Trip Answers

Question answered:20/11/06 Warning! this question is over two years old.

We found little information specifically on the use of Yasmin in patients with a history of ulcerative colitis. The SPC for Yasmin, however, states:

 

 

“Other medical conditions which have been associated with adverse vascular events include diabetes mellitus, systemic lupus erythematosus, haemolytic uraemic syndrome and chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis).

 

Worsening of endogenous depression, of epilepsy, of Crohn's disease and of ulcerative colitis has been reported during COC use.” [1]

 

In 2003 the Faculty for Family Planning and Reproductive Health Care (FFPRHC) produced guidance on contraceptive choices for women with irritable bowel syndrome in which they recommend:

 

“Contraceptive options for women with IBD who fulfil the WHO Medical Eligibility Criteria for Contraceptive Use are the same as for women without IBD. Women with IBD who are especially at an increased risk of VTE, or who have co-existing disease such as primary sclerosing cholangitis and osteoporosis, may not fulfil medical eligibility criteria. The efficacy of oral methods may be reduced in women with small bowel disease due to malabsorption. The risks and benefits of all contraceptive options should be discussed individually.

 

Combined oral contraception (COC)
COC can be used by women with IBD who fulfil the WHO Medical Eligibility Criteria for Contraceptive Use.” [2]

 

Table 2 contains a quick reference to contraceptive provision for women with IBS.

 

A second answer, produced by the FFPRHC in July 2006, provides the same information:

 

“FFPRHC CEU guidance recommends that women with inflammatory bowel disease (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 evidence). Women with ulcerative colitis can use oral contraception (Grade C evidence). No evidence was identified specifically relating to the risk of venous thromboembolism (VTE) in combined oral contraceptive (COC) users with IBD. Women who have had a colectomy and ileostomy have no enteroheptaic circulation of ethinyl estradiol. The efficacy of COC does not appear to be reduced in this situation…”

 

Table 1, in the full version of the answer, contains the UKMEC categories for the use of contraception in women with IBD. Combined oral contraception is deemed a ‘category 2’ method which means IBS is a “condition where the advantages of using the method usually outweigh the theoretical or proven risks”. [3]

 

For further information, the NLH Q & A Service would recommend contacting the FFPRHC for further information on the use of Yasmin in patients with ulcerative colitis:

 

Clinical Effectiveness Unit, FFPRHC
Tel: 01224) 553623
Email: ffp.ceu@abdn.ac.uk

 

References
1. SPC for Yasmin. February 2006. (http://emc.medicines.org.uk/emc/industry/default.asp?page=displaydoc.asp&documentid=8777).
2. FFPRHC. Contraceptive Choices forWomen with Inflammatory Bowel Disease. July 2003. (http://www.ffprhc.org.uk/admin/uploads/IBD%20final%20pdf.pdf).
3. FFPRHC. For women with polyarthritis and ulcerative colitis who have had a colectomy, can combined oral contraception or an intrauterine device be used safely? July 2006. (http://www.ffprhc.org.uk/admin/uploads/No1718.pdf).

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