TOPLINE

In female individuals with ulcerative colitis (UC), exposure to hormonal contraception was not associated with an increased risk for recurrent flares or a consistent increase in cumulative systemic inflammatory burden compared with no exposure.

METHODOLOGY

• Researchers conducted a retrospective observational cohort study to evaluate the association between exposure to hormonal contraception and the risk for recurrent flares and inflammatory burden in female individuals with UC.
• They included 225 female individuals with UC (median age at diagnosis, 35 years) across two tertiary centres in Spain, of whom 58 were exposed to hormonal contraception following the diagnosis of UC.
• Data on exposure to hormonal contraception before and after the diagnosis of UC were ascertained from electronic prescription records of each patient.
• The primary outcome was the comparison of the cumulative risk for recurrent flares among those exposed vs not exposed to hormonal contraception. Flares were defined as a partial Mayo score greater than 1 with the need for therapy intensification, which included corticosteroid prescriptions, starting or increasing biologic/small molecule doses, or thiopurine intensification.
• Secondary outcomes included longitudinal changes in levels of biomarkers (C-reactive protein [CRP], platelet count, erythrocyte sedimentation rate, albumin, alpha-1-acid glycoprotein, and faecal calprotectin) during exposure to hormonal contraception and cumulative inflammatory burden for systemic biomarkers.

TAKEAWAY

• Over the median follow-up duration of 5.3 years, 374 flares were reported. Exposure to hormonal contraception was not linked to an increased risk for recurrent flares.
• Each additional year of age at diagnosis was associated with a 3% reduction in the risk for flares (adjusted hazard ratio [aHR], 0.97; P < .001). Extensive UC at diagnosis (aHR, 1.85; P = .003) and ex-smoker status (aHR, 2.07; P = .031) were independent predictors of recurrent flares.
• In longitudinal analysis, CRP levels were higher during periods of exposure to hormonal contraception (P = .0038), whereas no significant differences were observed in levels of other biomarkers.
• No significant difference was seen in cumulative systemic inflammatory burden during periods of exposure to hormonal contraception.

IN PRACTICE

"[The] results provide real-world data to inform contraceptive counseling in women with UC, while acknowledging uncertainty around smaller effects and rare adverse events," the authors wrote.

"No adverse events were documented, but given the limited number of exposed patient-years, rare safety events require an evaluation in larger cohorts," they added.

SOURCE

The study was led by Beatriz Gros, MD, PhD, and Carlos Frutos, MD, Gastroenterology and Hepatology Department, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain. It was published online on August 18, 2026, in Inflammatory Bowel Diseases.

LIMITATIONS

Residual confounding cannot be ruled out due to the retrospective design. The small sample size of the exposed group may have limited the ability to detect smaller effects. The flare definition excluded mesalazine adjustments. No thrombotic events were observed; however, the study was not powered to check for rare safety problems.

DISCLOSURES

No funding was declared for this study. Several authors declared serving as speakers, consultants, or advisory board members or receiving grants or honoraria from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.