Women with SLE should be carefully evaluated and assessed before administration of any exogenous hormones containing estrogen. To avoid hypercoagulability, particular care should be taken prior to prescribing any estrogen therapy to SLE patients who also suffer from APS, and use of combination OCs is contraindicated in patients with active lupus nephritis. Recent studies have shown safety and efficacy of progestogen-only contraceptives in SLE patients, and the use of an IUD has also been proved safe for use in SLE patients who are not severely immunocompromised. Regardless of form or regimen, all SLE patients receiving any hormonal contraceptive therapy should be carefully followed and monitored for any signs of complications or flares.
1. Petri M. Systemic Lupus Erythematosus: Pathogenesis, Diagnosis, and Treatment. The Female Patient. 2003; 28(3):25-28;31.
2. Petri M. Pregnancy in the Lupus Patient. The Female Patient. 2003;28 (3):12-15.
3. National Institute on Arthritis and Musculoskeletal and Skin Diseases. NIAMS Launches Two Research Initiatives in Systemic Lupus Erythematosus. Available at: http://www.nia ms.nih.gov/ne/press/1996/01_15.htm.
4. Lockshin M. Lupus in the Female Patient. The Female Patient. 2000;9 (25):36-47.
5. Julkunen H. Pregnancy and lupus nephritis. Scand J Urol Nephrol. 2001; 35(4):319-327.
6. Lakasing L, Khamashta M. Contraceptive practices in women with systemic lupus erythematosus and/or antiphospholipid syndrome: what advice should we give them? J Fam Reprod Health Care. 2001;27(1)7-12.
7. Rampone A, Rampone B, Tirabasso S, et al. Contraception with the latest estroprogestagens in women suffering from systemic lupus erythematosus. Minerva Ginecol. 2001;53(1 Suppl 1):75-77.
8. Julkunen HA. Oral contraceptives in systemic lupus erythematosus: side-effects and influence on the activity of SLE. Scand J Rheumatol. 1991;20 (6):427-433.
9. Kaunitz AM. ACOG Practice Bulletin. The use of hormonal contraception in women with coexisting medical conditions. Number 18, July 2000. Int J Gynaecol Obstet. 2001;75(1):93-106.
10. Mintz G, Gutierrez G, Deleze M, Rodriguez E. Contraception with progestagens in systemic lupus erythematosus. Contraception. 1984;30(1): 29-38.
11. Frederiksen MC. Depot medroxyprogesterone acetate contraception in women with medical problems. J. Reprod Med. 1996;41(5 Suppl): 414-418.
12. Jungers P, Liote F, Dehaine V, et al. Hormonal contraception and lupus. Ann M ed Interne (Paris). 1990;141 (3):253-256.
13. Julkunen HA, Kaaja R, Friman C. Contraceptive practice in women with systemic lupus erythematosus. Br J Rheumatol. 1993;32(3):227-230.
Thomas E. Nolan, MD, MBA