Pruritus risk with hormonal contraception use in women with ICP

The findings, presented at AASLD The Liver Meeting in Denver, Colorado, USA, also showed that women who reported pruritus with the use of combined hormonal contraception had a 45–53% risk for having pruritus with progesterone-only contraception as well. 

Laura Bonebrake (Saint Louis University, Missouri, USA) pointed out that the timing of ICP onset may play a role in the future risk for pruritus with hormonal contraceptive use. The study showed that women with early-onset ICP (<28 weeks’ gestation) were more at risk than those with late-onset ICP (≥28 weeks’ gestation). 

“These are probably your patients that may end up having genetic abnormalities,” and “who should be further screened or further looked at by hepatologists,” Bonebrake told medwireNews. 

She commented: “We are starting to highlight that after pregnancy we need to be looking at these women and making sure they are on the right track for liver health lifelong.” 

The study used data from a patient registry on 102 women with a history of ICP who after pregnancy self-reported their hormonal contraceptive use and any pruritus, the rates of which were “a little higher than we would expect,” said Bonebrake. 

In all, 23.5% of 78 women reported onset of pruritus with the use of the combined estrogen/progesterone pill, while 18.6% of 35 women experienced pruritus with the progesterone-only pill and 22.2% of 28 women with a progesterone intrauterine device. 

Among women on the combined pill, those with early-onset ICP were more likely to experience pruritus, at a rate of 38.2%, compared with 17.0% for those with late-onset ICP. The odds ratio was 1.34, which did not reach statistical significance, but this was likely due to the small sample size, the researchers suggest. 

Bonebrake stressed that “consideration could be given to test this group for genetic predispositions or other liver conditions.” 

She concluded: “Further investigation is needed to measure liver function testing in postpartum ICP patients to determine if pruritus represents a true recurrence of liver dysfunction with hormonal use and to outline appropriate management of ICP patients with contraceptive options after pregnancy.”