Can women with systemic lupus erythematosus safely use exogenous estrogens?

The current study was initiated to estimate the use of oral contraceptives and estrogen replacement therapy in women with systemic lupus erythematosus (SLE). Four hundred and four patients were surveyed from five medical centers. Two hundred and twenty four (55%) had ever used oral contraceptives, however, only 51 (13%) were taking oral contraceptives at the time SLE was diagnosed. Fifty five (14%) used oral contraceptives after their disease was diagnosed. Only seven (13%) reported an exacerbation of disease activity, mostly confined to the musculoskeletal system. In one substudy, there were no significant differences observed between women with or without SLE with regard to the frequency of ever-use of oral contraceptives. In contrast, significantly fewer women with established SLE were taking oral contraceptives at the time of interview compared with healthy women, p < 0.02. In a second substudy, information on past and present usage of estrogen replacement therapy was obtained in women followed at two of the sites included in the main study. Fifty-five (59%) of the 94 postmenopausal patients at these centers had ever taken estrogen therapy, 23 (24%) at the time of diagnosis. Forty-eight women (51%) began or remained on estrogen therapy after the diagnosis of SLE, four (8%) of whom reported exacerbations of disease activity. A significantly higher percentage of Caucasian women had taken or were taking estrogen replacement compared with other ethnic groups. This study suggests that exogenous hormones were generally well tolerated by women with SLE; this preliminary observation is based on patient recall. The low frequency of current oral contraceptive use in lupus patients of reproductive age may reflect, in part, bias of the managing rheumatologists and obstetricians/gynecologists. Given the health needs of and potential benefits for women with SLE, these observations suggest that larger prospective studies are critical and are likely to change prescribing practices for exogenous estrogen.