S891 Hormone Replacement Therapy Is Associated With Decreased Disease Severity and Risk for Surgery in Post-Menopausal Women With Inflammatory Bowel Disease

Introduction: Current data on the effect of hormone replacement therapy (HRT) on inflammatory bowel disease (IBD) activity in post-menopausal women are very limited and mixed. Our aim was to characterize the population of post-menopausal women with IBD and to determine the effect that HRT may have on disease activity. Methods: We performed a retrospective cohort study of postmenopausal women with IBD at the University of Minnesota (M Health Fairview) who were started on HRT between 1/1/2000 and 1/1/2020. Electronic health records were manually reviewed for demographics, menopause history, IBD history, medications, IBD related surgeries and hospitalizations at any time pre- and post-HRT, and disease activity within 3 years pre- and post-HRT. The physician global assessment (PGA) score was used to quantify disease activity. Patients served as their own controls as data were collected prior to and after HRT initiation. McNemar’s test was used to compare outcomes pre- and post-HRT given the paired nature of the data. Results: Of the 221 patients recognized from initial search, we identified 19 women with IBD who transitioned into menopause and were subsequently started on HRT. Median age of menopause of the cohort was 44 years (range 25-53) and distribution of IBD type was 63% Crohn’s disease and 37% ulcerative colitis. Seven patients (37%) required escalation of IBD therapy after HRT and average time to escalation was 7 months. A higher frequency of moderate to severe disease activity was observed prior to HRT initiation (42% premenopause vs 16% postmenopause; p=0.03). Similarly, there was a higher frequency of surgery pre-HRT (53% premenopause vs. 16% postmenopause; p=0.02). No difference was observed in the rate of hospitalization pre- and post-HRT (Table 1). Conclusion: In post-menopausal women with IBD, HRT may be associated with a decreased risk for moderate to severe disease and IBD-related surgery. Additional studies with larger cohorts are needed to further evaluate the impact of HRT in this patient population.Table 1.: Compared outcomes pre- and post-HRT initiation *Variables presented as counts (percent); P-values generated using McNemar’s test.