Oral Contraceptives With Estrogen Do Not Worsen Symptoms Of Lupus, Two Studies Say

Main Category: Lupus
Article Date: 16 Dec 2005 - 7:00 PDT

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Taking oral contraceptives with estrogen does not exacerbate lupus symptoms in women living with the disease, according to two studies published in the Dec. 15 issue of the New England Journal of Medicine, the Wall Street Journal reports. Physicians have "long refrained" from prescribing birth control pills with estrogen to lupus patients because of previous studies that showed human patients and mice who took hormonal contraceptives had more "episodes of symptoms worsening" or "flares" of the disease, according to the Journal (Pagan Westphal, Wall Street Journal, 12/15). However, the previous human trial used oral contraceptives containing more estrogen than the contraceptive pills used today, according to Michelle Petri, director of the Lupus Center at Johns Hopkins University School of Medicine. Petri and colleagues in their study examined women living with lupus at 14 sites in the U.S., randomly assigning 91 women to take estrogen-progestin oral contraceptives and 92 women to take a placebo. After one year of taking the pills, seven women in each group experienced a "severe lupus flare-up," and both groups had an average of about 1.4 mild or moderate flare-ups of lupus symptoms each year, the AP/Philadelphia Inquirer reports (Johnson, AP/Philadelphia Inquirer, 12/15). Each woman participating in the study also agreed to use an additional form of birth control throughout the study, and women who became pregnant were instructed to stop taking the study drug (Petri et al., NEJM, 12/15). In the other study, Jorge Sanchez-Guerrero of the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran in Mexico City and colleagues from the institute and the World Health Organization administered to 162 women living with lupus either oral contraceptives containing estrogen, nonestrogen oral contraceptives or intrauterine devices. The study found that "there were no significant differences among the groups during the trial in global or maximum disease activity, incidence or probability of flares or medication use" (Sanchez-Guerrero et al., NEJM, 12/15). After one year, women in all three groups had similar "disease severity scores," the Journal reports (Wall Street Journal, 12/15).

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"Generations of doctors have not prescribed oral contraceptives to lupus patients. ... We were all wrong," Petri said, adding, "It has shaken up the whole notion of what's contributing to lupus in the first place" (Emery, Reuters, 12/14). In an accompanying NEJM editorial, Bonnie Bermas, a rheumatologist at Brigham and Women's Hospital in Boston, said that physicians now can suggest oral contraceptives as a birth control option for lupus patients, which is important because some of the drugs taken to treat the disease are harmful to fetuses (Wall Street Journal, 12/15). Bermas also says that prescribing oral contraceptives to women with lupus is important because planned pregnancies and conception during remission of the disease are more likely to have better outcomes; oral contraceptives might help maintain ovarian function and prevent infertility, which can occur because of the drugs taken to treat lupus; and oral contraceptives might reduce the risk of bone density loss and osteoporosis, which can occur as a result of treatment for lupus (Bermas, NEJM, 12/15). The Lupus Foundation of America said it is developing physician guidelines that say it is safe to prescribe oral contraceptives to lupus patients. "Certainly this will become a standard of care," Lupus Foundation CEO Sandra Raymond said (Wall Street Journal, 12/15).

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