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The disease course in microscopic colitis may be influenced by hormonal factors

Sjöberg, Klas LU orcid ; Vigren, Lina LU ; Mellander, Marie Rose ; Janczewska, Izabella ; Strid, Hans ; Hörnquist, Elisabeth Hultgren and Münch, Andreas (2025) In BMC Gastroenterology 25(1).
Abstract

Background: Microscopic colitis (MC) is characterized by non-bloody, watery diarrhea predominantly in elderly women. Known risk factors are smoking, medication with NSAIDs, PPIs or SSRIs, while data on hormonal factors is sparse. The aim of the present study was to investigate whether hormonal factors that disrupt the sex hormonal balance could have an impact on the disease course in MC. Methods: A questionnaire was distributed to 384 women with microscopic colitis (MC) (mean age 64 years, range 35–90) from five centers in Sweden about demographic aspects including age at diagnosis, disease duration, treatment, and polycystic ovary syndrome, endometriosis, bilateral oophorectomy, previous or ongoing medication with hormones or in vitro... (More)

Background: Microscopic colitis (MC) is characterized by non-bloody, watery diarrhea predominantly in elderly women. Known risk factors are smoking, medication with NSAIDs, PPIs or SSRIs, while data on hormonal factors is sparse. The aim of the present study was to investigate whether hormonal factors that disrupt the sex hormonal balance could have an impact on the disease course in MC. Methods: A questionnaire was distributed to 384 women with microscopic colitis (MC) (mean age 64 years, range 35–90) from five centers in Sweden about demographic aspects including age at diagnosis, disease duration, treatment, and polycystic ovary syndrome, endometriosis, bilateral oophorectomy, previous or ongoing medication with hormones or in vitro fertilization (IVF) in relation to the disease course. Results: The association with smoking could be verified. In relation to the disease course the odds ratio (OR) was higher for celiac disease and oral contraceptives but lower for hormone replacement therapy but for the two latter non-significant. However, bilateral oophorectomy had a significantly lower OR (0.41, CI 0.19–0.86, p = 0.019). No other factors had any substantial impact on the disease course. Conclusion: An association was verified with smoking. Celiac disease may be associated with more active disease. The observed lower OR for more active disease after bilateral oophorectomy is in line with a previously suggested association between the risk of MC and the hormonal balance. The exact mechanisms behind the hormonal effect on the disease course found in the present study are although still obscure.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Contraceptives, Estrogen, MHT, Microscopic colitis, Oophorectomy, Sex hormones
in
BMC Gastroenterology
volume
25
issue
1
article number
438
publisher
BioMed Central (BMC)
external identifiers
  • scopus:105008691428
  • pmid:40537741
ISSN
1471-230X
DOI
10.1186/s12876-025-04083-8
language
English
LU publication?
yes
id
762527e6-ab69-449a-9534-45a48803d1a9
date added to LUP
2025-10-27 09:55:23
date last changed
2025-10-28 03:00:13
@article{762527e6-ab69-449a-9534-45a48803d1a9,
  abstract     = {{<p>Background: Microscopic colitis (MC) is characterized by non-bloody, watery diarrhea predominantly in elderly women. Known risk factors are smoking, medication with NSAIDs, PPIs or SSRIs, while data on hormonal factors is sparse. The aim of the present study was to investigate whether hormonal factors that disrupt the sex hormonal balance could have an impact on the disease course in MC. Methods: A questionnaire was distributed to 384 women with microscopic colitis (MC) (mean age 64 years, range 35–90) from five centers in Sweden about demographic aspects including age at diagnosis, disease duration, treatment, and polycystic ovary syndrome, endometriosis, bilateral oophorectomy, previous or ongoing medication with hormones or in vitro fertilization (IVF) in relation to the disease course. Results: The association with smoking could be verified. In relation to the disease course the odds ratio (OR) was higher for celiac disease and oral contraceptives but lower for hormone replacement therapy but for the two latter non-significant. However, bilateral oophorectomy had a significantly lower OR (0.41, CI 0.19–0.86, p = 0.019). No other factors had any substantial impact on the disease course. Conclusion: An association was verified with smoking. Celiac disease may be associated with more active disease. The observed lower OR for more active disease after bilateral oophorectomy is in line with a previously suggested association between the risk of MC and the hormonal balance. The exact mechanisms behind the hormonal effect on the disease course found in the present study are although still obscure.</p>}},
  author       = {{Sjöberg, Klas and Vigren, Lina and Mellander, Marie Rose and Janczewska, Izabella and Strid, Hans and Hörnquist, Elisabeth Hultgren and Münch, Andreas}},
  issn         = {{1471-230X}},
  keywords     = {{Contraceptives; Estrogen; MHT; Microscopic colitis; Oophorectomy; Sex hormones}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Gastroenterology}},
  title        = {{The disease course in microscopic colitis may be influenced by hormonal factors}},
  url          = {{http://dx.doi.org/10.1186/s12876-025-04083-8}},
  doi          = {{10.1186/s12876-025-04083-8}},
  volume       = {{25}},
  year         = {{2025}},
}