Oral hormonal contraceptive use and gastrointestinal symptoms in young women: a cross-sectional study

BACKGROUND: Gastrointestinal symptoms may affect contraceptive tolerability, yet domain-specific symptoms associated with oral contraceptive use remain insufficiently described. OBJECTIVE: To compare gastrointestinal, physical, and psychological symptoms among young adults using no birth control, a combined oral contraceptive (COC), or a progestin-only pill (POP). METHODS: Participants aged 18-25 years completed a cross-sectional online survey. The sample included 669 participants: 427 using no birth control, 196 using a COC, and 46 using a POP. Outcomes included five PROMIS gastrointestinal domains, a study-specific regional abdominal pain sum, eight Cohen-Hoberman Inventory of Physical Symptoms (CHIPS) domains, and anxiety, depressive symptoms, and health anxiety. Race/ethnicity and current sexual activity were included as additional fixed factors in primary models. RESULTS: The multivariate PROMIS effect of contraceptive group was not significant. Constipation was the only PROMIS domain meeting the Bonferroni-corrected criterion, with higher adjusted estimated marginal means among COC users than participants using no birth control. COC users also reported higher regional abdominal pain scores than POP users. The CHIPS multivariate effect was not significant, but gastrointestinal subscale scores were higher among COC users than participants using no birth control. Psychological outcomes showed a small multivariate group effect, but no individual outcome met the Bonferroni-corrected criterion. CONCLUSION: Oral contraceptive use was associated with modest, domain-specific gastrointestinal differences rather than a broad gastrointestinal or physical symptom profile. Because the study was cross-sectional and residual confounding remains possible, findings should be interpreted as associations rather than causal effects.