Risks of hormonal contraception in SLE clarified

WHILE many women with systemic lupus erythematosus (SLE) can safely use hormonal contraceptives, experts advise careful consideration of a range of possible risk factors before recommending their use.

Researchers from the World Health Organization and the US Centers for Disease Control conducted a systematic review of 13 studies including two randomised controlled trials.

The researchers said that in particular women with positive antiphospholipid antibodies were at higher baseline risk of arterial and venous thrombosis and combined hormonal contraception should be avoided.

Contraceptive choice for women with SLE should take account of any co-existing medical conditions, such as atherosclerosis, hypertension or thrombocytopenia.

Contraception was an important issue for women with SLE, they said, as pregnancy could trigger disease flares.

Women who experienced moderate to severe increases in symptoms during pregnancy were also more likely to have obstetric complications.

The authors concluded that the available evidence suggested that use of combined oral contraceptives did not worsen the condition in most women.

However, the evidence regarding cardiovascular outcomes was limited.

“Available evidence indicates that many women with SLE can be considered good candidates for most contraceptive methods,” they concluded, but added that further research was needed.

Obstet Gynecol 2009;114:341-53