IBD and Your Contraceptive Choices

Family planning is important for women with Crohn's or Ulcerative Colitis

Various contraceptives including pills and condoms
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The choice to have children or not is one of the most important decisions many people will make in life. There are a host of aspects to think about when it comes to pregnancy and birth, and chief among these is how your choices will affect your inflammatory bowel disease (IBD). One of the most vital factors in giving the best possible choice for a healthy pregnancy and baby in women with IBD is the state of the disease when conception takes place.

Gastroenterologists advise that it is better for women with IBD to conceive when the IBD is in remission, when disease activity (mainly inflammation) is gone or is as limited as possible.

Making Choices About Birth Control

Engaging a gastroenterologist and an obstetrician-gynecologist as well as other healthcare professionals (such as a dietician and a colorectal surgeon for those who have had surgery in the past) is important before getting pregnant. Therefore, the decision of when to have children is best planned out carefully for women with IBD. That leads to making choices about using birth control until the time is right for a pregnancy.

Every woman will need to make her own decisions about contraception which takes into account health conditions, lifestyle, and preferences. Broadly speaking, birth control typically involves barriers that prevent sperm and egg from connecting, chemicals that kill sperm, or hormones that prevent ovulation.

 Permanent birth control is also available, for men and for women, but this is typically only recommended for certain circumstances or when an individual decides to stop having children.

Fertility in Many Women With IBD Is Near-Normal

Women with IBD were once encouraged to avoid becoming pregnant, but this is no longer the case.

In many cases, women with IBD are not at an increased risk of pregnancy complications, but being in remission ensures the best chance for a healthy pregnancy and baby. Women with IBD who haven't had j-pouch surgery typically have normal or near-normal fertility rates.

This may come as a surprise to some women, which is why it is key that women with IBD use a reliable form of contraception if a pregnancy isn't wanted, because having IBD is not going to reduce the chances of becoming pregnant. Here in this article some temporary contraceptive choices for women and their effect on IBD are discussed.

Barrier Methods of Birth Control

Barrier birth control, such as a diaphragm, cervical cap, contraceptive sponge, or a condom (male or female), are often good choices for women with IBD who don't want to use hormonal-based birth control methods. However, a diaphragm or a cervical cap may not work at preventing pregnancy in women with IBD who have fistulas that involve the vagina (such as a rectovaginal fistula) or affect other reproductive organs. Women who are more prone to infections in the bladder or in the vagina might also be advised against using a diaphragm or a cervical cap because these devices might increase the risks of developing an infection.

Using a spermicide (a foam, jelly, gel, or suppository that kills sperm) along with these barrier methods is often recommended in order to increase their effectiveness. Condoms will help prevent the spread of sexually transmitted diseases (STDs), while diaphragms, cervical caps, and sponges will not.

Birth Control Pill ("The Pill")

There is some speculation that taking a combination contraceptive pill ("the pill") carries a risk for women who have IBD or who are at risk of developing IBD. A combination pill contains synthetic forms of two female hormones: estrogen and progestin (when produced in the body this hormone is called progesterone).

There are a few studies that have found a relationship between taking the pill and in either developing IBD or in causing a flare-up of the IBD. However, it's not understood why this might happen nor is there agreement on how strong this risk is or how gynecologists should manage women with IBD who want to take the pill.

Women who do decide to take the pill should not smoke, because smoking was implicated as a factor for women who developed IBD in these studies. Women over the age of 35 who smoke and take the pill may be at an increased risk of developing blood clots. Smoking is associated in particular with the development of Crohn's disease, and people with Crohn's are strongly urged not to smoke.

Another factor to consider when taking the pill is its ability to be absorbed in the intestine. People who have IBD may have trouble absorbing certain medications in their intestines, though this is going to vary widely. If the pill is not being absorbed, it's not doing its job, and could mean an increased chance of getting pregnant. When women with IBD are experiencing a flare-up, or even diarrhea, another form of contraception should be considered. Women with IBD who have any concerns about taking the pill should discuss it with a gastroenterologist and a gynecologist. The pill will not protect against STDs.

Birth Control Implants

A birth control implant is a small piece of plastic that is placed in the upper arm which contains the hormone progestin and works to stop ovulation for about 3 years. The contraceptive implant is one of the more frequently recommended contraceptive methods for women with IBD who are not considering pregnancy in the near future, because it's effective, doesn't require taking a pill every day, and lasts a long time. One thing to remember with an implant is that it won't protect at all against STDs.

Birth Control Patch

The birth control patch is a small sticker-like patch that is placed on the skin to release hormones, estrogen, and progestin. The patch is changed weekly. It works similar to the birth control pill and may be associated with some of the same concerns about an increased risk of developing IBD. The patch is not commonly used, but some women may decide it is the best fit for their lifestyle. The patch will not protect against STDs.

Birth Control Shot

The birth control shot is an injection that's given every 3 months and works by preventing ovulation. The hormone that's used in the shot is progestin, so this form of birth control is similar to the birth control implant. The major disadvantage with the birth control shot is that it can cause thinning of the bones. This is of special concern to women with IBD, who may already be at risk for osteopenia and osteoporosis, as a result of either vitamin deficiencies or as an adverse effect of the medication. The shot also does not protect against STDs. It can be a viable contraception choice for women with IBD, but the concerns about bone health should be discussed with a gastroenterologist and a gynecologist.

Contraceptive Vaginal Ring

The vaginal ring is a plastic ring that contains estrogen and progestin and is inserted into the vagina. It's worn for 3 weeks followed by one week without it, and uses a lower dose of hormones than other hormonal birth control methods. It's not recommended for women who smoke or who have a history of blood clots. Again, because the vaginal ring uses a combination of hormones, it might be associated with some of the same risks regarding IBD as the oral contraceptive pill, though the jury is still out on that. This form of birth control will not protect against STDs.

Intrauterine Device (IUD)

An IUD is a contraceptive device that's inserted through the cervix and into the uterus by a healthcare professional (usually a gynecologist). It works to prevent a pregnancy either by hindering sperm from connecting with an egg or by releasing the hormone progestin, which prevents ovulation. IUDs last years, depending on the type that used, anywhere from 3 to 12 years. Removing the IUD restores a woman's fertility. IUDs are extremely effective in preventing pregnancy and can even be used in women who haven't had any children. Studies have shown no effect on IBD, making them a highly recommended birth control choice for women with Crohn's disease or ulcerative colitis. An IUD, however, won't protect against STDs.

Using More Than One Form of Birth Control

At times, it may be best to use 2 or more forms of birth control, such as during a flare-up, or after surgery. These times would not offer the best opportunity for a healthy pregnancy and baby, so it is important to ensure that precautions are taken.

A Word From Verywell

Whatever your plans are regarding pregnancy in the future, it is important to be aware of all your available contraceptive choices. You will want to ensure that your method of choice works for you, your partner, and your family, but also that it will be as effective as possible during those times when a pregnancy is best avoided.

Sources:

Cornish JA, Tan E, Simillis C, et al. "The Risk of Oral Contraceptives in the Etiology of Inflammatory Bowel Disease: A Meta-Analysis." Amer J of Gastro 2008;103:2394-2400.

Gawron LM, Gawron AJ, Kasper A, Hammond C, Keefer L. "Contraceptive Method Selection by Women with Inflammatory Bowel Diseases: A Cross-sectional Survey." Contraception. 2014 May; 89: 419–425.

Khalili H, Higuchi LM, Ananthakrishnan AN, et al. "Oral contraceptives, reproductive factors and risk of inflammatory bowel disease." Gut. 2013 Aug; 62: 1153–1159.

Martin J, Kane SV, Feagins LA. "Fertility and Contraception in Women With Inflammatory Bowel Disease." Gastroenterol Hepatol (N Y). 2016 Feb;12:101-109.

Zapata LB, Paulen ME, Cansino C, et al. "Contraceptive use among women with inflammatory bowel disease: A systematic review. " Contraception. 2010 Jul;82:72-85.

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