Doctors in two separate studies are contradicting earlier advice, and are now advocating the use of oral contraceptives for women with lupus.1,2 For some two decades, women with the disease were told that using oral contraceptive pills were risky because they could cause lupus flare-ups. But it appears that the original advice, based on some studies in animals, may have been wrong.
Associated with Pulmonary Hypertension
Lupus is a type of connective tissue disease that can lead to pulmonary hypertension in some patients.3 It's an autoimmune disease in which the immune system abnormally attacks parts of the body, rather than disease-causing organisms in the body, as it's supposed to do. Lupus can manifest itself in many different ways, such as inflammation in the joints, rashes on the skin, or unexplained fever. Other symptoms include chest pain, swollen glands, extreme fatigue, unusual hair loss and low blood count.4
The most common symptoms are achy joints, frequent high fevers and arthritis.5
No Risk from 'The Pill'
In two studies presented at the annual meeting of the American College of Rheumatology last October, no differences were found in the disease between women who used birth control pills or those who used intrauterine devices.
"Oral contraceptives do not increase the rate of severe or mild/moderate flares in systemic lupus erythematosus [SLE]," wrote Michelle Petri, MD, a professor of Medicine at Johns Hopkins University in Baltimore, and her colleagues, in one study. "With the exception of women at increased risk for thrombosis, results from the only prospective trial to date support the safe use of oral contraceptives in SLE."
Petri's group enrolled 183 women, and found no differences in disease severity between those using oral contraceptives versus a placebo. Lupus exacerbations occurred in 7 of 91 women taking oral contraceptives in the study, and 7 of 92 women taking placebo. Each patient was evaluated at 1, 2, 3, 6, 9, and 12 months after starting on birth control or placebo. Only one patient experienced deep vein thrombosis, or blood clot, during the trial.
As a result, Petri's team concluded oral contraceptives are no worse for women with lupus than if they were not using them at all. Women at risk for developing blood clots are the only exception. Petri says about one-third of women with lupus face this risk.
More Support for Oral Contraceptive Use
In a second study by doctors at Instituto Nacional de Ceincias Medicas y Nutricion in Mexico City, F. Jorge Sanchez-Guerrero, MD, a professor of Immunology/Rheumatology and his associates compared the outcomes of women using two different oral contraceptives versus those who used intrauterine devices. The rate of disease flare-up was compared between women who used the two different birth control pills, and between the three groups of women.
As in the American study, Sanchez-Guerrero's group found no differences in lupus relapse among all the women in the trial. Each of the women were examined at 6 different periods during the study, but in the end, all of the patients faced the same low risk of symptom recurrence, the Mexican study team learned.
Pregnancy Warning
While lupus can cause many symptoms, women can have normal fertility, Petri explained. Still, pregnancy in lupus patients may increase the risk of flare-ups and can be risky for both mother and child, which may be born prematurely or may miscarry.
It's estimated that about 1.5 million Americans have a form of lupus. It occurs approximately 10 times more frequently in women compared to men.
1. Sanchez-Guerrero J, Mestanza M, Jim ML et al. Safety of use and effect on disease activity of three contraceptive methods in women with systemic lupus erythematosus. 2004 Annual Scientific Meeting of the American College of Rheumatology. 2004 Oct 16-21. San Antonio, TX.
2. Petri M, Buyon JP, Kim M et al. Combined oral contraceptives (OC) are not associated with an increased rate of flare in SLE patients. 2004 Annual Scientific Meeting of the American College of Rheumatology. 2004 Oct 16-21. San Antonio, TX.
3. Fagan KA, Badesch DB. Pulmonary hypertension associated with connective tissue disease. Prog Cardiovasc Dis 2002 Nov-Dec;45(3):225-34.
4. National Institute of Arthritis and Musculoskeletal and Skin Diseases. National Insitutes of Health (NIH). Do I Have Lupus? Available at: http://www.niams.nih.gov/hi/topics/lupus/tengo/english.htm#a. Accessed January 20, 2005.
5. Lupus Foundation of America. Lupus Fact Sheet. Available at: http://www.lupus.org/education/factsheet.html. Accessed January 20, 2005.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications. 
