In addition to studies on combination OC use in patients with SLE, research has also been conducted to determine the safety and efficacy of progestogen-only use in women with SLE as a safer alternative to combination OCs. While progestogen-only contraception can cause side-effects in patients with SLE, it does not appear to activate the condition. 8 In its July 2000 practice bulletin, The American College of Obstetricians and Gynecologists recommends use of injectable forms of contraception or implants as safer alternatives to combination OCs in women with one or more conditions such as lupus, sickle cell anemia, migraine headaches, and hypertension or diabetes with vascular disease, or older than age 35 years. 9
Mintz et al tested the effectiveness and tolerance of progestogens as an alternative to combination OC use for women with SLE. 10 In this study, 10 patients with SLE were administered 200 mg intramuscular norethisterone enanthate, and 15 patients with SLE received 0.03 mg/day of oral levonorgestrel. Both groups were compared with a control group of 18 patients. 10 In the norethisterone enanthate group, 4 episodes of active SLE occurred in 48 patient-months; in the levonorgestrel group, six episodes of active SLE occurred in 122 patient-months; and 9 episodes of active disease occurred in the control group in 298 patient-months. 10 There was a discontinuation of medication in 30% of patients due to intermenstrual bleeding, and no pregnancies occurred in any of the groups studied. 10 These results, therefore, suggest that progestogen use in patients with SLE may be a safe contraception method for some patients with SLE.
In addition to the above mentioned progestogens, a long-acting progestogen such as depot medroxyprogesterone acetate (DMPA) also may provide a safe alternative to estrogen-containing contraceptives for women with SLE. 11 Also, chlormadinone acetate (a 17-OH progesterone derivative) has also proved safe and effective for use in women with SLE as it has shown no metabolic or vascular side effects in these patients. 12
In addition to barrier methods, women with SLE who are not severely immunocompromised may safely use intrauterine devices (IUDs) as a nonhormonal form of contraception. 2
Julkunen et al performed a cross-sectional study of real contraceptive practices in a group of reproductive-aged Finnish women with SLE. 13 Part of this study assessed the side effects of both OC and IUD use. The risk of Deep venous thrombosis of patients using estrogen-containing OCs was slightly increased (relative risk 2.3, 95% confidence interval 0.5 to 10.3). 13 Twenty-five (78%) of the 32 patients who had used progestogen-only contraceptives discontinued use due to side effects from the medication; however, no major bleeding or pelvic infection occurred in any patients who used IUDs. 13