Have Lupus? What to Know About Birth Control

Autoimmune disorders like lupus affect which contraceptive options are safe and effective for family planning and Birth Control.

If you’re living with an autoimmune disorder, you’re definitely not alone. An estimated 7% of Americans have an autoimmune disease such as lupus, rheumatoid arthritis, or multiple sclerosis — there are more than 80.

For reasons that remain mysterious, autoimmune disorders disproportionately affect women. Often, they start before or during the childbearing years, so there’s a good chance you’ll need to consider these important questions: An autoimmune disorder like lupus Family planning and How does it affect pregnancy, a topic we discussed in a previous post? And what are my best options for birth control?

Fortunately, guidelines endorsed by the American College of Rheumatology and the American College of Obstetricians and Gynecologists can help you and your healthcare team answer these questions. These guidelines are based on expert opinion and clinical research.

Consider Lupus

Systemic lupus erythematosus (SLE, or lupus for short) is an autoimmune disease that can cause inflammation and damage to multiple organs throughout the body. About 90% of people with lupus are biologically female, and the disease begins between the ages of 15 and 35. Family planning is especially important for people with autoimmune disorders because some medications can interact with birth control pills, and unplanned pregnancies can occur. Dangerous for mother and fetus.

Fortunately, those who want to avoid pregnancy can choose from many safe and effective birth control options. Each has important pros and cons to think about (see the Harvard Health Birth Control Center for details). But if you have lupus, there are additional considerations to discuss with your health care team, including:

• How active or severe is your disease? When lupus is active, you may be especially prone to potentially dangerous blood clots, such as deep vein thrombosis and pulmonary embolism. Birth control that contains estrogen (such as many birth control pills, rings, and patches) can also make you more prone to blood clots. Therefore, an intrauterine device (IUD) or birth control pill that does not contain estrogen may be a safe option.
• Do you have antiphospholipid antibodies in your blood? These antibodies can also increase your risk of dangerous blood clots. Even if the lupus is inactive, people who have these antibodies should not use birth control that contains estrogen.
• What are your preferences and experiences with different forms of birth control? Some people prefer the most effective option (such as an IUD or birth control implant). Others want to avoid procedures or medications and so may prefer condoms or diaphragms. If one type of birth control (such as a condom) has failed to prevent pregnancy in the past, you may prefer to move on to something different. Sharing preferences and experiences with your healthcare team can help you make a choice that you feel comfortable using.
• What medications are you taking? Some medications (such as mycophenolate) can reduce the effectiveness of birth control pills.

If you have lupus, talk to your doctor about your options and decide together on the safest and most effective option. It’s also a good idea to discuss emergency options, such as the so-called morning-after pill or Plan B.

Do You Smoke?

If you smoke, make every effort to quit. You probably already know about the usual health risks associated with smoking, such as an increased risk of cancer, heart attack, stroke and lung disease. But the combination of lupus and smoking significantly increases the risk of abnormal clotting — which increases even more if you add estrogen-containing birth control.

In addition, smoking can make certain treatments less effective and increase the risk of developing more severe lupus. If you find it difficult to quit smoking on your own, ask your health care team for help.