Nausea and gastric myoelectrical activity are influenced by hormonal contraception in chronic gastroduodenal disorders

Background: Chronic gastroduodenal disorders 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: One hundred twenty-seven people were included: 43 females using hormonal contraception, 30 not using hormonal contraception, 30 postmenopausal females, and 24 males. Hormonal contraception users had higher nausea than non-users (3.80 [IQR 2.00-5.42] vs 2.25 [0.20-4.43]; p<0.05), particularly when using combined oral contraceptives 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). Principal Gastric Frequency was higher in hormonal contraception users (median 3.1cpm vs. 3.00cpm, p<0.001), and highest with progestogen-only formulations (p<0.02).

Conclusion: Women with gastroduodenal disorders on hormonal contraception experience increased nausea in comparison to non-users, with substantial variation dependent on contraceptive type. Hormonal contraception users also demonstrated modified gastric electrophysiology. These results imply that non-hormonal contraceptive alternatives should be trialled as a means to reduce symptoms in gastroduodenal disorders.