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Drug Safety

, Volume 39, Issue 3, pp 193–197 | Cite as

Risk of Inflammatory Bowel Disease with Oral Contraceptives and Menopausal Hormone Therapy: Current Evidence and Future Directions

  • Hamed KhaliliEmail author
Current Opinion

Abstract

Crohn’s disease (CD) and ulcerative colitis (UC), collectively known as inflammatory bowel diseases, are archetypical inflammatory disorders of the gastrointestinal tract with rising incidence worldwide. Although the role of genetic factors in disease development has been highlighted by genome-wide association studies, environmental risk factors likely play a pivotal role in development of CD and UC. Prior observational studies have suggested a link between exogenous hormone use and risk of CD and UC. Specifically, studies have shown an association between oral contraceptive use and risk of CD and menopausal hormone therapy and risk of UC. Although the exact mechanism of these associations is largely unknown, a number of hypotheses have been proposed. First, oral estrogen has been shown to modify intestinal permeability, a critical step in the pathophysiology of inflammatory bowel disease. Second, exogenous hormone use through its effect on endogenous levels of hormones may enhance the development of Th1- and Th2-mediated inflammatory diseases. Lastly, recent data have linked modification in the gut microbiome to endogenous levels of androgens, which are also known to be altered with exogenous hormone use and influence the development of autoimmune diseases. This supports the intriguing hypothesis that the gut microbiome lies at the crossroads of pathways linking exogenous hormone use with innate and adaptive immunity. Future studies should therefore focus on bridging these epidemiologic findings to disease pathogenesis through comprehensive understanding of the complex interaction between exogenous hormone use, sex steroid biomarkers, genetic risk loci, and alterations in the intestinal microbial environment in the etiology of CD and UC.

Keywords

Ulcerative Colitis Oral Contraceptive Menopausal Hormone Therapy Exogenous Hormone Intestinal Barrier Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with Ethical Standards

Funding

No sources of funding were used to assist in the preparation of this study.

Grant support

Dr. Khalili is supported by a career development award from the American Gastroenterological Association (AGA) and by the National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK099681).

Conflict of interest

Dr. Khalili has received consulting fees from Abbvie Inc.

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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Division of GastroenterologyMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Clinical and Translational Epidemiology UnitMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Digestive Healthcare Center—Crohn’s and Colitis CenterMassachusetts General HospitalBostonUSA

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