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Crohn’s Disease and Oral Contraceptives: What to Know

Medically Reviewed by Minesh Khatri, MD on June 30, 2022

You’ve learned to avoid things that make your Crohn’s symptoms worse, like high-fiber foods, stress, and not enough exercise. Now it might be time to add birth control pills to the list.

Research has shown that combination birth control pills aren’t kind to your gut. They could raise your risk of Crohn’s disease by 24% to 50%, especially if you have certain genes. And people with Crohn’s who use the pill are more likely to have severe symptoms and need surgery for their disease. Keep reading to learn more, including tips for safer birth control options.

What Are the Main Types of Birth Control Pills?

There are two types of birth control pills:

Combination pills. These contain lab-made versions of the hormones estrogen and progesterone, which your body makes naturally. Combo pills help you avoid pregnancy in a few ways:

  • They stop ovulation, which means your ovaries don’t release an egg every month.
  • They thicken mucus in your cervix so sperm can’t reach the egg if it is released.
  • They make it harder for a fertilized egg to implant in the uterus.

Minipills. These work a lot like combo pills, but only contain progestin. It’s safe to use the minipill when you have Crohn’s.

How Does Estrogen Impact Crohn’s?

Whether you were assigned female at birth or undergo gender-affirming hormone therapy, estrogen is important for your:

  • Reproductive health
  • Bones
  • Heart health
  • Brain
  • Skin, kidneys, liver, and other organs

Scientists have linked more than 140 genes to Crohn’s, but only about 20% of people have them. Even with a genetic risk, research suggests something in the environment has to trigger the disease.

Estrogen – both what your body makes naturally and from the pill – can affect your gut in a few ways. These include:

Immune system problems. Estrogen plays a key role in your body’s response to infection. It’s involved in the production of immune proteins called cytokines. Some cytokines trigger massive inflammation when they go on the attack. Others quiet inflammation so it doesn’t harm healthy tissue.

Estrogen can skew the balance between the two types of cytokines. So inflammation doesn’t shut off when it should. It’s like a smoke alarm that continues to beep long after the smoke has cleared. And ongoing inflammation can lead to Crohn’s disease.

Estrogen receptors. Your body’s full of estrogen receptors. Those are proteins inside cells that estrogen binds to. They play a crucial role in controlling cell functions. In Crohn’s disease, an estrogen receptor in the intestine called G protein-coupled estrogen receptor (GPER) can lead to belly pain, inflammation, and increased motility (when food moves through your digestive tract too quickly).

Estrogen receptors also affect the barrier that separates your intestine from the rest of your body. When the barrier isn’t tight enough, large molecules like proteins can squeeze through the cracks, enter your bloodstream, and set the stage for an inflammatory response.

Dysregulated microbiome (dysbiosis). The microbiome is the common name for the trillions of mostly friendly bacteria, viruses, and other microbes that live in and on your body. They have a huge impact on your health. Among other things, they help digest food, make vitamins, and control your immune system. The pill can upset the fragile balance of microbes in your gut. This could mean you have fewer friendly bugs and more harmful ones. Or you may have less diversity overall. In both cases, changes to the normal order may trigger inflammation that damages the gut and leads to Crohn’s over time.

What You Can Do

If you have Crohn’s and use the pill, the best advice is to stop. Your chance of complications goes up the longer you take it. And if a family member has Crohn’s or another autoimmune disease, don’t start. Having a genetic link puts you at higher risk.

Still, it’s important to use some type of birth control if you’re sexually active, especially when you have Crohn’s. If you become pregnant while your disease is active, your baby might be born early and weigh less than normal. And though some drugs used to treat Crohn’s are safe for pregnant people, others may not be.

Research suggests a good chunk of people with Crohn’s don’t use birth control, even when they have severe disease and don’t want to get pregnant. But it’s important to protect yourself. There are plenty of birth control methods that don’t contain estrogen to choose from.

Barrier methods. These are condoms, diaphragms, and cervical caps. They physically block sperm from reaching the uterus during sex and have few if any side effects. If you’re allergic to latex, look for options like polyurethane condoms and silicone diaphragms. Eighteen to 28% of people will get pregnant with this type of birth control, and you must remember to use it every time you have sex.

Long-acting reversible birth control. Intrauterine devices (IUDs) and progestin implants are the best options for women with Crohn’s. They last for several years, so you don’t have to remember your diaphragm or remind your partner to use a condom. They’re also about 99% effective. Only about 1 in every 100 people who use them get pregnant. If you’ve had pelvic surgery, it could be painful to place an IUD, so talk to your doctor before you decide.

Emergency contraception (morning after pill). This is a safe way to prevent pregnancy after unprotected sex. There are two main emergency birth control pills that don’t contain estrogen: Plan B One Step (plus generics) and Ella. You should be able to buy Plan B over the counter or online, though laws are quickly changing in some states. You need a prescription for Ella.

Show Sources

SOURCES:

Clinical and Experimental Gastroenterology: “Exercise in patients with inflammatory bowel diseases: Current perspectives.”

Alimentary Pharmacology and Therapeutics: “Use of contraceptives and risk of inflammatory bowel disease: a nested case–control study.”

European Journal of Gastroenterology & Hepatology: “Exposure to oral contraceptives increases the risk for development of inflammatory bowel disease: a meta-analysis of case-controlled and cohort studies.”

Drug Safety: “Risk of Inflammatory Bowel Disease with Oral Contraceptives and Menopausal Hormone Therapy: Current Evidence and Future Directions.”

Gastroenterology Clinics of North America: “Crohn’s Disease: Genetics Update.”

Gastroenterology: “Association Between Long-term Oral Contraceptive Use and Risk of Crohn’s Disease Complications in a Nationwide Study.”

Cleveland Clinic: “Minipill.”

The Journal of Clinical Endocrinology & Metabolism: “What Does Estrogen Do?”

Inflammation & Allergy - Drug Targets: “Estrogen, a double-edged sword: Modulation of TH1- and TH2-mediated inflammations by differential regulation of TH1/TH2 cytokine production.”

World Journal of Gastroenterology: “Role of cytokines in inflammatory bowel disease.”

Frontiers in Endocrinology: “Significance of G Protein-Coupled Estrogen Receptor in the Pathophysiology of Irritable Bowel Syndrome, Inflammatory Bowel Diseases and Colorectal Cancer.”

Gastrointestinal and Liver Physiology: “Estrogen receptor-β signaling modulates epithelial barrier function.”

UptoDate: “Patient education: Inflammatory bowel disease and pregnancy (Beyond the Basics).”

Gastroenterology & Hepatology: “Contraceptive Use in Women with Inflammatory Bowel Disease.”

Gastroenterology & Hepatology: “Fertility and Contraception in Women with Inflammatory Bowel Disease.”

The American College of Obstetricians and Gynecologists: “Barrier Methods of Birth Control: Spermicide, Condom, Sponge, Diaphragm, and Cervical Cap.”

UptoDate: “Patient education: Emergency Contraception (Beyond the Basics).”

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