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Menopausal Hormone Therapy and Risk of Diverticulitis

Jovani, Manol, MD, MPH1,2; Ma, Wenjie, ScD1,2; Joshi, Amit D., MBBS, PhD1,2; Liu, Po-Hong, MD, MPH1,2; Nguyen, Long H., MD, MSc1,2; Cao, Yin, ScD1,2,3; Tam, Idy4; Wu, Kana, MD, PhD5; Giovannucci, Edward L., MD, ScD5,7; Chan, Andrew T., MD, MPH1,2,7,8; Strate, Lisa L., MD, MPH9

American Journal of Gastroenterology: February 2019 - Volume 114 - Issue 2 - p 315–321
doi: 10.14309/ajg.0000000000000054

Introduction: Diverticulitis is a significant cause of morbidity among older women, and little attention has been paid to understanding its etiology. We have shown that menopausal hormone therapy (MHT) is associated with the risk of inflammatory bowel disease. In this study, we prospectively examined the association between MHT and the risk of incident diverticulitis.

Methods: We studied 65,367 postmenopausal women enrolled in the Nurses' Health Study who provided detailed information on hormone use and other medical and lifestyle factors biennially, and on diet every 4 years. Between 2008 and 2014, participants reported any episodes of diverticulitis that required antibiotics and the date of occurrence. We used Cox proportional hazards regression models to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: Over 24 years encompassing 1,297,165 person-years of follow-up, we documented 5,425 incident cases of diverticulitis. We observed an increased risk of diverticulitis among both current (HR 1.28; 95% CI 1.18–1.39) and past (HR 1.35; 95% CI 1.25–1.45) MHT users compared to never users. The increased risk was observed among participants using estrogen only (HR 1.30; 95% CI 1.20–1.41) and those using combined estrogen and progesterone (HR 1.31; 95% CI 1.21–1.42) compared to nonusers. The risk did not increase with longer duration of use (P-trend = 0.76). The association between MHT and diverticulitis was not modified by age, body mass index, past oral contraceptive use, or fiber intake (all P-interaction >0.11).

Conclusions: Menopausal hormone therapy was associated with an increased risk of diverticulitis. Further studies are needed to understand the potential mechanisms that may underlie this association.

1Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA;

2Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA;

3Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA;

4Tufts University School of Medicine, Boston, Massachusetts, USA;

5Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA;

6Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA;

7Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA;

8Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA;

9Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington, USA.

Correspondence: Lisa L. Strate, MD, MPH. E-mail:

SUPPLEMENTARY MATERIAL accompanies this paper at and

The last two authors are co-senior authors.

Received August 05, 2018

Accepted November 08, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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