Definitions of the grades of recommendation, based on levels of evidence (A-C, Good Practice Point), are provided at the end of the "Major Recommendations" field.
What effect does inflammatory bowel disease (IBD) have on reproductive health?
- Health professionals managing women with IBD should discuss its potential effect on reproductive health, pregnancy, and contraceptive requirements (Grade C).
Does IBD have an effect on menstrual cycle, fertility, and pregnancy?
- Pregnancy in women with IBD should be a planned event when disease is well controlled (Grade B).
Do medications used in the treatment of IBD affect fertility, pregnancy, or contraception?
- Effective contraception must be used while taking methotrexate, and for at least 3 months after its discontinuation (Grade C).
- Women using combined oral contraception (COC) should use additional contraception while taking non-enzyme-inducing antibiotic courses of less than 3 weeks and for 7 days after they are discontinued (Grade C).
- COC users who are established on non-enzyme-inducing antibiotics for more than 3 weeks do not require additional contraception unless they change to a different antibiotic (Grade C).
- Women using progestogen-only methods of contraception do not need additional contraceptive protection when taking non-enzyme-inducing antibiotics for any duration (Grade C).
How does surgery for IBD affect fertility and pregnancy?
- The risk of subfertility following surgical intervention should be discussed with women with IBD as this may influence decisions regarding the timing of childbearing (Good Practice Point).
- Clinicians should consider ectopic pregnancy in their differential diagnosis of abdominal pain in sexually active women with IBD (Good Practice Point).
How does pregnancy affect IBD?
- Appropriate referral for pre-pregnancy counselling should be available to all women with IBD to optimise management before conception (Good Practice Point).
How might IBD affect contraceptive use?
- Women should be advised that the efficacy of oral contraception is unlikely to be reduced by large bowel disease but may potentially be reduced in women with Crohn's disease (CD) who have small bowel disease and malabsorption (Good Practice Point).
How might extra-intestinal manifestations of IBD affect contraceptive use?
- Co-existing disorders in women with IBD should be considered when assessing eligibility for contraceptive use (Grade C).
Women with IBD who have additional risk factors for osteoporosis should have bone mineral density (BMD) measured (Good Practice Point).
How might surgery for IBD affect contraceptive use?
- Women with IBD should stop COC at least 4 weeks before major elective surgery, and alternative contraception should be provided (Good Practice Point).
- Women with IBD using progestogen-only contraception need not discontinue it prior to major elective surgery (Good Practice Point).
What are the contraceptive options for women with IBD?
- Women with IBD should be offered the same contraceptive choices as women without IBD. Certain contraceptive methods may have specific cautions for disorders associated with IBD (Grade C).
- Women with ulcerative colitis (UC) can use oral contraception (Grade C).
- Women with Crohn's Disease who have small bowel involvement or malabsorption may have a reduced efficacy of oral contraception (Grade C).
- Women with IBD with low bone density or who have had repeat courses of corticosteroids or malabsorption should be advised against the use of depot medroxyprogesterone acetate (DMPA) (Grade C).
- Laparoscopic sterilisation is an inappropriate method of contraception for women with IBD who have had previous pelvic or abdominal surgery (Grade B).
Barrier methods may be inappropriate for women with IBD who are using potentially teratogenic drugs or in whom disease is active and severe (Good Practice Point).
Does contraceptive use influence IBD?
- Women can be reassured that a pathogenic role for COC in IBD is unsubstantiated (Grade B).
How does IBD affect self-esteem, self-image, and psychosexual health?
- Health professionals should provide an opportunity for women to discuss issues relating to sexuality and body image and know where to refer locally when appropriate (Good Practice Point).
How might a multidisciplinary approach improve IBD management?
- Managed clinical care pathways should be developed locally to promote integrated working between different service providers to ensure that all reproductive health care needs of women with IBD are met (Good Practice Point).
Definitions
Grades of Recommendation based on levels of evidence as follows:
A: Evidence based on randomised controlled trials (RCTs)
B: Evidence based on other robust experimental or observational studies
C: Evidence is limited but the advice relies on expert opinion and has the endorsement of respected authorities
Good Practice Point where no evidence exists but where best practice is based on the clinical experience of the Expert Group
