Kane SV and Reddy D (2008) Hormonal replacement therapy after menopause is protective of disease activity in women with inflammatory bowel disease. Am J Gastroenterol 103: 1193–1196

That estrogen might reduce IBD activity is plausible as estrogens have anti-inflammatory properties and the menstrual cycle seems to affect IBD symptom severity. Kane and Reddy, therefore, investigated whether the estrogen-deficient, menopausal state increases IBD activity; these researchers also aimed to identify modifiers of IBD activity in postmenopausal women.

The researchers retrospectively analyzed the medical records of 65 postmenopausal women with IBD (40 with Crohn's disease and 25 with ulcerative colitis). Each patient acted as her own control since disease activity in the 5 years before the menopause (excluding a 2 year perimenopausal period) was compared with that in the 5 years after the menopause. Median age at menopause was 48.2 years.

During the premenopausal and postmenopausal periods, similar proportions of women experienced a disease flare. Hormone-replacement therapy (HRT) had been used by 20 women after the menopause. Interestingly, women who used HRT were 82% less likely to have active disease in the postmenopausal period than were non-users of HRT, and this protective effect showed evidence of HRT dose-dependency, although patient groups were small. Furthermore, the medical management of postmenopausal women who experienced a flare and were HRT users was more conservative than that of non-users.

The researchers conclude that HRT use in the early postmenopausal period reduces IBD activity, but caution that their findings require confirmation in a large study.