Hormonal Birth Control & IBD – Is There A Link?

Having written routinely over the last year both on the topics of Women’s Health and Digestive Health, it only seemed fitting that I broach a topic that intersects them both.

This potential area of exploration was brought to my attention by a colleague in the healthcare field who had asked if I was aware of any connection between hormonal birth control and gut health outcomes.

I wasn’t, but it only took a quick glance at some data to realize this was a something worth exploring further.

According to Statistics Canada data, hormonal contraceptives are the most used prescription pharmaceutical for women in both the 25-44 and  15-24 demographic.

That’s a pretty significant data point, but speaks nothing of the connection between contraception and digestive health.

Let’s take a closer look to see if there’s anything there.

Birth Control And The Gut

Hormonal birth control includes synthetic forms the hormones estrogen and progestin ( either both or just progestin, and the distinction may matter – read on to learn why)  that lead to physiological alterations that greatly reduce the chance of becoming pregnant ( preventing ovulation chief among them).

Emerging evidence suggests that there is a bi-directional relationship between estrogen and our gut bacteria that is often referred to as the estrogen-gut axis.

The use of oral estrogen may alter gut permeability and certain immune inflammatory responses.

Although much more work needs to be done in this area, some preliminary studies also suggest that progesterone may alter gut permeability and populations of certain bacteria.

Gut permeability, for those that may be unfamiliar,  refers to how tightly woven the gut lining is.

A healthy gut lining is generally minimally permeable and prevents unwanted compounds or toxins from penetrating the tissues of the GI tract where they may cause damage or inflammation.

As a result, increased permeability has been linked with inflammatory bowel conditions.

With that in mind, there is certainly some potential scientific basis for a theoretical relationship between birth control and the human gut.

This is where it gets a bit more interesting.

In a 2013 paper out of the Gut Journal the investigators uncovered observational data to suggest an association between oral contraceptive use and the risk of Crohn’s disease (an inflammatory bowel disease).

In other words, women who used oral contraceptives were more likely to have Crohn’s disease.

Women who both used oral contraceptives and smoked were at an increased risk of ulcerative colitis, another inflammatory bowel condition.

While we certainly cannot draw definitive conclusions from these observational findings, some members of the medical community seem to cautiously suggest that there may be an increased risk for developing inflammatory bowel disease in those who use birth control.

What About If You Already Have Inflammatory Bowel Disease?

According to CDC statistics, about 3 million Americans (1% of the population) are living with an IBD diagnosis and the condition is more common in women than it is in men.

Yet the overwhelming majority (80%+) of women living with IBD who started on hormonal contraceptives reported no changes in symptoms.

But there’s some nuance here.

A 2016 paper out of the Gastroenterology journal identified that women living with Crohn’s Disease who used combination contraception (both estrogen + progestin) for >3 years, were more likely to require a surgical intervention for Crohn’s than those who did not.

This association was not observed for progestin-only contraception and opens the door for a discussion in the medical community regarding the suitability of estrogen-based contraception in women living with Crohn’s disease.

Final Thoughts

While far from definitive in any capacity, I sincerely hope you’ve found today’s post insightful at the very least.

If the topics of gut health and women’s health are of general interest to you, I encourage you to click through and read my other content in these subject areas – both of which are subjects that I spend a great deal of time thinking about, researching and helping my clients conquer.

Until then,

Andy De Santis RD MPH