease: An updated systematic review

Hormonal contraceptive use by women with inflammatory bowel disease (IBD) might affect risk of adverse outcomes or contraceptive effectiveness. Our objective was to update a previous systematic review on the safety and effectiveness of contraceptive use among women with IBD.

We searched multiple databases from inception through July 15, 2024 for articles on contraception and IBD. Outcomes were IBD disease activity or relapse, other adverse health outcomes, and oral contraceptive (OC) effectiveness. We assessed risk of bias for each study and certainty of evidence for most outcomes.

Fifteen articles met our inclusion criteria; eight were new. Twelve had high risk of bias and three moderate risk. One cohort study found lower odds of IBD symptoms among hormonal contraceptive users compared with non-hormonal users, but higher odds of intestinal inflammation over 1 year. Nine cohort studies found inconsistent results regarding OC use and disease activity or relapse, with increased and decreased associations; most were not statistically significant. Two cohort studies found no statistically significant associations between OC use and venous thromboembolism (VTE) among IBD patients. One study found no statistically significant association between OC use and abnormal cervical smears. Two pharmacokinetic studies suggested no differences in plasma concentrations of steroid hormones after oral ingestion among participants with and without IBD. We found no evidence examining risk of osteoporosis or osteopenia among women with IBD using contraception.

Limited evidence suggested inconsistent findings for increased risk of disease activity or relapse among women with IBD using hormonal contraception (very low certainty of evidence), no differences in other adverse events (very low certainty of evidence), and no differences in contraceptive hormone concentrations.

This updated review expands upon the previous review with eight newly identified studies. However, evidence is still limited in quantity and quality, with inconsistent findings on risk of disease activity or relapse and lack of high-quality evidence on risk of VTE and contraceptive effectiveness. Information in this review may be used by guideline development groups that publish evidence-based contraception guidance for clinicians and patients. Further research can focus on these gaps to provide information needed by women with IBD as they make contraceptive choices.