Contraceptive use in Lupus
Oral contraceptives are a combination of estrogen & progesterone. Given the presence of female hormones, their use may result in a flare of lupus activity. Secondly, they may also increase the risk of thrombosis in a SLE patient with anti phospholipid antibodies. Hence they are not advisable in anybody with lupus. Earlier studies did in fact show a significant increase in lupus flares with the use of oral contraceptives. Safety of Estrogen in Lupus Erythematosus: National Assessment (SELENA) trial was conducted to look at the issue of safety of oral contraceptives in lupus. This study was a well planned study involving 183 SLE patients. This study did not reveal any risk of lupus flare with the use of oral pills. The present consensus however is to avoid the use of pills in those with active unstable lupus & those with anti phospholipid antibodies.
Progesterone only pills
These seem to be safer as progesterone does not cause flare up of lupus activity.
Intra uterine devices
Intra uterine devices are prone to infections given the fact that a lupus patient is on multiple immunosuppressants & steroids.
Progesterone alone generally does not lead to a lupus flare. However, US FDA has has advised that the use of depo-progesterone be limited to 2 years because of an increased risk of osteoporosis with long-term use.
These are the best method in lupus as there is no risk of lupus flare.
Ref: Michelle Petri, The Hopkins Lupus Pregnancy Center: Ten Key Issues in Management Rheum Disease Clinics of North America 33 (2007) 227–235.