Contraceptive practices in women with systemic lupus erythematosus and/or antiphospholipid syndrome: What advice should we be giving?

Introduction. Systemic lupus erythematosus (SLE) is an autoimmune oestrogen -mediated disease. Antiphospholipid syndrome (APS) is art autoimmune acquir ed thrombophilia. These two conditions may co-exist and are most frequently diagnosed in young women. Hormonal contraception may promote lupus activit y and thromboses. Medical practitioners may not know what advice to give th ese women regarding contraception. Objectives. To determine the past and present contraceptive practices of wo men with SLE and/or APS, and to establish the incidence of complications re lated to use of various contraceptives Also, the contraceptive information given to women following diagnosis was evaluated. Study design. Observation al 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 contrace ptive 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 thrombos es during use. There were no problems specific to women with SLE and/or APS using arty other form of contraception. Thirty-nine (45%) women received n o contraceptive information following their diagnosis, 37 (46%) were fold t o 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 usin g the COCP containing either second or third generation progestogens sugges ts that these women should be advised against using this form of contracept ion. Women with SLE and/or APS should be given more information about contr aceptive issues.