Oral contraceptives and systemic lupus erythematosus: what should we advise to our patients?

Oral contraceptives (OC) are the contraceptive method of choice for the majority of Western world women. Decision on giving OC to patients with Systemic Lupus Erythematosus (SLE) puts special issues and concerns. In fact, OC have been evocated as etiologic risk factors for SLE and also associated with an increased risk of flares. During periods of active disease an effective contraception is mandatory, but OC puts safety problems in this setting. On the other hand, many SLE patients will be on a low activity or remission state with much less aggressive medication for most of the time. Cumulative damage due to SLE and comorbidities such as cardiovascular disease, antiphospholipid syndrome/ antibodies also has to be considered for pregnancy and contraception decisions. Advice on the benefits and risks of OC is an important and difficult aspect of the care of women with SLE. This advice should be done based on the best evidence and always considering our particular subject and its changing risk profile. This review will focus on OC in SLE women and particularly on current evidence on safety.