Do progestin (Progesterone) birth control methods cause Inflammatory Bowel Disease (IBD)?

Do Progestin Birth Control Cause IBD?

No, progestin-only contraceptives do not cause inflammatory bowel disease (IBD). The evidence consistently shows that progestin-only methods are safe for women with or without IBD, and current guidelines classify them as preferred contraceptive options with advantages outweighing any theoretical risks.

Guideline-Based Safety Classification

The CDC Medical Eligibility Criteria for Contraceptive Use provides clear guidance on progestin contraceptives and IBD:

• Progestin-only pills are classified as Category 2 for women with IBD (Crohn's disease or ulcerative colitis), meaning the advantages generally outweigh theoretical or proven risks 1, 2
• Progestin-only pills do not increase the risk of disease relapse in women with existing IBD 2
• Intrauterine devices (LNG-IUD) and progestin-only implants are Category 1 (preferred first-line methods with no restrictions) for women with IBD 2

Research Evidence on Causation

The most recent high-quality research distinguishes between combined oral contraceptives (containing estrogen) and progestin-only methods:

Progestin-Only Methods Are NOT Associated with IBD Development

• A 2022 nested case-control study of 4,932 IBD cases found that progestin-only pills had no effect on Crohn's disease risk (OR 1.09,95% CI 0.84-1.40) 3
• The same study showed only a modest association with ulcerative colitis (OR 1.35), which was substantially lower than combined oral contraceptives 3
• Parenteral progestin contraception (injections, implants) showed no association with either Crohn's disease or ulcerative colitis (OR 1.15 and 1.17, respectively) 3
• The authors concluded that the estrogen component, not progestin, likely drives IBD pathogenesis 3

Combined Oral Contraceptives (Estrogen + Progestin) Show Different Risk Profile

For context, combined oral contraceptives containing estrogen do show associations with IBD:

• A 2017 meta-analysis found 30% increased risk for IBD with combined oral contraceptive exposure 4
• The 2022 study confirmed increased risk with combined pills (OR 1.60 for Crohn's disease, OR 1.30 for ulcerative colitis) 3
• Risk increased with duration of exposure to combined pills (6.4% per additional month for Crohn's disease) 3

Clinical Considerations for Progestin Use

When prescribing progestin-only contraceptives to women with IBD:

• Absorption may be reduced in women with substantial malabsorption from severe IBD or small bowel surgery 2
• Progestin-only pills require strict daily adherence but carry no increased venous thromboembolism risk 2
• Long-acting reversible contraceptives (LARCs) like implants and IUDs are preferred as they bypass absorption issues and don't require daily adherence 2

Important Distinction: Causation vs. Use in Existing IBD

The evidence addresses two separate clinical questions:

1. Do progestin contraceptives cause new IBD? No, the research shows no causal relationship 3
2. Are progestin contraceptives safe in women with existing IBD? Yes, they are safe and preferred options 1, 2

Common Pitfalls to Avoid

• Do not confuse combined oral contraceptives with progestin-only methods - the estrogen component appears responsible for any IBD risk 3
• Do not unnecessarily restrict contraceptive options for women with IBD based on outdated concerns 2
• Do not overlook absorption issues in women with severe small bowel disease when prescribing oral progestin-only pills 2
• Counsel women with IBD about contraception early as part of preconception planning to optimize disease control before pregnancy 1