People with inflammatory bowel disease (IBD) have an increased risk of blood clots due to having inflammation. Other risk factors can include things like smoking, using steroids, and being overweight. Most forms of hormonal contraception (birth control pills) have estrogen which can also increase clotting risk. We studied whether people with IBD that had risk factors for clotting were also put on birth control pills. This could be an opportunity for prevention (as other birth control options are available that do not increase clotting risk). Over 3000 women with IBD completed surveys asking about birth control methods and other risk factors for clotting. Birth control pills were used in over 30% of women with IBD. Women with risk factors for clotting (smoking, steroids, obesity) still had the same rates of birth control pill use as those without these risk factors. Based on this study, it is important for GI doctors to ask patients about birth control use and find out whether they also have other risk factors for a blood clot. By changing the form of contraception, this could prevent a complication of a blood clot in the future.

Women with inflammatory bowel disease, or IBD, frequently experience changes in abdominal symptoms (e.g. bowel frequency and pain) in relation to the different stages of the menstrual cycle. This may be related to the hormonal changes during the various stages of the cycle. Menopause is the state when the menstrual cycles and associated hormonal fluctuations stop permanently. This can occur naturally in relation to age or can be secondary to surgery or medical therapy that impact the reproductive organs. The impact of menopause on disease activity of patients with IBD is unknown. We assessed the disease characteristics of menopausal women within the CCFA Partners network. We also evaluated the impact of menopause and hormone replacement therapy, or HRT, on disease activity. A total of 2252 women were included in this study. Of these, 799 indicated that they had gone through menopause. The majority of post-menopausal women reported natural menopause with an average age of 50 in both Crohn's disease and ulcerative colitis patients. About half the post-menopausal women indicated a current or prior use of HRT. The post-menopausal state was associated with increased disease activity in both Crohn's disease and ulcerative colitis patients. This association was more prominent for women at age = 45 compared to those older than 45 years. Interestingly, the use of HRT did not impact disease activity at any age. Those findings suggest that the cessation of hormonal fluctuation in post-menopausal women as well as the age play role in predicting disease activity in women with IBD.

In a study of over 1200 females with inflammatory bowel disease, or IBD, more than half reported worsening disease symptoms during menstrual periods. Women who reported worse symptoms during menses were younger than those who did not. About 10% said that hormonal contraceptive agents improved their symptoms, but about 8% said that hormonal contraceptive agents made their symptoms worse. Among women who had reached menopause, an older age of IBD onset was associated with worse symptoms after menopause. This study shows that symptom severity is influenced during times of hormone changes in many women with IBD and that duration of IBD may play a role in hormonally mediated symptoms.