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May I congratulate the authors of the commentary describing contraceptive options for women with systemic lupus erythematosis (SLE).1 This was a comprehensive summary and I was interested in their views regarding the suitability of progestogen-only methods in women with antiphospholipid antibodies. The authors felt these methods were unsafe in such women (World Health Organization Medical Eligibility Criteria for Contraceptive Use Category 3 – generally risks outweigh the benefits of use). As up to 42% of women with SLE will be positive for these antibodies2 the authors are reducing contraceptive choice to barrier methods, copper intrauterine devices or sterilisation.
About one-third of women with antiphospholipid antibodies develop a venous thromboembolism (VTE) in their lifetime and this risk is further increased in pregnancy and the puerperium.2 Maternal mortality in women suffering from SLE is thought to be 2–3%.3 We now have good evidence that progestogen-only contraceptive methods such as the levonorgestrel-releasing intrauterine system and desogestrel pill do not increase the risk of VTE in the general population.4 A recent study also suggested that oral pregnane progestogen contraceptives appear to have little effect on the development of VTE in women with SLE (where 29.4% of 187 women had detectable antiphospholipid antibodies).5
Perhaps the authors would like to provide an additional comment?
Competing interests The author has received financial support to attend pharmaceutical advisory board meetings, undertake research studies, speak at educational meetings and conferences along with travel grants from Astellas, Bayer, Consilient Healthcare, HRA Pharma, Merck, Pfizer and Vifor Pharma.
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