Introduction 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.
Objectives 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.
Study design 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.
Conclusion 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.
- antiphospholipid syndrome
- systemic lupus erythematosus
- Accepted October 2, 2000.
- Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
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