Use of exogenaus estrogens in systemic lupus erythematosus

Objective: To review the current literature on the safety of using exogenou s estrogens in patients with systemic lupus erythematosus (SLE). Method: A MEDLINE search for articles published between 1970 and 2000 regar ding the relationship between estrogens and SLE was performed. Emphasis was put on human studies, treatment trials, and epidemiologic surveys. Results: The use of exogenous estrogens in healthy women increases the risk of SLE development, For patients with established SLE, a hypoestrogenemic state appears to be protective against severe flares, whereas exogenous est rogen administration or hyperestrogenemia induced by hormonal manipulation may exacerbate the disease in certain individuals. Both the use of oral con traceptives and the use of hormonal replacement therapy (HRT) increase the chance of venous thromboembolism. The presence of antiphospholipid antibodi es may aggravate the risk of thrombosis in SLE, In retrospective studies, H RT appears to be well tolerated ire postmenopausal SLE patients. Conclusions: There are no prospective data that show a deleterious effect o f exogenous estrogens on disease activity in human SLE, Oral contraceptives may be considered for patients with SLE in the absence of active nephritis or antiphospholipid antibodies. The slight increase in venous thromboembol ic risk should not be the chief deterrent to the use of HRT in postmenopaus al SLE patients, considering its various health benefits. Semin Arthritis Rheum 30:426-435. Copyright (C) 2001 by W.B. Saunders Compa ny.