Hormonal Replacement Therapy after Menopause Is Protective of Disease Activity in Women with Inflammatory Bowel Disease

Purpose: The effect of menopause and hormone replacement therapy (HRT) has not been previously studied in patients with inflammatory bowel disease (IBD). Experimental data suggest that estrogen is a potent anti-inflammatory agent. The aim of our study was to assess disease course in women as it related to hormonal replacement therapy following menopause. Methods: We performed a retrospective review of female IBD patients followed at a tertiary care center. Women who had documented loss of menses for at least one year with elevated FSH or who had undergone total abdominal hysterectomy with bilateral oophrectomy were eligible. Medical records were reviewed as well as patient interviews conducted when records were incomplete. Disease activity was measured using either the modified Truelove and Witts score for patients with ulcerative colitis (UC) or the CDAI for patients with Crohn's disease (CD) at each visit. A flare was defined as an increase in score of at least 2 points in the Truelove and Witts score or a CDAI > 150. Information regarding age of onset of menopause, use of HRT, smoking, and medications used for the treatment of IBD were recorded. Results: A total of sixty-five women were studied, twenty-five with UC and forty with CD. The average age of menopause was 48.2 years (range 38–53). Twenty-five patients had disease indices consistent with a flare within two years of menopause, 14/40 (35%) with CD and 11/25 (44%) patients with UC respectively. Twenty women (31%) in the cohort had a history of HRT use following menopause. The Odds Ratios for disease activity are presented below in Table 1. The Odds Ratio did not change when adjusted for use of immunomodulators or steroids, or type of preparation of hormonal therapy.Table 1: No Caption available.Conclusions: Women who were taking HRT were less likely to experience a flare of their disease in the first two years following the onset of menopause. This apparent protective effect is strengthened by the dose-response seen with extended vs. limited use. Studies with larger numbers of women observed for longer periods of time need to be done to verify this association. This research was sponsored by a research grant from Procter and Gamble Pharmaceuticals.