Nausea and Gastric Myoelectrical Activity are Influenced by Hormonal Contraception in Chronic Gastroduodenal Disorders

Abstract

Background: Chronic gastroduodenal disorders such as chronic nausea and vomiting syndrome (CNVS), functional dyspepsia (FD) and gastroparesis, are more prevalent among young women, many of whom are hormonal contraception users. We aimed to evaluate the effects of hormonal contraception on symptom severity and gastric myoelectrical activity in people with chronic gastroduodenal disorders. Methods: This analysis was conducted on a large international cohort of patients who met Rome IV criteria for CNVS or FD and had undergone body surface gastric mapping using Gastric Alimetry (Alimetry, New Zealand). Symptoms were continuously reported on 0-10 Likert scales using a validated symptom logging app. Results: 127 people were included: 43 females using hormonal contraception, 30 premenopausal females not using hormonal contraception, 30 postmenopausal females, and 24 males. Premenopausal females who used hormonal contraception had higher nausea scores than non-users (3.80 [IQR 2.00-5.42] vs 2.25 [0.20-4.43]; p<0.05), particularly when using the combined oral contraceptive pill (COCP) with hormone-free intervals compared to continuous use (5.20 [4.30-6.00] vs. 2.40 [1.70-3.80], p=0.02). Premenopausal women were more symptomatic than postmenopausal women and men (p<0.001). The Principal Gastric Frequency was higher in hormonal contraception users (median 3.1 cpm [IQR 3.00-3.30] vs. 3.00 cpm [2.90-3.10], p<0.001), and highest in users of progestogen-only formulations (p<0.02). Conclusion: Women with gastrointestinal disorders on hormonal contraception experience increased nausea in comparison to non-users of hormonal contraception, with substantial variation in nausea severity dependent on contraceptive type. Hormonal contraception users also demonstrated modified gastric electrophysiology. Women with chronic gastroduodenal symptoms should be asked about their use of hormonal contraception and non-hormonal contraceptive alternatives trialled as a means to reduce symptoms.