Oral contraception and systemic lupus erythematosus (SLE)

The choice of an optimal contraceptive method is a significant problem in female SLE patients. In view of the influence of sex hormones on the evolution of SLE oral contraceptive (OC) therapy has to be efficient reversible and safe without aggravation to the already-present condition and must not cause metabolic and vascular side effects. Ethinyl estradiol-containing preparation even at 30 mcg/day have been shown to trigger a crisis or unmask SLE and they exert adverse metabolic and vascular effects. Therefore combination estrogen- progestogen OCs do not stimulate SLE activity but norsteroids have harmful metabolic side effects and microprogesterones are not sufficiently reliable. In light of the decreased level of plasma androgens in female SLE patients an attempt to modulate the hormonal milieu by lowering the estrogen-to-androgen ratio while ensuring contraception was attempted using cyproterone acetate. This agent markedly lower and plasma estrogens and was effective and well- tolerated but its longterm on bone mineralization remains to be evaluated. Chlormadinone acetate a 17-OH progesterone derivative was proven effective and devoid of any metabolic or vascular side effects and should be recommended as the safest routine OC therapy in women with SLE. (authors modified) (summaries in FRE ENG)