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What are the contraceptive options for women with systemic lupus erythematosus?

Jordan Daily – Family planning is an important clinical consideration in women with systemic lupus erythematosus (SLE), since the peak incidence of this disorder is in women of childbearing age. Pregnancy in SLE patients, especially during the period of disease activity, is associated with several complications such as pulmonary hypertension and cardiovascular disease, high rates of maternal morbidity and mortality, and health problems for the fetus. Furthermore, many drugs used to treat SLE, such as methotrexate and warfarin, are prohibited during pregnancy.

What is systemic lupus erythematosus?

Systemic lupus erythematosus (SLE) is the most common type of lupus, an autoimmune disease in which the immune system attacks the body’s own tissues, causing widespread inflammation and tissue damage in affected organs. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels. There is no cure for lupus, but medical interventions and lifestyle changes can help control it.
Signs and symptoms:
• Symptoms can vary and can change over time. Common symptoms include:
• extreme tiredness
• joint pain
• swollen joints
• headache
• A rash on the cheeks and nose called “butterfly rash”
• hair loss
• anemia
• Blood clotting problems
• Fingers turn white or blue and numbness occurs when cold, which is known as Raynaud’s phenomenon
• Other symptoms depend on the part of the body that the disease is attacking, such as the digestive system, the heart, or the skin.
Lupus symptoms are also symptoms of many other diseases, which can make diagnosis difficult. If you have any of these symptoms, see your doctor. Your doctor can perform tests to gather the information needed to make an accurate diagnosis.
An episode of SLE symptoms called flares may occur now and then, sometimes years apart, and at other times they go away – called remissions. However, other adults may have repeated episodes of SLE throughout their lives.

What are the complications of lupus erythematosus?

SLE can have both short and long-term effects on a person’s life. Early diagnosis and effective treatment can help reduce the harmful effects of SLE and improve the chance of a better quality of life. Poor access to care, late diagnosis, less effective treatments, and poor adherence to treatment regimens may increase the adverse effects of SLE, causing further complications and an increased risk of death.
SLE can limit a person’s physical, mental, and social functioning. These limitations that people with SLE experience can affect their quality of life, especially if they experience fatigue. Fatigue is the most common symptom that negatively affects the quality of life of people with SLE.
Adherence to treatment regimens is often a problem, especially among young women of reproductive age (15 to 44 years). Since the treatment of SLE may require the use of strong immunosuppressive medications which can have serious side effects, patients should stop taking the medication before and during pregnancy to protect the unborn child from harm.

Who is at risk of SLE?

SLE can affect people of all ages, including children. However, women of reproductive age (15 to 44 years) are more likely to develop SLE. Women of all ages are affected much more than men (estimates range from 4 to 12 women to 1 man). Racial and ethnic minorities (Black/African Americans, Latinos, Asians, American Indians/Alaska Natives) are affected more than whites/Caucasians.
Despite the risks of an unwanted pregnancy in the case of systemic lupus erythematosus (SLE), many women with lupus do not adequately use effective contraceptives.
The choice of the optimal method of birth control for women with systemic lupus erythematosus (SLE) depends on multiple factors, including the patient’s values and preferences, contraceptive efficacy and side effects, underlying disease activity, and drug interactions. Both rheumatologists and gynaecologists contribute to identifying these factors and ultimately making recommendations to the patient.
Family planning options in systemic lupus:
– The most important updates covering family planning options are:
For women who wish to use non-permanent long-acting contraceptives, the levonorgestrel IUD is a safe and effective option for most patients with SLE. It is worth noting that an increased incidence of pelvic infection (PID) has not been reported in patients taking immunosuppressive drugs.
– For women who wish to use oral hormonal contraceptives and who have low and stable lupus activity, they can use estrogen-progestin-containing contraceptives with ethinyl estradiol doses of 30 mcg or less (the dose used in clinical trials).
– For patients with lupus erythematosus who do not wish to use an IUD and have a high disease activity, positive index, or other contraindications to estrogen use, progestin-only contraceptives can be used.

The institute for Family Health / King Hussein Foundation contributed this article to Jordan Daily 

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