Systemic lupus erythematosus primarily affects women of reproductive age.  Lupus often worsens during pregnancy, leads to higher rates of pregnancy-related complications, and may be treated with teratogenic medications.  Nevertheless, many lupus patients report no recent contraceptive counseling from clinicians.

Several studies examined the effect of hormonal birth control on the frequency and severity of lupus flares.  They found no significant differences among the treatment and placebo groups.  These studies excluded women with severe lupus, and therefore have limited generalizability; but it is reasonable to conclude that hormonal contraception does not significantly increase disease activity for most patients with lupus.

The United States Medical Eligibility Criteria (MEC) for Contraceptive use guides contraceptive choices for patients with lupus.  For lupus patients who have antiphospholipid antibodies, estrogen-containing methods carry an unacceptable thrombotic risk, and the risks of progestin-only methods outweigh the benefits.  Lupus patients who have multiple thrombotic risk factors (such as smoking, bed rest, or obesity) may not be eligible for any hormonal method.  For lupus patients without thrombotic risk factors but with severe thromboctyopenia, progestin injection and copper IUD get a “3” rating, while all other methods get a “2” rating.  Hormonal methods may benefit patients with thrombocytopenia by reducing menstrual bleeding.  For lupus patients who do not have antiphospholipid antibodies or severe thrombocytopenia, all hormonal methods get a “2” rating, and the copper IUD gets a “2” or “1” rating.

Medically complex patients often get shortchanged in preventive care.  Don’t forget to ask women with lupus about their contraceptive needs!

Resources

Medical Eligibility Criteria for Initiating Contraception

Sources

Sammaritan LR.  Therapy insight:  guidelines for selection of contraception in women with rheumatic diseases.  Nature Clinical Practice Rheumatology. 2007, 3:273.81.

Culwell KR, Curtis KM.  Contraception for Women with Systemic Lupus Erythematosus.  Journal of Family Planning and Reproductive Health Care. 2013, 39(1):9-11.

Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.