Hormonal Replacement Therapy After Menopause Is Protective of Disease Activity in Women With Inflammatory Bowel Disease

Sunanda V. Kane, Deepa Reddy
In: The American Journal of Gastroenterology · 2008 · vol. 103(5) , pp. 1193–1196 · doi:10.1111/j.1572-0241.2007.01700.x · PMID:18177456 · W2043493147
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This study found that while menopausal status did not affect the likelihood of inflammatory bowel disease flares, postmenopausal hormone replacement therapy significantly protected against disease activity.

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This retrospective study investigated the impact of menopause on inflammatory bowel disease activity by analyzing clinical scores in sixty-five women with ulcerative colitis or Crohn's disease. The researchers compared disease flares before and after menopause while assessing potential modifiers such as smoking history, prior oral contraceptive use, and postmenopausal hormone replacement therapy (HRT). Results indicated that the likelihood of a flare did not significantly differ between pre- and postmenopausal periods, but HRT use demonstrated a significant protective effect against disease activity with a notable dose-response relationship. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

BACKGROUND AND AIMS: The nature of inflammatory bowel disease (IBD) following menopause has not been previously studied. The aim of this study was to characterize the effect of menopause on disease activity and identify possible modifiers of disease activity. METHODS: This was a retrospective study of women followed at the University of Chicago IBD Clinic. Disease activity was assessed using clinical scoring systems during the pre- and postmenstrual periods of subjects. Variables of interest included: history of smoking, use of oral contraceptives (OCP) prior to onset of menopause, and use of hormone replacement therapy (HRT). RESULTS: Sixty-five women were included, 20 with ulcerative colitis and 45 with Crohn's disease. The median age of menopause was similar to historical controls. Twenty-three patients (35%) experienced active symptoms in the premenopausal time period and 25 patients (38%) had disease indices consistent with a flare within the first 2 yr after menopause (P > 0.05). There was no relation between those who had a pre- versus postmenstrual flare as a group (P > 0.05). However, there was a significant protective effect on disease activity with postmenopausal HRT use (hazard ratio [HR] 0.18, 95% confidence interval [CI] 0.04-0.72). There was also a dose-response effect noted with an HR with longer duration of use (0.20, 0.07-0.65). CONCLUSIONS: The likelihood of having a flare postmenopause is not different from having it premenopause. HRT, however, may provide a protective effect for disease activity in the postmenopausal period. The anti-inflammatory effects of estrogen may be the mechanism for this observation.
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Background

AND AIMS The nature of inflammatory bowel disease (IBD) following menopause has not been previously studied. The aim of this study was to characterize the effect of menopause on disease activity and identify possible modifiers of disease activity.

Methods

This was a retrospective study of women followed at the University of Chicago IBD Clinic. Disease activity was assessed using clinical scoring systems during the pre- and postmenstrual periods of subjects. Variables of interest included: history of smoking, use of oral contraceptives (OCP) prior to onset of menopause, and use of hormone replacement therapy (HRT).

Results

Sixty-five women were included, 20 with ulcerative colitis and 45 with Crohn's disease. The median age of menopause was similar to historical controls. Twenty-three patients (35%) experienced active symptoms in the premenopausal time period and 25 patients (38%) had disease indices consistent with a flare within the first 2 yr after menopause (P > 0.05). There was no relation between those who had a pre- versus postmenstrual flare as a group (P > 0.05). However, there was a significant protective effect on disease activity with postmenopausal HRT use (hazard ratio [HR] 0.18, 95% confidence interval [CI] 0.04–0.72). There was also a dose–response effect noted with an HR with longer duration of use (0.20, 0.07–0.65).

Conclusions

The likelihood of having a flare postmenopause is not different from having it premenopause. HRT, however, may provide a protective effect for disease activity in the postmenopausal period. The anti-inflammatory effects of estrogen may be the mechanism for this observation.

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