Risks from Contraceptive Methods Prove Equal for Lupus Patients

Newswise — The use of combined oral contraceptives, progestin-only oral contraceptives (minipill) and copper intrauterine devices (IUD) appear to produce the same level of risk for disease activity and flares in women with systemic lupus erythematosus, known as lupus, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Antonio, Texas.

The effect of contraceptive methods on disease activity and, therefore, the safety of their use by the many women who have the auto-immune disease, lupus, has yet to be defined. Lupus, which causes inflammation in joints, tendons, and other connective tissues and organs affects one million people in the U.S. and Europe, 90 percent of them women who are young and in their child-bearing years. To date, doctors have questioned prescribing oral contraceptives or estrogen replacement therapy for these women because of a widely held view that estrogens can make the disease worse.

To determine if other contraceptive methods offered lupus patients safer options, researchers conducted a single-blind, randomized clinical trial in which 162 women with lupus were divided in groups of 54 each and assigned one of three contraceptive methods. Combined oral contraceptives (ethinyl estradiol plus levonorgestrel) were given to one group, average age 27.4 years of age; progestin-only oral contraceptive given to a second group, average age 26.6 years of age; and an intrauterine device placed in patients in the third group, average 27.4 years of age. Other than the IUD participants' tendency to smoke less than the hormonal method users, the three groups were similar in demographic and disease characteristics.

All patients were monitored for disease activity at baseline, one, two, three, six, nine and 12 months by a rheumatologist who was unaware of the contraceptive method assigned. A gynecologist evaluated gynecological symptoms, adverse effects and medication compliance. Patients were also surveyed for hospitalization and other major events.

The disease activity as well as number of lupus flares proved to be similar across all three groups. Hormonal methods appeared to increase the risk of thrombotic events and IUD users showed a trend towards an increased risk of severe infections.

"Our results did not show a clinically relevant increase of disease activity by using estrogen containing contraceptive pills," said F. Jorge Sanchez-Guerrero, MD, Immunology/Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion, Mexico City, Mexico, and an investigator in the study. "The choice of a contraceptive method in women with lupus must take into account the condition of the disease, the potential risks and benefits of the methods, and the expressed desires of the patients."

The American College of Rheumatology is the professional organization for rheumatologists and health professionals who share a dedication to healing, preventing disability and curing arthritis and related rheumatic and musculoskeletal diseases. For more information on the ACR's annual meeting, see http://www.rheumatology.org/annual.