In a previous post, we discussed how inflammatory bowel disease (IBD) can affect your periods. We take this conversation a step further and discuss what women with IBD need to know when choosing contraception.
We’ve enlisted the help of Sara N. Horst, MD, MPH, a gastroenterologist at Vanderbilt University Medical Center, to break down the science and provide actionable tips to help you make the right choice.
Discuss contraception with your gastroenterologist
You may think that your gynecologist is the only doctor who you should talk to about contraception. But if you have IBD, you also need to bring your gastroenterologist into the conversation.
Here is a list of questions from Dr. Horst that you should ask yourself to help you prepare for the discussion:
Do you plan to become pregnant within the next year, the next few years, or not at all?
If you want to prevent pregnancy for the foreseeable future, you can potentially use longer-term methods of contraception (such as an intrauterine device or IUD). While your plans can always change, it’s a good idea to start thinking about this before starting a new type of contraception.
What type of contraception are you considering?
It’s important to be aware of the benefits and drawbacks of each type of contraception before making a decision.
Dr. Horst tells us that, “some studies have shown [that the] oral contraceptive pill (OCP), patch, or ring may have [a] higher risk of unintended pregnancy over long-acting reversible contraceptives such as implants or intrauterine devices.”
Dr. Horst also says that you should consider your “chance of adherence”, or the chance that you will remember to take a daily pill or change the patch on a regular basis.
What is your risk for blood clots?
It’s important to know your risks for deep vein thrombosis (DVT), pulmonary embolism (PE), or other types of blood clots before choosing a method of contraception. If you don’t know your risks, don’t worry! Dr. Horst says this is something your doctor can help you find out.
Why do you need to know your risks for blood clots? According to Dr. Horst, “clotting risk can be increased in some patients with IBD and contraception can sometimes increase this risk as well”, especially contraception that contains estrogen.
How to compare your contraception options if you have IBD
Now that you have prepared your answers to the above questions, let’s compare some of the specific options for contraception.
Luckily, those with IBD are not left completely in the dark on this subject. “The Centers for Disease Control (CDC) has offered guidance based mostly on a systematic review for patients with IBD.”1 says Dr. Horst.
Dr. Horst tells us that the “benefits generally outweigh risks for” some types of contraception. This includes copper IUDs, levonorgestrel-releasing IUDs, and implants.
While the benefits are still greater than the risks for most people, Dr. Horst cautions that the medroxyprogesterone acetate (DMPA) injection should be “used with caution in patients with bone loss (osteopenia/osteoporosis).”
Another lower-risk option are progestin-only birth control pills, sometimes called the “minipill”.
According to Dr. Horst, there are certain considerations for some of the other forms of contraception. For example, vaginal rings and combined hormonal contraceptives like oral contraceptive pills (OCP) should be “used with caution in those at risk for clot.”
Another important point that Dr. Horst reiterates is that barrier methods like condoms “may be less effective unless used correctly for pregnancy” and they do not protect against STDs.
Will certain types of contraception affect your IBD?
Now that you have an idea of what types of contraception may be best for you, it’s important to also take your IBD into consideration before making a decision.
When it comes to the influence of contraception on IBD, “studies are conflicted”, says Dr. Horst. She goes on to say that, “a few smaller studies suggested increased risk of flare in IBD”, but “newer data compiled in a systematic review did not find increased risk of flare.”1
Furthermore, a large nationwide registry study which looked at the influence of contraception on those with ulcerative colitis (UC), “did not find increased risk of disease progression in UC.”3
The bottom line, according to Dr. Horst, is that “more recent data suggests contraception such as OCP does not increase the risk of flare but likely more research is needed!”
If you have IBD, it’s important to prepare for a conversation about contraception with your gastroenterologist. You should ask them to help you understand your unique risks and benefits when it comes to choosing the contraception option that is right for you.
- Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep. 2016;65:1.
- Gawron L, Sanders J, Steele K, Flynn A. Reproductive Planning and Contraception for Women with Inflammatory Bowel Diseases. Inflammatory Bowel Diseases 2016; 22:459.
- Khalili H, Neovius M, Ekborn A, et al. Oral Contraceptive Use and Risk of Ulcerative Colitis Progression: a Nationwide Study.
- Limdi J, Farraye F, Cannon R, et al. Contraception, Venous Thromboembolism, and Inflammatory Bowel Disease: What Clinicians (and Patients) Should Know. Inflammatory Bowel Diseases 2019; 25:1603.
- Nirupama Bonthala, Sunanda Kane. Updates on Women’s Health issues in Patients with Inflammatory Bowel Disease. Curr Treat Options Gastro 2018;16:86.
Katelyn Collins, RD is a registered dietitian and health writer specializing in digestive health. Katelyn’s personal experience with a digestive condition first sparked her passion for nutrition and health. Since then, she has been a vocal advocate for the digestive health community and has dedicated her own