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Hormone therapy increased risk for ulcerative colitis, not Crohn’s disease
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Postmenopausal hormone therapy was associated with an increased risk for ulcerative colitis but not Crohn’s disease in a recent study.
Researchers conducted a prospective cohort study of 108,844 postmenopausal women without previous histories of ulcerative colitis (UC) or Crohn’s disease (CD). The women, enrolled in 1976 in the Nurses’ Health Study, had a median age of 54 years. Biennial updates included menopausal status, hormonal therapy use and other risk factors. Gastroenterologists confirmed data through medical record reviews for patients who self-reported CD or UC diagnoses.
As of 2008 and through 1.89 million person-years of follow-up, researchers documented 138 cases of UC and 138 cases of CD. For incident UC, the multivariate-adjusted HR was 1.71 (95% CI, 1.07-2.74) for women who currently used hormones compared with 1.65 (95% CI, 1.03-2.66) for previous users. Cox proportional hazards models included age adjustments, age at menopause, smoking history, BMI, oral contraceptive and NSAID use, latitude of residence at aged 30 years, age at menarche and other factors.
UC risk appeared to increase with the length of hormone use, ranging from an HR of 1.61 (95% CI, 1.01-2.56) to 1.80 (95% CI, 1.02-3.15) for use from 1 to 5 years compared with more than 10 years, respectively. It then declined with duration since discontinuing therapy. Researchers found no difference in risk for UC based upon the type of hormone used (estrogen, HR=1.55; 95% CI, 0.94-2.56; vs. estrogen plus progestin, HR=1.62; 95% CI, 0.98-2.67).
No association was observed between active hormone use (multivariate-adjusted HR=1.19; 95% CI, 0.78-1.82) or past users (HR=0.72; 95% CI, 0.44-1.17) and women who never used hormones when comparing CD risk. This association did not change when adjusting for estrogen only vs. a combination of estrogen and progestin.
“These findings provide novel insights into unique biological pathways related to estrogens that mediate the pathogenesis of UC,” the researchers concluded. “Because there are already many cogent reasons for women to minimize their use of postmenopausal hormones given their potential for adverse effects, our results have more mechanistic than clinical implications.”
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