[Use of estrogen in women with systemic lupus erythematosus--should, should not?]

Changes in sex hormone metabolism seem to play a role in the expression of systemic lupus erythematosus (SLE). Epidemiological studies have demonstrated an increased risk of developing SLE in women using oestrogens for more than ten years. Onset or aggravation of symptoms have been described in case reports and small retrospective series of SLE patients. Oestrogen replacement therapy is generally well tolerated whereas oral contraceptives containing oestrogen can induce flares in a small proportion of SLE patients. A generally negative attitude towards oestrogens seems inadequate since controlled prospective studies are lacking. Patients with stable disease may use oestrogen provided there is close follow-up, particularly during the first six months of treatment. Treatment with oestrogen is contraindicated in SLE patients with a history of thromboembolism, positivity for phospholipid antibodies, and in the presence of severe organ involvement.