Oral contraceptives and systemic lupus erythematosus

The discontinuation of oral contraceptive use at the time of diagnosis of systemic lupus erythematosus (SLE) has been the usual practice in patients enrolled in the Hopkins Lupus Cohort. The evidence in the literature of a deleterious effect of combined oral contraceptives upon the activity of SLE or on thromboembolism (TE) in SLE is reviewed together with an examination of the potential beneficial effects of oral contraceptives, including better contraception, the control of cyclic SLE disease activity, prevention of osteoporosis, and the preservation of fertility during cyclophosphamide treatment. It is argued that while SLE is a hormonally-driven disease, multiple hormones, and not just estrogen, play a role. Estrogen use as both combined oral contraceptives and for hormone replacement therapy has not been systematically studied, so no quantification of risk and no identification of high-risk groups can be made.