Contraceptive practices in women with systemic lupus erythematosus and/or antiphospholipid syndrome: what advice should we be giving?
BACKGROUND
Systemic lupus erythematosus (SLE) is an autoimmune oestrogen-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.


OBJECTIVE
To determine the past and present contraceptive practices of women with SLE and/or APS, and to establish the incidence of complications related to use of various contraceptives. Also, the contraceptive information given to women following diagnosis was evaluated.


METHODS
Observational questionnaire-based study of 86 women with SLE and/or APS attending the Lupus/Thrombophilia Clinics at St. Thomas' Hospital.


RESULTS
One of the 19 (5%) women with SLE using the combined oral contraceptive pill (COCP) at the time of diagnosis reported a 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/or 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/or thromboses.


CONCLUSIONS
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/or APS should be given more information about contraceptive issues.
Lakasing
L
L
Department of Obstetrics and Gynaecology, GKT School of Medicine, London, UK. lorin.lakasing@kcl.ac.uk
Khamashta
M
M
D000293:Adolescent; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000175:diagnosis*; D015331:Cohort Studies; D003267:Contraception / Q000592:standards* / Q000639:trends; D003270:Contraceptive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003657:Decision Making; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis*; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D006113:United Kingdom
D003270:Contraceptive Agents