Additional harms of contraceptives

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----- Forwarded Message -----From: Minh Nguyen <komei57@...>Deacon Bruno <deacon_bruno@...>

Sent: Monday, May 21, 2012 11:40 PMSubject: Interesting!

This is from the MEDPAGE. Another interesting side effect of the pill that I was not aware of.

God bless,

Minh

2 Medical News: Estrogen a Culprit in Inflammatory Bowel Disease - in Meeting Coverage, DDW from Me…

www.medpagetoday.com/MeetingCoverage/DDW/32794?utm_content= & utm_medium=email & utm_cam… 1/2

Action Points

Note that these studies were published as

abstracts and presented at a conference. These

data and conclusions should be considered to

be preliminary until published in a peer-reviewed

journal.

Postmenopausal women who take hormone

replacement therapy (HRT) are at increased risk

for developing ulcerative colitis, whereas younger

women using oral contraceptives are more likely

to develop Crohn's disease.

Note that it is unknown why the effects on

inflammatory bowel disease would be different

for estrogen levels associated with oral

contraceptives compared with those with

hormone replacement therapy.

Estrogen a Culprit in Inflammatory Bowel Disease

By Walsh, Staff Writer, MedPage Today

Published: May 20, 2012

Reviewed by Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

and Dorothy Caputo, MA, BSN, RN, Nurse Planner

SAN DIEGO -- Postmenopausal women who

take hormone replacement therapy (HRT) are

at increased risk for developing ulcerative

colitis, whereas younger women using oral

contraceptives are more likely to develop

Crohn's disease, a researcher said here

during a session on inflammatory bowel

disease.

Among current users of HRT, there was a

74% increase in risk of ulcerative colitis (HR

1.74, 95% CI 1.09 to 2.77), compared with

women who had never taken hormone

replacements, according to Hamed Khalili,

MD, of Massachusetts General Hospital in

Boston, and colleagues.

But among premenopausal women, the agedadjusted hazard ratio for Crohn's disease was

2.65 (95% CI 1.53 to 4.60) among those

currently on oral contraceptives compared

with those who had never used these agents, Khalili reported here during the annual Digestive

Disease Week.

Estrogen is thought to have various effects on the intestinal barrier, modifying colonic permeability

and mediating inflammation through effects on estrogen receptors, which could lead to changes in

gut immunity.

However, previous research has been limited to retrospective analyses and small numbers, so

Khalili and colleagues examined rates of ulcerative colitis and Crohn's disease in the Nurses'

Health Study, which began enrolling women in 1976.

For the postmenopausal HRT analysis, they included 108,589 women whose median age was 54

and who had no history of either ulcerative colitis or Crohn's disease.

During 1,891,153 person-years of follow-up, there were 138 new cases each of Crohn's disease

and ulcerative colitis.

Risk of ulcerative colitis was increased not only among current users of HRT, but also among

former users (HR 1.68, 95% CI 1.05 to 2.71).

The risk of ulcerative colitis was higher with longer use of HRT (P=0.02 for trend), but that risk

dropped based on the length of time the woman had stopped HRT.

The adjusted risk was 2.11 (95% CI 1.16 to 3.84) among those who had not been taking the

hormones for 5 years or less. The adjusted risk was 1.27 (95% CI 0.72 to −2.24) for those who had

stopped more than 5 years previously.

The type of hormone therapy used did not appear to influence ulcerative colitis risk.

Among these older women, there was no association between HRT and Crohn's disease (HR 1.19,

95% CI 0.78 to 1.81), Khalili said.

In the oral contraceptive analysis, Khalili and colleagues followed 232,730 women for a total of

more than 5 million person-years.

During that time, there were 309 cases of Crohn's disease and 362 cases of ulcerative colitis.

For Crohn's disease, the risk remained elevated even among past users of oral contraceptives (HR

1.50, 95% CI 1.13 to 1.98).

After adjustment for multiple reproductive factors including age at menarche, parity, and5/21/12 Medical News: Estrogen a Culprit in Inflammatory Bowel Disease - in Meeting Coverage, DDW from Me…

www.medpagetoday.com/MeetingCoverage/DDW/32794?utm_content= & utm_medium=email & utm_cam… 2/2

Khalili had no financial disclosures.

One co-author is a consultant to Policy Analysis, and a second is a consultant for Bayer AG, Millennium

Pharmaceuticals, and Pfizer.

menopause status, the multivariate hazard ratios for Crohn's disease remained at 2.66 (95% CI

1.52 to 4.64) for those currently taking oral contraceptives and 1.40 (95% CI 1.06 to 1.86) for

those who had done so in the past.

In contrast to the HRT study, this analysis found no link between oral contraceptives and risk for

ulcerative colitis, with a multivariate adjusted hazard ratio of 1.22 (95% CI 0.71 to 2.09).

Together, these two analyses suggest that estrogen influences the biological pathways that lead to

inflammatory bowel disease, Khalili said.

As to why the effects would be different for estrogen levels associated with oral contraceptives

compared with those with hormone replacement therapy, he observed that "estrogen has

pleiotropic effects," and there may be different risk factors at different ages, but said he had no

specific mechanism to offer.

One implication of the study was that clinicians might advise women who have a strong family

history of Crohn's disease to use other forms of birth control to minimize their chance of developing

the condition.

Primary source: Digestive Disease Week

Source reference:

Khalili H, et al "Hormonal replacement therapy and risk of ulcerative colitis and Crohn's disease among

postmenopausal women: results from a large prospective cohort of U.S. wome