Contraceptive method selection by women with inflammatory bowel diseases: a cross-sectional survey



      Women with inflammatory bowel diseases (IBDs) utilize contraception at a lower rate than the general population. We sought to identify factors associated with contraceptive use and selection of more effective methods in IBD patients at risk for unintended pregnancy.

      Study Design

      An online survey was distributed to women with IBD in January 2013. Contraceptive methods were categorized by effectiveness and associations with use explored by demographics, disease characteristics and reproductive goals.


      A total of 162 respondents were analyzed: 62% had Crohn’s disease and 38% ulcerative colitis. Mean age was 31 (range 20–45), 97% identified as White, and 53% were nulliparas. Seventy-four percent were currently using IBD medications. A quarter of participants (23%) used no contraception, 17% used highly effective methods, 41% used short-term hormonal methods, and 19% chose barrier/behavioral methods. Prior IBD-related surgery, biologic therapy use and low education attainment were associated with no contraception use. Of contraceptive users, age, parity, insurance status, IBD surgery and prior immunomodulator use were associated with highly effective method selection.


      A quarter of women with IBD at risk for pregnancy in this study population reported no contraceptive method use. Higher levels of IBD activity influence contraceptive use and method selection, which could guide future patient and provider educational interventions.


      Pregnancy planning is important for women with inflammatory bowel diseases to avoid adverse outcomes in a disease-poor state. Use of contraception assists in avoidance of unintended pregnancy. IBD characteristics are targets for educational interventions to improve uptake of highly effective contraceptive methods.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lin J.
        • Cao Q.
        • Zhang J.
        • Li Y.
        • Shen B.
        • Zhao Z.
        • et al.
        Micro RNA expression patterns in indeterminate colitis.
        Mod Pathol. 2013; 26: 148-154
        • Molodecky N.A.
        • Soon I.S.
        • Rabi D.M.
        • Ghali W.A.
        • Ferris M.
        • Chernoff G.
        • et al.
        Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review.
        Gastroenterology. 2012; 142: 46-54
        • Baiocco P.J.
        • Korelitz B.I.
        The influence of inflammatory bowel disease and its treatment on pregnancy and fetal outcome.
        J Clin Gastroenterol. 1984; 6: 211-216
        • Tavernier N.
        • Fumery M.
        • Peyrin-Biroulet L.
        • Colombel J.F.
        • Gower-Rousseau C.
        Systematic review: fertility in non-surgically treated inflammatory bowel disease.
        Aliment Pharmacol Ther. 2013; 38: 847-853
        • Yarur A.
        • Kane S.V.
        Update on pregnancy and breastfeeding in the era of biologics.
        Dig Liver Dis. 2013; 45: 787-794
        • Riis L.
        • Vind I.
        • Politi P.
        • Wolters F.
        • Vermeire S.
        • Tsianos E.
        • et al.
        Does pregnancy change the disease course? A study in a European cohort of patients with inflammatory bowel disease.
        Am J Gastroenterol. 2006; 101: 1539-1545
        • Fonager K.
        • Sorenson H.T.
        • Olsen J.
        • Dahlerup J.F.
        • Rasmussen S.N.
        Pregnancy outcome for women with Crohn's disease: a follow-up study based on linkage between national registries.
        Am J Gastroenterol. 1998; 93: 2426-2430
        • Norgard B.
        • Fonager K.
        • Sorenson H.T.
        • Olsen J.
        Birth outcomes of women with ulcerative colitis: a nationwide Danish cohort study.
        Am J Gastroenterol. 2000; 95: 3165-3170
        • Stephansson O.
        • Larsson H.
        • Pedersen L.
        • Kieler H.
        • Granath F.
        • Ludvigsson J.F.
        • et al.
        Crohn's disease is a risk factor for preterm birth.
        Clin Gastroenterol Hepatol. 2010; 8: 509-515
        • Norgard B.M.
        Birth outcome in women with ulcerative colitis and Crohn's disease, and pharmacoepidemiological aspects of anti-inflammatory drug therapy.
        Dan Med Bull. 2011; 58: B4360
        • Marri S.R.
        • Ahn C.
        • Buchman A.L.
        Voluntary childlessness is increased in women with inflammatory bowel disease.
        Inflamm Bowel Dis. 2007; 13: 591-599
        • Mosher W.D.
        • Jones J.
        Use of contraception in the United States: 1982–2008.
        Vital Health Stat 23. 2010; 29: 1-44
      1. Centers for Disease Control, U.S. medically eligibility criteria for contraceptive use. 2010. Accessed Dec 29, 2011.

        • Zapata L.B.
        • Paulen M.E.
        • Cansino C.
        • Marchbanks P.A.
        • Curtis K.M.
        Contraceptive use among women with inflammatory bowel disease: a systematic review.
        Contraception. 2010; 82: 72-85
        • Steiner M.J.
        • Trussell J.
        • Mehta N.
        • Condon S.
        • Subramanian S.
        • Bourne D.
        Communicating contraceptive effectiveness: a randomized controlled trial to inform a World Health Organization family planning handbook.
        Am J Obstet Gynecol. 2006; 195: 85-91
        • Olsen K.O.
        • Joelsson M.
        • Laurberg S.
        • Oresland T.
        Fertility after ileal pouch-anal anastomosis in women with ulcerative colitis.
        Br J Surg. 1999; 86: 493-495
        • Ording Olsen K.
        • Juul S.
        • Berndtsson I.
        • Oresland T.
        • Laurberg S.
        Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample.
        Gastroenterology. 2002; 122: 15-19
        • Johnson P.
        • Richard C.
        • Ravid A.
        • Spencer L.
        • Pinto E.
        • Hanna M.
        • et al.
        Female infertility after ileal pouch-anal anastomosis for ulcerative colitis.
        Dis Colon Rectum. 2004; 47: 1119-1126
        • Doherty G.A.
        • Cheifetz A.S.
        Management of acute severe ulcerative colitis.
        Expert Rev Gastroenterol Hepatol. 2009; 3: 395-405
        • Severijnen R.
        • Bayat N.
        • Tolboom J.
        • Bongaerts G.
        Enteral drug absorption in patients with short small bowel: a review.
        Clin Pharmacokinet. 2004; 43: 951-962
        • Manaf R.A.
        • Ismail I.Z.
        • Latiff L.A.
        Contraceptive use among women with chronic medical conditions and factors associated with its non-use in Malaysia.
        Glob J Health Sci. 2012; 4: 91-99
        • Yazdany J.
        • Trupin L.
        • Kaiser R.
        • Schmajuk G.
        • Gillis J.Z.
        • Chakravarty E.
        • et al.
        Contraceptive counseling and use among women with systemic lupus erythematosus: a gap in health care quality?.
        Arthritis Care Res. 2011; 63: 358-365
        • Moleski S.M.
        • Choudhary C.
        Special considerations for women with IBD.
        Gastroenterol Clin North Am. 2011; 40: 387-398
        • Gawron L.M.
        • Hammond C.
        • Keefer L.
        Documentation of reproductive health counseling and contraception in women with inflammatory bowel diseases.
        Patient Educ Couns. 2013; 94: 134-137
        • Nguyen G.C.
        • Chong C.A.
        • Chong R.Y.
        National estimates of the burden of inflammatory bowel disease among racial and ethnic groups in the United States.
        J Crohns Colitis. 2013;
        • Marri S.R.
        • Buchman A.L.
        The education and employment status of patients with inflammatory bowel diseases.
        Inflamm Bowel Dis. 2005; 11: 171-177