Specialists have produced evidence-based guidance on contraception for women with inflammatory bowel disease (Crohn’s disease or ulcerative colitis). The Faculty of Family Planning & Reproductive Health Care, part of the UK’s Royal College of Obstetricians and Gynaecologists, set up an expert multidisciplinary panel to produce the guidance, which is published in the latest issue of the faculty’s peer-reviewed journal.

The paper, entitled Contraceptive Choices for Women with Inflammatory Bowel Disease, notes that an estimated 160 people in every 100,000 will have ulcerative colitis, while Crohn’s disease is less common, affecting an estimated 50 people per 100,000.

Reproductive implications

The report states: “IBD usually presents in the reproductive years, and may therefore affect reproductive health, pregnancy, and influence contraceptive needs. An appreciation of the impact of pregnancy on IBD, and the effects of IBD and its treatments on pregnancy and fertility, allows clinicians to assess the importance of effective contraception.”

A total of 23 recommendations are made, including the following:

* “Women with IBD should be offered the same contraceptive choices as women without IBD. Certain contraceptive methods may have specific cautions for disorders associated with IBD.”

* “Women using combined oral contraceptives should use additional contraception when taking non-enzyme-inducing antibiotic courses of less than 3 weeks and for 7 days after they are discontinued.”

* “Women should be advised that the efficacy of oral contraception is unlikely to be reduced by large bowel disease but may potentially be reduced in women with Crohn’s disease who have small bowel disease and malabsorption.”

* “The risk of subfertility following surgical intervention should be discussed with women with IBD as this may influence decisions regarding the timing of childbearing.”

* “Pregnancy in women with IBD should be a planned event when disease is well controlled.”

The contraceptive methods discussed in detail include combined oral contraceptives, progestogen-only pills, progestogen-only injectables, progestogen-only implants, progestogen-releasing intrauterine systems, copper-bearing intrauterine devices, barrier methods, and laparoscopic sterilization.

Issue 15: 28 Jul 2003
Source: Journal of Family Planning and Reproductive Health Care 2003; 29: 127-34