Hormonal contraceptives can be safe for many with lupus

The use of hormonal contraception appears to be appropriate in many women with lupus, according to research published in the August issue of Obstetrics & Gynecology.

Kelly R. Culwell, MD, of the World Health Organization in Geneva, and colleagues analyzed data from 13 studies involving women using contraception after being diagnosed with systemic lupus erythematosus (SLE).

Two randomized controlled trials offered good evidence that women with inactive or stable active lupus didn’t have increased flares or worsening disease activity from using combined oral contraceptives, and no increase in disease activity was seen with progestogen-only contraceptives across four studies. However, the authors note, thrombosis may be a concern with oral contraceptive use in women with positive antiphospholipid antibodies. Copper intrauterine devices don’t appear to be linked to worsening disease activity or infection.

“Available evidence indicates that many women with SLE can be considered good candidates for most contraceptive methods, including hormonal contraceptives. Women with positive antiphospholipid antibodies are at significantly increased risk of arterial and venous thrombosis and therefore the use of combined hormonal methods should be avoided in these women," the authors conclude. “Overall, the benefits of contraception for many women with SLE likely outweigh the risks of unintended pregnancy.”

Culwell KR, Curtis KM, Del Carmen Cravioto M. Safety of contraceptive method use among women with systemic lupus erythematosus: a systematic review.

Obstet Gynecol.

2009;114:341-353.