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Safety of Contraceptive Method Use Among Women With Systemic Lupus Erythematosus: A Systematic Review

Culwell, Kelly R. MD, MPH1; Curtis, Kathryn M. PhD2; del Carmen Cravioto, Maria MD3

doi: 10.1097/AOG.0b013e3181ae9c64
Reviews

OBJECTIVE: To evaluate the evidence on the safety of contraceptive method use among women with systemic lupus erythematosus (SLE).

DATA SOURCES: We searched the PubMed, MEDLINE, and LILACS databases for peer-reviewed articles published from database inception through January 2009, concerning the safety of contraceptive use among women with SLE.

METHODS OF STUDY SELECTION: We included studies that examined health outcomes among women using a contraceptive method after the diagnosis of SLE. The quality of each individual piece of evidence was assessed using the U.S. Preventive Services Task Force grading system.

TABULATION, INTEGRATION, AND RESULTS: Our search yielded 275 articles. A total of 14 articles that reported on 13 studies met our inclusion criteria. Available evidence, including two good-quality randomized controlled trials, indicates that use of combined oral contraceptives does not lead to increased flares of disease or worsening disease activity in women with inactive or stable active SLE. No increase in disease activity with use of progestogen-only contraceptives was noted in four studies. Limited evidence indicates a possible increased risk of thrombosis in women with positive antiphospholipid antibodies and history of oral contraceptive use. Limited evidence indicates that the use of the copper intrauterine device is not associated with worsening disease activity or infection in women with SLE.

CONCLUSION: Available evidence indicates that many women with SLE can be considered good candidates for most contraceptive methods, including hormonal contraceptives. The benefits of contraception for many women with SLE likely outweigh the risks of unintended pregnancy in this population. Women with positive antiphospholipid antibodies are not good candidates for combined hormonal contraception given their elevated baseline risk of thrombosis.

In the absence of certain risk factors and coexisting conditions, many women with systemic lupus erythematosus can be considered good candidates for most contraceptive methods.

From the 1Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland; 2Centers for Disease Control and Prevention, Atlanta, Georgia; and 3Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, Mexico.

Supported by resources from the World Health Organization (Geneva, Switzerland), the Centers for Disease Control and Prevention (Atlanta, GA), the U.S. Agency for International Development (Washington, DC), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Rockville, MD).

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the World Health Organization or the Centers for Disease Control and Prevention.

Corresponding author: Kelly R. Culwell, MD, Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211-Geneva 27, Switzerland; e-mail: culwellk@who.int.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 The American College of Obstetricians and Gynecologists