Systemic lupus erythematosus (SLE) is an autoimmune estrogen-mediated disease. Antiphospholipid syndrome (APS) is an autoimmune acquired thrombophilia. These two conditions may co-exist and are most frequently diagnosed in young women. Hormonal contraception may promote lupus activity and thromboses. Medical practitioners may not know what advice to give these women regarding contraception.
Researchers conducted this study to determine the past and present contraceptive practices of women with SLE and APS and establish the incidence of complications related to various contraceptives. Also, the contraceptive information given to women following diagnosis was evaluated.
The present research was an observational questionnaire-based study of 86 women with SLE and APS attending the Lupus/Thrombophilia Clinics at St. Thomas’ Hospital.
One of the 19 (5%) women with SLE using the combined oral contraceptive pill (COCP) at the time of diagnosis reported severe lupus ‘flare’. Seven of the 32 (22%) women with APS using the COCP suffered from thromboses during use. There were no problems specific to women with SLE and APS using any other form of contraception. Thirty-nine (45%) women received no contraceptive information following their diagnosis, 37 (46%) were told to avoid the COCP due to the increase in lupus ‘flare’ and thromboses.
There is no clinically significant association between COCP use and lupus ‘flare’. The high incidence of thromboses in women with APS using the COCP containing either second or third-generation progestogens suggests that these women should be advised against using this form of contraception. Women with SLE and APS should be given more information about contraceptive issues.
Reference: https://srh.bmj.com/content/27/1/7
