Inflammatory bowel disease and oral contraception

Case and controlled studies show a correlation between the use of hormonal contraceptives and the occurrence of enterocolitis. The studies are categorized as showing "definite" "probable" or "possible" correlation. Among the cases of ischemic colitis or enteritis were 7 probable and 40 possible correlations with oral contraceptives. The pathogenetic mechanism for ischemic enterocolitis may be the hypercoagulability and tendency toward intravascular thrombosis which are observed during estrogen therapy. Another form of enterocolitis studies was 1 resembling Crohns disease. Different studies of patients with Crohns disease showed that 75% 64% and 63% respectively were using oral contraceptives at the time of diagnosis. 1 study determined that the risk of Crohns disease increased by a factor of 8 following 5 years of oral contraceptives and by a factor of 4 following 1 year. The risk returned to that of the control group 4 years after discontinuation of the contraceptive. The case studies of Crohns disease include 3 having a definite correlation with contraceptives 7 with a probable correlation and 3 with a possible correlation. Ischemic and/or immunologic pathogenesis are possibilities being considered for contraceptive-induced Crohns disease. There were 21 additional case studies of interocolitis which either showed characteristics of both the ischemic and Crohns forms or which resembled neither. Of these 2 showed a definite correlation with the use of oral contraceptives 7 a probable correlation and 12 a possible correlation. Any female patient of childbearing age with chronic inflammatory bowel disease should be asked whether she is taking an oral contraceptive and if so should discontinue it immediately unless the disease can be traced to another pathogen. If the disease disappears after discontinuation of the drug the diagnosis of a connection to the contraceptive will be supported. Any patient with chronic inflammatory bowel disease of the ischemic or Crohns type should be discouraged from beginning hormonal contraceptive therapy.