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Therapy Insight: guidelines for selection of contraception in women with rheumatic diseases

Nature Clinical Practice Rheumatology volume 3, pages 273–281 (2007)Cite this article

Abstract

Use of contraceptives by women with rheumatic diseases, especially those with systemic lupus erythematosus, has long been thought to carry risks, such as disease exacerbation, thrombosis and other adverse effects. The use of effective contraception has, therefore, been avoided, despite many affected women being of reproductive age. Knowledge of risks and benefits of contraceptive methods in the general population has improved, as have the safety and effectiveness of hormonal contraceptives. Methods of administration have evolved and now include transdermal and intravaginal routes, a progesterone-releasing intrauterine device, and an extended-cycle oral contraceptive. Birth control pills are not all alike; the risk of adverse effects varies depending on the amount of estrogen and type of progestin used. Data show that patients with stable systemic lupus erythematosus are not at increased risk of disease flare while taking standard oral contraceptives. Despite a lack of randomized studies, evidence strongly suggests that the elevated risk of thrombosis makes estrogen-containing contraceptives unsuitable for patients with antiphospholipid antibody. Other important issues include potential interactions between hormonal contraceptives and other medications and possible risk of infection if an intrauterine device is used. Rheumatologists are increasingly working with gynecologists and patients to make choices about which contraceptive methods to use. Decisions should be individualized according to the patient's medical status, personal preference, and stage of reproductive life.

Key Points

  • Most patients with rheumatic disease are able to choose a safe and effective contraceptive from the options available

  • Combined oral contraceptives do not increase risk of disease flare in patients with stable systemic lupus erythematosus

  • Estrogen-containing contraceptives are contraindicated in patients at increased risk for thrombosis, including patients who test positive for antiphospholipid antibody

  • Progesterone-only contraceptives—oral, intramuscular, or intrauterine device—do not increase risk of thrombosis risk and are recommended for patients who have a contraindication to estrogen

  • Medroxyprogesterone acetate and the Mirena® intrauterine device decrease menstrual blood flow in patients receiving warfarin

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Author notes

  1. Department of Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA sammaritan@hss.edu

Authors and Affiliations

  1. LR Sammaritano is an Associate Professor of Clinical Medicine at the Weill Medical College of Cornell University, Hospital for Special Surgery in New York, NY, USA.,

    Lisa R Sammaritano

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Sammaritano, L. Therapy Insight: guidelines for selection of contraception in women with rheumatic diseases. Nat Rev Rheumatol 3, 273–281 (2007). https://doi.org/10.1038/ncprheum0484

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