Study demonstrates safety of oral contraceptives in women ...( upus arose in part from the fact that l...),Health

upus arose in part from the fact that lupus is far more common in women (women with the disease outnumber men 10 to 1), and that it typically begins during the childbearing years (after the onset and before the cessation of menstruation) when female hormone levels are at their peak. In mouse models of lupus, giving estrogen makes lupus worse and, depending on the genetic background, influences the activity of white blood cells called B cells that are believed to play a key role in the disease process.

But for most women with moderate lupus that is inactive or stable, taking estrogen whether as part of an oral contraceptive or hormone replacement therapy appears to have no detrimental effect on disease activity, say co-authors Jill Buyon, M.D., of New York's Hospital for Joint Diseases, and Michelle Petri, M.D., M.P.H., of the Johns Hopkins University, who jointly led the study. However, they note that oral contraceptives still are not advised for women who have a history of, or are at high risk for, blood clots, because estrogens have been associated with dangerous blood clots.

The recently published study on oral contraceptives is one of two separate randomized, placebo-controlled studies that comprise the Safety of Estrogens in Lupus Erythematosus, National Assessment (SELENA) Trial. The other study, which showed no increased risk of severe flares in postmenopausal women on hormone replacement therapy, was published earlier this year (Buyon JP, et. al. The effect of combined estrogen and progesterone hormone replacement therapy on disease activity in systemic lupus erythematosus: a randomized trial," Ann Intern Med 2005;142:953-962).

"There are settings in which estrogens might provide benefit," say the authors. Among women with lupus, they say, there is a high elective abortion rate approaching 23 percent of pregnancies which may reflect a failure of the birth control method used or the absence of an adequate birth control program.
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Contact: Ray Fleming
flemingr@mail.nih.gov
301-496-8190
NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases
22-Dec-2005

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