Format

Send to

Choose Destination
Rheumatology (Oxford). 2019 Jul 1;58(7):1259-1267. doi: 10.1093/rheumatology/kez014.

Use of combined hormonal contraceptives among women with systemic lupus erythematosus with and without medical contraindications to oestrogen.

Author information

1
Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada.
2
Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.
3
Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
4
Centre for Prognosis Studies in the Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
5
Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
6
Division of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico.
7
Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
8
Rheumatology Department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
9
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
10
Cedars-Sinai Medical Centre, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
11
Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
12
Division of Rheumatology, Department of Medicine, New York School of Medicine, New York, NY, USA.
13
Centre for Rheumatology, Department of Medicine, University College London, London, UK.
14
Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.
15
Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
16
Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.
17
Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Québec City, Quebec, Canada.
18
Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland.
19
Division of Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
20
Lupus Research Unit, Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK.
21
Feinstein Institute for Medical Research, Manhasset, NY, USA.
22
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
23
Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, PA, USA.
24
Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden.
25
Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK.
26
Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm, Sweden.
27
Joseph Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain.
28
Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
29
Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, USA.
30
University of California San Diego School of Medicine, La Jolla, CA, USA.
31
Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
32
Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
33
Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
34
Copenhagen Lupus and Vasculitis Clinic, Section 4242, Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
35
Division of Rheumatology, Columbia University Medical Center, New York, NY, USA.
36
Department of Rheumatology, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada.
37
Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal and Dermatological Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
38
NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
39
Centre de Reference Maladies Auto-immunes et Systemiques Rares, Service de Medecine Interne, Hospital Cochin, Paris, France.

Abstract

OBJECTIVES:

To assess the prevalence of combined hormonal contraceptives (CHCs) in reproductive-age women with SLE with and without possible contraindications and to determine factors associated with their use in the presence of possible contraindications.

METHODS:

This observational cohort study included premenopausal women ages 18-45 years enrolled in the SLICC Registry ⩽15 months after SLE onset, with annual assessments spanning 2000-2017. World Health Organization Category 3 or 4 contraindications to CHCs (e.g. hypertension, aPL) were assessed at each study visit. High disease activity (SLEDAI score >12 or use of >0.5 mg/kg/day of prednisone) was considered a relative contraindication.

RESULTS:

A total of 927 SLE women contributed 6315 visits, of which 3811 (60%) occurred in the presence of one or more possible contraindication to CHCs. Women used CHCs during 512 (8%) visits, of which 281 (55%) took place in the setting of one or more possible contraindication. The most frequently observed contraindications were aPL (52%), hypertension (34%) and migraine with aura (22%). Women with one or more contraindication were slightly less likely to be taking CHCs [7% of visits (95% CI 7, 8)] than women with no contraindications [9% (95% CI 8, 10)].

CONCLUSION:

CHC use was low compared with general population estimates (>35%) and more than half of CHC users had at least one possible contraindication. Many yet unmeasured factors, including patient preferences, may have contributed to these observations. Further work should also aim to clarify outcomes associated with this exposure.

KEYWORDS:

anti-phospholipid syndrome; contraception; epidemiology; systemic lupus erythematosus

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center