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Birth Control Pills And Lupus SLE

July 23rd, 2009 → 10:07 am @ A.D. Odom

Say the words birth control pills and a huge question mark comes up. Didn’t you see it? I did, I do and that blasted question mark kept appearing for me as a young woman. Why? I never trusted the stuff.

My mother, bless her heart, was very proactive. She had that “little talk” with me as a young woman and when I turned that miraculous age of 18, she had me exploring the various forms of birth control. For her, ideally, the best form was the diaphragm. Unfortunately, I was too young at the time and lacked the wherewithal to actually work the mechanics of that so we decided — yes we — that I should go with “the pill.” In hindsight, that was a very bad mistake. At 19 years of age I started taking oral contraceptives (“OC”).

I went through puberty with clear skin. Never had a single pimple and was hated by many because I had such beautiful skin. However, after starting my first dose of Ortho Novum I began having side-effects. One devastating side-effect was severe acne. My face, shoulders, and arms blew up with blister-like acne some of them so gross I could no longer take it. I asked my OB-Gyn for assistance and he prescribed a lower dose of the stuff and still, I had problems. Two years later I opted out and figured out how to work the mechanics of the above-mentioned diaphragm, particularly after learning “the pill” actually controlled your body and how it functioned.

What I didn’t know then and have since learned is one side-effect of Ortho Novum is rare reports of oral contraceptive-induced systemic lupus (using the above link, scroll down to “Immunologic side effects”). I had no idea. I cannot say this was the beginning of my experience with lupus related symptoms (skin lesions and other systemic conditions) because I experienced other systemic conditions earlier, i.e., chronic tonsillitis or strep throat, something similar to asthma but it wasn’t asthma, joint aches and fatigue, etc. As a result, I cannot blame Ortho Novum for lupus because these conditions began when I was about 5- or 6-years old. However, it is still disconcerting to learn for a few, OC induced systemic lupus is a possibility.

Do Birth Control Pills Cause Lupus?

Well, like anything it depends on who or what you read. Personally, I like to err on the side of caution particularly after what I went through with the aforementioned Ortho Novum.

A study was published in the April 15 issue of Arthritis & Rheumatism stating women who take birth control pills, especially higher-dose versions, may have an increased risk of getting lupus, an autoimmune disease. According to one of the researchers for the study, Samy Suissa, PhD, professor of epidemiology at McGill University in Montreal “Women who take oral contraceptives have a 50% higher risk of having lupus than women who don’t take them.”

Suissa and her colleagues also found a risk higher in women who take the higher dose pills — those with 50 micrograms of estrogen or more — and in women currently taking them who have just taken the pills for a few months.

Disturbing right? It was for me because I remember all too well the severity of what I experienced after taking birth control pills. First, my gall bladder went haywire or this is what I was told after my pancreas inexplicably started swelling causing more pain than I ever wanted to experience in life. Later I developed itchy little bumps on my arms and chest which were never adequately explained but I was given a steroidal cream and they went away. As if that was not enough, I experienced all sorts of infections. The madness stopped when I gave up “the Pill.”

The above study evaluated more than 1.7 million women, ages 18 to 45, who were in the U.K. General Practice Research Database, which includes more than 6 million people.

Suissa’s team matched up each patient with lupus to 10 people from the study database who did not have lupus when the patient was diagnosed. They discovered the use of oral contraceptives was linked with an increased risk of getting the disease. “I think we have clear evidence that these pills, especially at higher doses, can increase the risk of lupus,” Suissa says. However, the contraceptive alone probably did not boost the risk, he says. “We think it probably interacts with some genetic predisposition.”

Equally disturbing was while the overall risk of birth control pill use and lupus was boosted by 50%, or 1.5 times, Suissa says, the risk went up by 2.5 times among new users, during the first three months. Okay, that does bother me.

Birth Control And Women With Lupus SLE

A recent study published in the August issue of Obstetrics & Gynecology states the use of hormonal contraception appears to be appropriate in many women with lupus. Kelly R. Culwell, M.D., of the World Health Organization in Geneva, and colleagues analyzed data from 13 studies involving women using contraception after being diagnosed with systemic lupus erythematosus (SLE).

This study dealt primarily with women who have already been diagnosed with lupus. The study found women with inactive or stable active lupus didn’t have increased flares or worsening disease activity from using combined oral contraceptives, and no increase in disease activity was seen with progestogen-only contraceptives across four studies. However, the authors note, thrombosis may be a concern with oral contraceptive use in women with positive antiphospholipid antibodies.

Available evidence indicates that many women with SLE can be considered good candidates for most contraceptive methods, including hormonal contraceptives. Women with positive antiphospholipid antibodies are at significantly increased risk of arterial and venous thrombosis and therefore the use of combined hormonal methods should be avoided in these women, the authors conclude. Overall, the benefits of contraception for many women with SLE likely outweigh the risks of unintended pregnancy.

Summary

Bottom line, weigh the pros and cons. If you have not been diagnosed with lupus but experience strange health issues while on a form of oral contraceptive, talk with your doctor and have the medication changed or reduced. If you have been diagnosed with lupus you will need to be either in remission or stable. However, if you have positive antiphospholipid antibodies, proceed cautiously or not at all.

Most experts agree that the hormone estrogen has an impact on lupus. For those of us with lupus or undiagnosed lupus, we must be very careful when dealing with anything containing hormones. Many women with lupus have low levels of progesterone and androgen, which can then compound the effect estrogen has on immune system cells. In fact, one of my doctors truly believes my going into menopause some years ago might have caused me to come out of remission and landed me where I am today.

For those who do not have lupus there is still a need for caution. Bevra Hahn, MD, chief of rheumatology and arthritis at the University of California Los Angeles David Geffen School of Medicine and a member of the medical-scientific advisory council for the Lupus Foundation states “the risk for oral contraceptives causing lupus is there, but it’s small.” The take-home point? “The lower the estrogen content you can manage, the less likely [the pill] is to cause lupus in someone who doesn’t have it,” she says.

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