S886 Hormone Replacement Therapy Is Associated With Disease Activity Improvement Among Post-Menopausal Women With Inflammatory Bowel Disease

Abstract

Introduction: There have been limited data on the impact of hormone replacement therapy (HRT) in post-menopausal women with inflammatory bowel disease (IBD). In this study, we sought to characterize the population of post-menopausal women with IBD and to determine the effect of HRT on disease activity. Methods: A retrospective cohort study of postmenopausal women with IBD at the University of Minnesota and Jefferson University Hospital was conducted from 1/1/2000-1/1/2020. Electronic health records were manually reviewed for demographics, menopause history, IBD history including disease activity, surgeries, hospitalizations, and medications pre- and post-HRT. The physician global assessment (PGA) score was used to quantify disease activity. To control for the effects of menopause, IBD patients who had not undergone HRT were used as controls. Patients were matched by age at menopause onset (+/- 5 years) and IBD type. McNemar’s test was used to compare outcomes pre- and post-HRT given the paired nature of the data. Pearson's chi-squared test was used to compare patients and controls. Results: Of the 249 patients recognized from the initial search, we identified 37 women who were menopausal and started on HRT. Mean age of menopause onset in the HRT patients was 46 years, 59% had Crohn’s disease (CD) and 41% had ulcerative colitis (UC). 31 matched controls that were within a 5-year range of menopause of the HRT patients were selected (61% CD, 39% UC). Based on PGA score, there was greater disease severity in the HRT cohort pre-menopause (p=0.03) and trend towards greater frequency of PGA score ≥2 (p=0.11). There was a significant reduction in frequency of PGA ≥2 post-HRT treatment (p< 0.01). HRT treatment was associated with a 5.6x increase in odds of post-HRT PGA score improvement compared to controls (OR 5.6; 95% CL 1.6, 19.7) in univariate logistic regression analysis. (Table) Conclusion: Post-menopausal IBD women who underwent HRT therapy had a significant improvement in their disease activity following HRT compared to post-menopausal women without HRT therapy, who showed no change in disease activity. Pre-HRT disease activity seemed to be higher in patients who underwent HRT compared to the controls. While we found more women with active disease underwent HRT, further study in a larger cohort of patients is needed to confirm this finding. Table 1. - Outcomes pre and post hormone replacement therapy Pre-HRT Post-HRT P-value Hospitalized (n=25) 10 (40%) 8 (32%) 0.32 Surgery 17 (46%) 5 (14%) < 0.01 PGA scores < 0.05 Remission 9 (24%) 17 (46%) Mild 16 (43%) 17 (46%) Moderate 7 (19%) 1 (3%) Severe 5 (14%) 2 (5%) Moderate to severe disease 12 (32%) 3 (8%) < 0.01