Hormonal Contraceptives and the Risk of Inflammatory Bowel Disease

Pavankumar Kamat


October 29, 2021


  • Longer exposure to combined oral contraceptive pills (COCPs), but not to progestogen-only pills (POPs), was associated with an increased risk of Crohn's disease (CD).

  • Exposure to COCPs and POPs was associated with a moderate increase in the risk of ulcerative colitis (UC).

  • No association was seen between the use of parenteral progestogen-only contraception and inflammatory bowel disease (IBD).

Why this matters

  • Findings shed light on the potential biological mechanisms involved in the pathogenesis of IBD, emphasising the significance of future studies focusing on specific exogenous sex hormones.

Study design

  • This nested case-control study used data from the IQVIA Medical Research Database.

  • 2231 and 2701 incident cases of CD and UC were matched with 13,279 and 16,061 control participants, respectively.

  • The association between various types of contraceptives and the risk of IBD was evaluated.

  • Funding: Charles Wolfson Charitable Trust and others.

Key results

  • Use of COCPs was associated with a higher risk of (adjusted OR [aOR]; 95% CI):

    • CD (1.60; 1.41-1.82); and

    • UC (1.30; 1.15-1.45).

  • Compared with non-users, each additional month per year of COCP exposure increased the risk of CD by 6.4% (95% CI, 5.1-7.7%) and the risk of UC by 3.3% (2.1-4.4%%).

  • Use of POPs was not associated with a higher risk of CD (aOR, 1.09; 95% CI, 0.84-1.40) but a modest association was seen with UC (aOR, 1.35; 95% Cl, 1.12-1.64).

  • Parenteral progestogen-only contraception was not linked to an increased risk of (aOR; 95% CI):

    • CD (1.15; 0.99-1.47); and

    • UC (1.17; 0.98-1.39).


  • Potential misclassification of contraceptive exposure.


Pasvol TJ, Bloom S, Segal AW, Rait G, Horsfall L. Use of contraceptives and risk of inflammatory bowel disease: A nested case-control study. Aliment Pharmacol Ther. 2021 Oct 18 [Epub ahead of print]. doi: 10.1111/apt.16647. PMID: 34662440  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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