Zapata Lauren B, Snyder Emily M, Tepper Naomi K, Curtis Kathryn M
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States; United States Public Health Service Commissioned Corps, Atlanta, GA, United States.
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States.
Contraception. 2025 Jul 18:111038. doi: 10.1016/j.contraception.2025.111038.
Hormonal contraceptive use by women with inflammatory bowel disease (IBD) might affect risk of adverse outcomes or contraceptive effectiveness. Our objective was to update a previous systematic review on the safety and effectiveness of contraceptive use among women with IBD.
We searched multiple databases from inception through July 15, 2024 for articles on contraception and IBD. Outcomes were IBD disease activity or relapse, other adverse health outcomes, and oral contraceptive (OC) effectiveness. We assessed risk of bias for each study and certainty of evidence for most outcomes.
Fifteen articles met our inclusion criteria; eight were new. Twelve had high risk of bias and three moderate risk. One cohort study found lower odds of IBD symptoms among hormonal contraceptive users compared with non-hormonal users, but higher odds of intestinal inflammation over 1 year. Nine cohort studies found inconsistent results regarding OC use and disease activity or relapse, with increased and decreased associations; most were not statistically significant. Two cohort studies found no statistically significant associations between OC use and venous thromboembolism (VTE) among IBD patients. One study found no statistically significant association between OC use and abnormal cervical smears. Two pharmacokinetic studies suggested no differences in plasma concentrations of steroid hormones after oral ingestion among participants with and without IBD. We found no evidence examining risk of osteoporosis or osteopenia among women with IBD using contraception.
Limited evidence suggested inconsistent findings for increased risk of disease activity or relapse among women with IBD using hormonal contraception (very low certainty of evidence), no differences in other adverse events (very low certainty of evidence), and no differences in contraceptive hormone concentrations.
This updated review expands upon the previous review with eight newly identified studies. However, evidence is still limited in quantity and quality, with inconsistent findings on risk of disease activity or relapse and lack of high-quality evidence on risk of VTE and contraceptive effectiveness. Information in this review may be used by guideline development groups that publish evidence-based contraception guidance for clinicians and patients. Further research can focus on these gaps to provide information needed by women with IBD as they make contraceptive choices.
炎症性肠病（IBD）女性使用激素避孕可能会影响不良结局风险或避孕效果。我们的目的是更新先前关于IBD女性使用避孕方法的安全性和有效性的系统评价。
我们检索了多个数据库，从建库至2024年7月15日，查找关于避孕与IBD的文章。结局指标为IBD疾病活动或复发、其他不良健康结局以及口服避孕药（OC）的有效性。我们评估了每项研究的偏倚风险以及大多数结局的证据确定性。
15篇文章符合我们的纳入标准；其中8篇是新发现的。12篇存在高偏倚风险，3篇存在中度偏倚风险。一项队列研究发现，与非激素使用者相比，激素避孕使用者出现IBD症状的几率较低，但1年内肠道炎症的几率较高。9项队列研究发现，关于OC使用与疾病活动或复发的结果不一致，关联有增加和减少；大多数无统计学意义。两项队列研究发现，IBD患者中OC使用与静脉血栓栓塞（VTE）之间无统计学意义的关联。一项研究发现，OC使用与宫颈涂片异常之间无统计学意义的关联。两项药代动力学研究表明，有IBD和无IBD的参与者口服摄入甾体激素后，血浆浓度无差异。我们未发现有证据研究使用避孕方法的IBD女性中骨质疏松或骨质减少的风险。
有限的证据表明，关于IBD女性使用激素避孕导致疾病活动或复发风险增加的研究结果不一致（证据确定性极低），其他不良事件无差异（证据确定性极低），且避孕激素浓度无差异。
本次更新的综述在先前综述的基础上增加了8项新发现的研究。然而，证据在数量和质量上仍然有限，关于疾病活动或复发风险的研究结果不一致，且缺乏关于VTE风险和避孕效果的高质量证据。本综述中的信息可供为临床医生和患者发布循证避孕指南的指南制定小组使用。进一步的研究可以聚焦于这些空白领域，为IBD女性在做出避孕选择时提供所需信息。
