The Protective Role of Hormonal Birth Control in Idiopathic Subglottic Stenosis.

Background: Idiopathic subglottic stenosis (iSGS) occasionally affects women of childbearing age. Surgical intervention is the primary treatment, yet limited research exists on factors influencing disease severity. This study explores the impact of hormonal contraception on iSGS recurrence rates and surgery-free intervals.

Methods: This retrospective study was conducted at a tertiary academic care center. Patients using hormonal birth control (e.g., estrogen-progesterone pills, progesterone implants) during their first procedure were classified in "Birth Control (BC)" group, while those not using contraceptives were placed in "No Birth Control (NBC)" group. Poisson regression evaluated recurrence rates, and Mann-Whitney tests assessed surgery-free intervals. Kaplan-Meier analysis estimated time to first recurrence, adjusting for age and follow-up duration.

Results: Twenty-six patients were in the NBC group and 12 in the BC group (average ages 37 and 34, respectively). Patients in the NBC group were 2.6 times more likely to experience recurrence compared to those in the BC group (p = 0.001). The expected number of recurrences for the BC group was 0.4 times that of the NBC group (95% CI: 0.2-0.7; p = 0.001). Furthermore, patients taking birth control were significantly less likely to have a first recurrence (HR: 0.4; 95% CI: 0.2-0.9; p = 0.025) and had longer times to first recurrence (Figure 1; p = 0.031).

Conclusions: Birth control appears to protect against iSGS severity, potentially through hormonal mechanisms. Hormonal contraception may serve as a non-surgical alternative for managing iSGS. Future prospective studies may evaluate outcomes in newly diagnosed iSGS patients started on birth control compared to those not using hormonal contraceptives.