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Introduction In PREdiCCt, the largest prospective study of IBD flare, female sex was strongly associated with increased patient-reported flares. Herein, we aimed to investigate associations between women’s health factors and disease flare.Methods Of 2629 participants, 1422 female patients in patient-reported remission were recruited from 47 UK sites and followed up prospectively for a minimum of 24 months. At study entry, patients completed questionnaires evaluating menstruation, menopause, and contraceptive use. Our primary objective was to determine the relationship between menopausal status and time to patient-reported or objective flare (CRP >5mg/L or FC >250μg/g and change in treatment). We further investigated hormonal contraception, menstrual patterns and IBD symptoms during menses with time to flare. Survival analyses with Cox frailty models were run adjusting for baseline FC and key clinical and demographic factors.Results We included 1044 patients [CD=555, UC/IBDU=465]. Pre-menopausal women had a higher baseline FC in clinical remission than post-menopausal women [p<0.001]. This association remains significant in a multivariable logistic regression model adjusted by age, disease duration, and biologic use (p=0.037). Pre-menopausal patients with irregular menstrual cycles and those reporting increased rectal bleeding during menses had a higher baseline FC (p=0.023 and p=0.024 respectively). Conversely, hormonal contraceptive use was associated with a lower baseline FC (p=0.016).The rates of objective flare were higher in pre- versus post-menopausal women on univariate analysis [17.1% vs 10.6%,p=0.0048 (figure 1B)], but not in the multivariable model (p=0.41). No significant differences were seen for patient-reported flare.Hormonal contraception was not associated with time to flare. Irregular menstrual cycle (variation ≥8 days) and prolonged menstrual period (>8 days) were associated with a shorter time to patient-reported [aHR 1.65 (1.19-2.30), p=0.0029 (figure 1C) and aHR 2.22 (1.20-4.10), p=0.011, respectively], but not objective flare. Similarly, women reporting increased rectal bleeding during menses had a shorter time to patient-reported flare [aHR 1.35 (1.00-1.82), p=0.047 (figure 1D)].Conclusions The absence of associations between women’s health factors and objective flares in PREdiCCt is reassuring. However, irregular cycles and prolonged menstrual periods were associated with higher risk of patient-reported flare. The observation that fully adjusted baseline FC is lower in post- versus pre-menopausal women merits further exploration.Abstract P198 Figure 1Time to flare for the PREdiCCt women´s health cohort. (A) patient-reported flare stratified by menopausal status; (B) objective flare stratified by menopausal status; (C) patient-reported flare stratified by menstrual cycle regularity; (D) patient-reported flare stratified by reporting of increased rectal bleeding during menses