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IBD Awareness Week: IBD and BCP

I came across this question this morning on Crohnology:

Has anyone had difficulty with any types of birth control during a flare?

It got me thinking about if there's a relationship between IBD and birth control pills.  I've read research articles on how female hormones and monthly menstrual cycles can affect digestive symptoms, but that was mostly in people with IBS.  Before I continue, I want to preface my post that I'm not trying to cause any alarm, rather discuss my personal experience in this area and go over a few research studies on the topic.

I've been living a bit of a confused life as a person with Crohn's disease the past year and a half or so.  See, I had my first child in April of 2011.  Before getting pregnant I was in a minor flare up and got back together with my old friends "the biologics," this time in the form of Cimzia.  

Syringe courtesy of the OXO corporation, makers of fine kitchen spatulas.
I stayed on Cimzia until week 30 of my pregnancy, when I and my GI doc decided it was worth the risk of a flare to ensure the drug would be out of my baby's system at birth (see recent study on that idea).  I was prescribed a lower dose of budesonide to ride out the remaining 10 weeks.  I stopped taking it while in the hospital.

Before I decided to reproduce, I was on "the pill" since I was roughly 19 years old.  I was diagnosed with Crohn's at 26.  I'll be 37 in 25 days (but who's counting).

Since my daughter was born, I've been in remission and have not resumed any medications.  My GI doc wanted me to go back on Cimzia as a maintenance medication, but I balked at that idea and said I wanted to see how things went before I went back to the big guns. Plus, I was breastfeeding. The research says that roughly 50% of women will experience an IBD flare either during or shortly after pregnancy.  Anecdotally, I've heard from a few others on various Facebook IBD groups that there are other people who share my story of post-pregnancy remission. Even though being a new mom can be incredibly stressful.

Because I'm a research dork, I went to PubMed after reading the above Crohnology question and I searched for "oral contraceptive IBD" and found a 2008 meta-analysis published in the American Journal of Gastroenterology, which is a pretty high ranking GI journal, on this very topic.  For those of you who don't share in my geekdom, a meta-analysis is a review of all of the studies on a specific topic to date.  So the authors of this study went over 14 studies that included almost 76,000 women with IBD, roughly half having taken oral contraceptives and half not. So what did they find?
  1. Women who took oral contraceptives were 1.5 times more likely to develop IBD than those who did not.
  2. The relative risk of developing Crohn's Disease increased the longer the woman took oral contraceptives.
  3. The risk for developing IBD was no longer statistically significant once the oral contraceptive was stopped.

Conclusion?  There is a small, but significant, increase in risk of developing IBD in women who use oral contraceptives.  A similar meta-analysis performed in 1995 reported similar findings.

All is well!
I want to reiterate that this post isn't meant to cause alarm, and as with any research studies just because a relationship exists doesn't mean it is going to apply to you, personally.  I haven't gone back on "the pill" and I'm curious if this is contributing to my prolonged, med-free remission.  A 2010 review article reports that there's no risk of relapse from oral contraceptive use, so who knows. 

So, as with a lot of research out there, there is conflicting evidence.  This happens for a variety of reasons, including the way studies are designed, the size of the study's sample, and the quality of the research methods used.  It's enough to drive you to drink sometimes.

Until today, I was assuming pregnancy did something to reboot my immune system.  There is 1 study that reports that the relapse rate 3 years after pregnancy in people with Crohn's is lower than 3 years prior.  So that could be it. I thought maybe the hormonal changes from breastfeeding for 14 months did something, but I stopped that almost 6 months ago and except for a few minor bumps in the road, my remission is still going strong.  Except now I've jinxed myself with this post.  Time to go knock on some wood.

What do you think about these findings?  What has your experience been with IBD and hormones, either via contraceptives or monthly cycle?

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