Use of combined hormonal contraceptives among women with systemic lupus erythematosus with and without medical contraindications to oestrogen

Arielle Mendel, Sasha Bernatsky, Christian A. Pineau, Yvan St-Pierre, John G. Hanly, Murray B. Urowitz, Ann E. Clarke, Juanita Romero-Diaz, Caroline Gordon, Sang Cheol Bae, Daniel J. Wallace, Joan T. Merrill, Jill Buyon, David A. Isenberg, Anisur Rahman, Ellen M. Ginzler, Michelle Petri, Mary Anne Dooley, Paul Fortin, Dafna D. GladmanKristján Steinsson, Rosalind Ramsey-Goldman, Munther A. Khamashta, Cynthia Aranow, Meggan MacKay, Graciela Alarcón, Susan Manzi, Ola Nived, Andreas Jönsen, Asad A. Zoma, Ronald F. Van Vollenhoven, Manuel Ramos-Casals, Giuillermo Ruiz-Irastorza, Sam Lim, Kenneth C. Kalunian, Murat Inanc, Diane L. Kamen, Christine A. Peschken, Søren Jacobsen, Anca Askanase, Jorge Sanchez-Guerrero, Ian N. Bruce, Nathalie Costedoat-Chalumeau, Evelyne Vinet

Research output: Contribution to journalArticlepeer-review


Objectives. To assess the prevalence of combined hormonal contraceptives (CHCs) in reproductive-age women with SLE with and without possible contraindications and to determine factors associated with their use in the presence of possible contraindications. Methods. This observational cohort study included premenopausal women ages 18-45 years enrolled in the SLICC Registry ≤15 months after SLE onset, with annual assessments spanning 2000-2017. World Health Organization Category 3 or 4 contraindications to CHCs (e.g. hypertension, aPL) were assessed at each study visit. High disease activity (SLEDAI score >12 or use of >0.5 mg/kg/day of prednisone) was considered a relative contraindication. Results. A total of 927 SLE women contributed 6315 visits, of which 3811 (60%) occurred in the presence of one or more possible contraindication to CHCs. Women used CHCs during 512 (8%) visits, of which 281 (55%) took place in the setting of one or more possible contraindication. The most frequently observed contraindications were aPL (52%), hypertension (34%) and migraine with aura (22%). Women with one or more contraindication were slightly less likely to be taking CHCs [7% of visits (95% CI 7, 8)] than women with no contraindications [9% (95% CI 8, 10)]. Conclusion. CHC use was low compared with general population estimates (>35%) and more than half of CHC users had at least one possible contraindication. Many yet unmeasured factors, including patient preferences, may have contributed to these observations. Further work should also aim to clarify outcomes associated with this exposure.

Original languageEnglish
Pages (from-to)1259-1267
Number of pages9
JournalRheumatology (United Kingdom)
Issue number7
Early online date8 Feb 2019
Publication statusPublished - 1 Jul 2019


  • Anti-phospholipid syndrome
  • Contraception
  • Epidemiology
  • Systemic lupus erythematosus


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