Does Slynd (drospirenone) birth control cause Inflammatory Bowel Disease (IBD)?

Does Slynd Birth Control Cause IBD?

No, Slynd (drospirenone) does not cause inflammatory bowel disease (IBD). However, combined oral contraceptives containing estrogen have been associated with an increased risk of developing IBD, while progestin-only pills like Slynd show minimal to no association with IBD development.

Evidence on Contraceptives and IBD Development

Progestin-Only Pills (Including Slynd)

• Progestin-only pills are not associated with Crohn's disease development (OR 1.09, not statistically significant) 1
• There is only a modest association with ulcerative colitis (OR 1.35), which is substantially lower than combined oral contraceptives 1
• The FDA label for drospirenone lists inflammatory bowel disease as a postmarketing adverse reaction, but this reflects reporting from an uncertain population size and does not establish causation 2

Combined Oral Contraceptives (Estrogen-Containing)

• Combined oral contraceptives increase the risk of developing IBD by over 30% compared to non-users (OR 1.32) 3
• Specifically, they increase Crohn's disease risk by 24% (OR 1.24) and ulcerative colitis risk by 30% (OR 1.30) 3
• Each additional month of combined oral contraceptive exposure per year increases Crohn's disease risk by 6.4% and ulcerative colitis risk by 3.3% 1
• The estrogen component appears to drive IBD pathogenesis, not the progestin component 1

Safety of Slynd in Patients with Existing IBD

Guideline Recommendations

• Progestin-only pills are classified as Category 2 for women with IBD, meaning advantages generally outweigh theoretical or proven risks 4
• The CDC Medical Eligibility Criteria confirms that progestin-only pills do not increase risk of disease relapse in women with existing IBD 4
• Intrauterine devices and progestin-only implants are preferred first-line contraceptive methods for women with IBD (Category 1) 5

Clinical Considerations

• Absorption of progestin-only pills may be reduced in women with substantial malabsorption from severe IBD or small bowel surgery 4
• Progestin-only pills require strict daily adherence and carry no increased venous thromboembolism risk 5
• Some women with IBD report improvement in cyclical menstrual-related IBD symptoms with hormonal contraception, though only 5% report worsening 6

Key Clinical Pitfalls to Avoid

• Do not confuse progestin-only pills with combined oral contraceptives when counseling patients about IBD risk—the estrogen component is the problematic factor 1
• Do not assume all hormonal contraceptives carry equal risk for IBD development or disease activity 5
• Do not prescribe combined hormonal contraceptives to women with active IBD due to compounding venous thromboembolism risk 5, 7
• Do not overlook that parenteral progestogen-only contraception (injections, implants) shows no association with IBD development (OR 1.15 for Crohn's disease, 1.17 for ulcerative colitis) 1

Bottom Line for Clinical Practice

Slynd, as a progestin-only pill, does not cause IBD and is a reasonable contraceptive option for women with or without existing IBD, though long-acting reversible contraceptives (IUDs and implants) remain the preferred first-line recommendation 5. The association between oral contraceptives and IBD development is primarily driven by estrogen-containing formulations, not progestin-only options like Slynd 1.