SLE and oral contraceptive pill (OCP) -Health awareness

SLE and oral contraceptive pill (OCP)

The issue about family planning should be widely discussed with those who have been diagnosed to have systemic lupus erythematosus (SLE). All methods should be considered including natural family planning and barrier method that carries lest risk, although the failure rate is high. OCP is still a method of contraception that worth to be considered. With the failure rate less than 1%, it will give comfort to those patients who are reliable and compliance to the medication, in the absence of contraindication.

Not a very long time ago, doctors are reluctant to give OCP to SLE patients because they are afraid that the exogenous estrogens could exacerbate the flare. On the other hand, a large NIH-supported study published in 2005, called Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) found that severe flares rate among women with lupus taking OCP and placebo (inactive pill) are about the same. Consequently, doctors are increasingly prescribing oral contraceptives to women with inactive or stable disease (14).

There are few advantages of OCP among SLE patients. First, planned pregnancy during remission period has better outcome both to mother and the baby. Secondly, patients with very active disease or use a teratogenic medication need a reliable birth control planning because accidental pregnancy might means hazards. Third, there is evidence that OCP may preserve ovarian function and therefore lessen the risk of infertility in patients on cyclophosphamide (if the patients need to be on cytotoxic agent therapy). Finally, OCP may also reduce bone loss in patients with glucocorticoids and further protect the patients from osteoporosis.

However, there is a suggestion that patients with lupus should be tested for the presence of antiphospholipid antibodies before oral contraceptives are started. OCP should probably be avoided among those with these antibodies or other hypercoagulable states including history of recurrent thromboembolic diseases(15).

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Reference:

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Handout on Health: Systemic Lupus Erythematosus.USA 2009. [ cited on 25 August 2009]. Available on http://www.niams.nih.gov/Health_Info/Lupus/default.asp#Lupus_8; accessed on 25/8/09
Bonnie B. Oral Contraceptives in Systemic Lupus Erythematosus – A Tough Pill to Swallow?, The New England Journal. 2005; 353(24):, 2602-2604.