IBD and Your Contraceptive Choices

Planning is important for people with vaginas with Crohn's or ulcerative colitis

The choice to have children or not is one of the most important decisions many people will make in life. There are a host of aspects to think about when it comes to pregnancy and birth, and chief among these is how your choices will affect your inflammatory bowel disease (IBD). One of the most vital factors in giving the best possible chance for a healthy pregnancy and baby in people with vaginas with IBD is the state of the disease when conception takes place. Gastroenterologists advise that it is better for people with vaginas with IBD to conceive when the IBD is in remission, meaning that disease activity (mainly inflammation) is gone or is as limited as possible.

Woman holding contraception
Alexthq / Getty Images

Making Choices About Birth Control

Engaging a gastroenterologist and an obstetrician-gynecologist as well as other healthcare professionals (such as a dietician and a colorectal surgeon for those who have had surgery in the past) is important before getting pregnant. Therefore, the decision of when to have children is best planned out carefully for people with vaginas with IBD. That leads to making choices about using birth control until the time is right for a pregnancy.

Every person with a vagina will need to make their own decisions about contraception which takes into account health conditions, lifestyle, and preferences. Broadly speaking, birth control typically involves barriers that prevent sperm and egg from connecting, chemicals that kill sperm, or hormones that prevent ovulation. Permanent birth control is also available, for people with penises and people with vaginas, but this is typically only recommended for certain circumstances or when an individual decides to stop having children.

Fertility in Many Women With IBD Is Near-Normal

People with vaginas with IBD were once told to avoid becoming pregnant, but this is no longer the case. In many cases, those with IBD are not at an increased risk of pregnancy complications, but being in remission ensures the best chance for a healthy pregnancy and baby. People with vaginas with IBD who haven't had j-pouch surgery typically have normal or near-normal fertility rates.

This may come as a surprise to some people, which is why it is key that people with vaginas with IBD use a reliable form of contraception if a pregnancy isn't wanted because having IBD is not going to reduce the chances of becoming pregnant. Here in this article, some temporary contraceptive choices for people with vaginas and their effect on IBD are discussed.

Barrier Methods of Birth Control

Barrier birth control, such as a diaphragm, cervical cap, contraceptive sponge, or a condom (external or internal), can be an option for people with vaginas with IBD who don't want to use hormonal-based birth control methods. However, a diaphragm or a cervical cap may not work at preventing pregnancy in people with vaginas with IBD who have fistulas that involve the vagina (such as a rectovaginal fistula) or affect other reproductive organs. People who are more prone to infections in the bladder or in the vagina might also be advised against using a diaphragm or a cervical cap because these devices might increase the risks of developing an infection.

Using a spermicide (a foam, jelly, or gel that kills sperm) along with a diaphragm or cervical cap is recommended in order to increase their effectiveness.

Condoms will help prevent the spread of sexually transmitted infections (STIs), while diaphragms, cervical caps, and sponges will not.

Birth Control Pill ("The Pill")

There is some speculation that taking a combination contraceptive pill ("the pill") carries a risk for people with vaginas who have IBD or who are at risk of developing IBD. A combination pill contains synthetic forms of two female hormones: estrogen and progestin (when produced in the body this hormone is called progesterone). There are a few studies that have found a relationship between taking the pill and in either developing IBD or in causing a flare-up of the IBD. However, it's not understood why this might happen nor is there agreement on how strong this risk is or how gynecologists should manage people with IBD who want to take the pill.

Those who do decide to take the pill should not smoke, because smoking was implicated as a factor for people who developed IBD in these studies. People with vaginas over the age of 35 who smoke should not take the combined contraceptive because it may increase the risk of developing blood clots. Smoking is associated in particular with the development of Crohn's disease, and people with Crohn's are strongly urged not to smoke.

Another factor to consider when taking the pill is its ability to be absorbed in the intestine. People who have IBD may have trouble absorbing certain medications in their intestines, though this is going to vary widely. If the pill is not being absorbed, it's not doing its job, and could mean an increased chance of getting pregnant. When people with vaginas with IBD are experiencing a flare-up or even diarrhea, another form of contraception should be considered. People with IBD who have any concerns about taking the pill should discuss it with a gastroenterologist and a gynecologist. The pill will not protect against STIs.

Birth Control Implants

A birth control implant is a small piece of plastic that is placed in the upper arm which contains the hormone progestin and works to stop ovulation for about three years. The contraceptive implant is one of the more frequently recommended contraceptive methods for a person with IBD who is not considering pregnancy in the near future, because it's effective, doesn't require taking a pill every day, and lasts a long time. One thing to remember with an implant is that it won't protect at all against STIs.

Birth Control Patch

The birth control patch is a small sticker-like patch that is placed on the skin to release hormones, estrogen, and progestin. The patch is changed weekly. It works similar to the birth control pill and may be associated with some of the same concerns about an increased risk of developing IBD. The patch is not commonly used, but some people may decide it is the best fit for their lifestyle. The patch will not protect against STIs.

Birth Control Shot

The birth control shot is an injection that's given every three months and works by preventing ovulation. The hormone that's used in the shot is progestin, so this form of birth control is similar to the birth control implant. The major disadvantage with the birth control shot is that it can cause thinning of the bones. This is of special concern to people with IBD, who may already be at risk for osteopenia and osteoporosis, as a result of either vitamin deficiencies or as an adverse effect of the medication. The shot also does not protect against STIs. It can be a viable contraception choice for people with vaginas with IBD, but the concerns about bone health should be discussed with a gastroenterologist and a gynecologist.

Contraceptive Vaginal Ring

The vaginal ring is a plastic ring that contains estrogen and progestin and is inserted into the vagina. It's worn for three weeks followed by one week without it and uses a lower dose of hormones than other hormonal birth control methods. It's not recommended for people who smoke or who have a history of blood clots. Again, because the vaginal ring uses a combination of hormones, it might be associated with some of the same risks regarding IBD as the oral contraceptive pill, though the jury is still out on that. This form of birth control will not protect against STIs.

Intrauterine Device (IUD)

An IUD is a contraceptive device that's inserted through the cervix and into the uterus by a healthcare professional (usually a gynecologist). It works to prevent a pregnancy either by hindering sperm from connecting with an egg or by releasing the hormone progestin, which prevents ovulation. IUDs last years, depending on the type that used, anywhere from three to 12 years. Removing the IUD restores a person's fertility. IUDs are extremely effective in preventing pregnancy and can even be used in people who haven't had any children. Studies have shown no effect on IBD, making them a highly recommended birth control choice for people with vaginas with Crohn's disease or ulcerative colitis. An IUD, however, won't protect against STIs.

Using More Than One Form of Birth Control

At times, it may be particularly important to make sure that your birth control is very reliable such as during a flare-up or after surgery.

A Word From Verywell

Whatever your plans are regarding pregnancy in the future, it is important to be aware of all your available contraceptive choices. You will want to ensure that your method of choice works for you, your partner, and your family, but also that it will be as effective as possible during those times when a pregnancy is best avoided.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Gawron LM. Contraceptive use in women with inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2018;14(3):176-179.

  2. US Department of Health & Human Services. Birth control methods.

  3. US Department of Health and Human Services. Contraceptive implant.

  4. US Department of Health and Human Services. Birth control patch.

  5. US Department of Health and Human Services. Birth control shot.

  6. US Department of Health and Human Services. Vaginal ring.

  7. US Department of Health and Human Services. Intrauterine device.

Additional Reading

By Amber J. Tresca
Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.