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IBD: Issues With Menstruation and Contraception

IBD: Issues With Menstruation and Contraception. Menstrual Cycle and Bowel-Pattern Fluctuations. Bowel-pattern fluctuation is common during the menstrual cycle IBD symptoms may increase during the menstrual cycle

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IBD: Issues With Menstruation and Contraception

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  1. IBD:Issues With Menstruation and Contraception

  2. Menstrual Cycle and Bowel-Pattern Fluctuations • Bowel-pattern fluctuation is common during the menstrual cycle • IBD symptoms may increase during the menstrual cycle • Suppression of menses via hormonal contraceptive methods may be considered in presence of debilitating symptoms

  3. Potential IBD-RelatedMenstrual Symptoms • Most frequently reported symptoms • Pelvic pain 52% • Lower back pain 36% • Diarrhea 26% • Irritability 23% • Headache 20% • Incidence of any menstrual symptoms significantly higher for IBD patients than for healthy controls (P.01) Kane SV, et al. Am J Gastroenterol. 1998;93:1867-1872.

  4. IBD: Issues With Menstruation • There is a trend for patients with CD to be affected by IBD symptoms during menstruation to a greater extent than are patients with UC • CD patients experienced diarrhea significantly more often than did controls (P=.004) Kane SV, et al. Am J Gastroenterol. 1998;93:1867-1872.

  5. OCs and IBD Risk • Controversial data • Increased incidence of CD with use of OCs? • OCs related to flare of CD activity? • Newer OCs with lower estrogen content associated with decreasing incidence of CD in women?

  6. CD Flare and OCs 60 50 40 OC use No OC use Patients With Flare (%) 30 20 10 0 0 100 200 300 400 500 Days After Inclusion Adapted from Cosnes J, et al. Gut. 1999;45:218-222 with permission from BMJ Publishing Group.

  7. OCs and IBD Risk 2.5 2.0 BaltimoreF:M incidencefor 20-29-year age group 1.5 OlmsteadF:M incidencefor 20-29-year age group F:M Incidence Ratio 1.0 US OC use(5 million) 0.5 0.0 1960 1965 1970 1975 1980 1985 1990 Adapted from Alic M. Gut. 2000;46:140 with permission from BMJ Publishing Group.

  8. Contraindications for OCs • History of thromboembolic disease • Active obstructive liver disease with elevated liver enzymes • Breast cancer • Smokers over the age of 35 • Pregnancy

  9. IBD and Contraception: Conclusions • OCs should have lower estrogen content (eg, 35 µg) • Avoid for women with known hypercoagulability • Avoid for women with IBD-associated liver disease • Avoid for women with IBD who smoke

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