Oral contraceptives in systemic lupus erythematosus: side-effects and influence on the activity of SLE

Scand J Rheumatol. 1991;20(6):427-33. doi: 10.3109/03009749109096822.

Abstract

The risk of a disease flare-up and the side-effects experienced during the use of oral contraceptives (OCs) were studied in 85 female SLE patients, 18-44 years old, regularly attending two specialist rheumatological clinics. Thirty-one patients had used combined oral contraceptives (cOCs) during or after the onset of SLE. Initial manifestations or exacerbations of SLE were noted in 4 (13%) of these patients during the first six months after starting cOCs and three of these four patients had major renal involvement. The incidence of disease flare-ups was the same as in patients not using cOCs. Two patients developed deep venous thrombosis during cOCs, and they both had antiphospholipid antibodies. Thirty-two patients had used progestagen-only contraceptives (PCs) and they were discontinued in 25 (78%) of the patients because of minor side-effects, mainly reflecting poor gynaecological tolerance. Albeit there is no definitive proof that cOCs actually precipitate or exacerbate SLE some patients may be more likely to have adverse effects while taking cOCs. It appears best to avoid cOCs in SLE patients with high levels of antiphospholipid antibodies and in patients with active nephritis. PCs cause many side-effects in SLE patients, but do not seem to activate the disease.

PIP: The pharmacology, clinical performance, and metabolic effects of the identical combined oral contraceptive Femodene (Schering) and Minulet (Wyeth), are compared with Microgynon 30, the most widely used pill in the United Kingdom. Femodene and Minulet both contain 30 mcg ethinyl estradiol and 75 mcg gestodene, while Microgynon contains 30 mcg ethinyl estradiol and 150 mcg levonorgestrel. Gestodene is active on its own, so it suppresses ovulation at a very low dose. It is a strong anti-estrogen, has low androgenic, and minimal anti-mineralocorticoid effects. Femodene/Minulet appears to cause less breakthrough bleeding, even in the 1st few cycles, than Microgynon. It raises triglycerides and phospholipids, but does not affect lipids or carbohydrates. Like many oral contraceptives, these formulations increase clotting Factor Vii, yet accelerate fibrinolysis. There have been extremely few reports of severe adverse effects: a 19-year old Femodene user died from pulmonary embolism. These formulations are 2-4 times as expensive as other popular combined oral contraceptives marketed in England.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Contraceptives, Oral, Combined / adverse effects*
  • Estrogens / adverse effects
  • Female
  • Humans
  • Lupus Erythematosus, Systemic / epidemiology
  • Lupus Erythematosus, Systemic / pathology*
  • Lupus Erythematosus, Systemic / physiopathology
  • Retrospective Studies
  • Risk Factors
  • Thrombophlebitis / epidemiology
  • Time Factors

Substances

  • Contraceptives, Oral, Combined
  • Estrogens