Hormone replacement therapy improves IBD symptoms in postmenopausal women

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Key takeaways:

  • Hormone replacement therapy was associated with a 5.6-times increase in odds of PGA score improvement.
  • There was no difference in IBD-related surgery between cohorts in the pre- or postmenopausal period.

Hormone replacement therapy was associated with improved disease symptoms, measured by the physician global assessment score, in a cohort of postmenopausal women with inflammatory bowel disease, according to data.

“Sex hormones such as estrogen are thought to play a role in modulating inflammation in the gastrointestinal tract,” Morgan Freeman, a second-year GI fellow in the division of gastroenterology, hepatology and nutrition at the University of Minnesota, and colleagues wrote in the Journal of Clinical Medicine. “However, there has been little evidence to characterize the impact of hormone replacement therapy (HRT) in postmenopausal women.

Results showed a significant reduction in frequency of physician global assessment score ≥ 2: Pre-hormone replacement therapy; 32% VS Post-hormone replacement therapy; 8%
Data derived from: Freeman M, et al. J Clin Med. 2024;doi:10.3390/jcm13010088.

“This gap in research and knowledge may make it difficult for clinicians to counsel patients on the possible effects of hormone replacement therapy for menopause symptoms. … With sparse data available to make informed decisions, patients may forego treatment of their menopause symptoms to avoid the unknown risks concerning how it may affect their IBD activity.”

To determine the effects of HRT on IBD activity, Freeman and colleagues conducted a retrospective, case-control cohort study of 37 postmenopausal women with IBD (59% Crohn’s disease) seen at the University of Minnesota and Thomas Jefferson University Hospital from January 2000 to January 2020.

Researchers measured disease activity using the physician global assessment (PGA) score and controlled for the effects of menopause by selecting 31 postmenopausal women who had not undergone HRT, matched by age and IBD type.

In the HRT cohort, the mean age at menopause onset was 46 years and the average duration of IBD before menopause was 12.7 years. Most patients (70%) initiated HRT with estrogen alone, while 30% started a combined estrogen and progesterone regimen. Researchers noted 24% of patients required an escalation in their therapy 1 year following HRT initiation.

According to study results, there was a significant reduction in frequency of PGA scores of at least two when comparing pre- and post-HRT treatment scores (32% vs. 8%). Univariate logistic regression analysis also showed HRT treatment correlated with increased odds of PGA score improvement compared with controls (OR = 5.6; 95% CI, 1.6-19.7).

Further, results showed there were no statistically significant differences in IBD-related surgery between matched cohorts in the pre- or postmenopausal period.

“The use of HRT was associated with improvements in inflammatory bowel disease symptoms in postmenopausal women,” Freeman and colleagues wrote. “In an area that is understudied and challenged with mixed data, we hope that our findings help with counseling patients on the anticipated impact of HRT on IBD activity, especially for patients with a more severe disease.”

They continued: “Future studies with a prospective design, larger sample size and objective disease activity measurements are needed to confirm our findings.”

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