In the management of adolescents with systemic lupus erythematosus (SLE), sexual activity and prevention of unwanted pregnancies are important topics. Many contraceptive methods are available nowadays. Oral contraceptives (OCs) are the preferred choice among adolescents in general. However, the use of these medications in adolescents with SLE raises serious concerns, particularly the risk of thrombotic events from estrogen exposure and the impact of these medications on lupus activity. In this article, different contraceptive methods available are reviewed and their application in adolescents with SLE is discussed. In conclusion, OCs are the methods of choice in adolescents with stable disease and no antiphospholipid antibodies (aPL) detected. In patients with aPL, fewer options are available, and the selection of the preferred form of contraception should be made on an individual basis. Lupus (2007) 16, 600—605.
Cassidy J., Petty R., Laxer R. et al. Textbook of pediatric rheumatology, 5th edition. Philadelphia: ElsevierSaunders, 2005: 342—391.
2.
Tucker LB, Menon S., Schaller JG, Isenberg DAAdult- and childhood-onset systemic lupus erythematosus: a comparison of onset, clinical features, serology and outcome. Br J Rheumatol1995; 34: 866—872.
3.
Jimenez S., Cervera R., Font J., Ingelmo M.The epidemiology of systemic lupus erythematosus. Clin Rev Allergy Immunol2003; 25: 3—12.
4.
Pande I., Shekaran NG, Kailash S. et al. Analysis of clinical and laboratory profile in Indian childhood systemic lupus erythematosus and its comparison with SLE in adults. Lupus1993; 2: 83—87.
5.
Rood MG, ten Cate R., van Suijlekom-Smit LW et al. Childhood-onset systemic lupus erythematosus: clinical presentation and prognosis in 31 patients. Scand J Rheumatol1999; 28: 222—226.
6.
Wang LC,Yang YH, Lu MY, Chiang BLRetrospective analysis of mortality and morbidity of pediatric systemic lupus erythematosus in the past two decades. J Microbiol Immunol Infect2003; 36: 203—208.
7.
Miettunen PM , Ortiz-Alvarez O., Petty RE et al. Gender and ethnic origin have no effect on long-term outcome of childhood-onset systemic lupus erythematosus. J Rheumatol2004; 31: 1650—1654.
8.
Grunbaum JA, Kann L., Kinchen S. et al. Youth risk behaviour surveillance — United States 2003 . MMWR Surveill Summ2004; 53: 1—96.
9.
Eaton DK, Kann L., Kinchen S. et al.Youth risk behaviour surveillance — United States, 2005 . MMWR Surveill Summ2006; 55: 1.
10.
Abma JC, Sonenstein FLSexual activity and contraceptive practices among teenagers in the United States, 1988 and 1995. Vital Health Stat2001 ; 21: 1—79.
11.
Britto MT, Rosenthal SL, Taylor J., Passo MHImproving rheumatologists' screening for alcohol use and sexual activity. Arch Pediatr Adolesc Med2000; 154: 478—483.
12.
Beresford MW , Davidson JEAdolescent development and SLE. Best Pract Res Clin Rheumatol2006; 20: 353—368.
13.
Sammaritano LRContraception in women with autoimmune diseases . In Lockshin M, Branch DW eds. Handbook of systemic autoimmune diseases . Amsterdam: Elsevier BV, 2006: 123—140.
14.
Abma JC, Martinez GM, Mosher WD, Dawson BSTeenagers in the United States: sexual activity, contraceptive use, and childbearing, 2002. National Center for Health Statistics. Vital Health Stat2004; 23(1): 48.
15.
Buyon JPCan women with systemic lupus erythematosus safely use exogenous estrogens?J Clin Rheumatol1995; 1: 205—212.
16.
Mok CC, Lau CS,Wong RWRisk factors for ovarian failure in patients with systemic lupus erythematosus receiving cyclophosphamide therapy. Arthritis Rheum1998; 41: 831—837.
17.
Boumpas DT, Austin HA3rd, Vaughan EM, Yarboro CH, Klippel JH, Balow JE. Risk for sustained amenorrhea in patients with systemic lupus erythematosus receiving intermittent pulse cyclophosphamide therapy. Ann Int Med1993 ; 119: 366—369.
18.
Ioannidis JP , Katsifis GE, Tzioufas AG, Moutsopoulos HMPredictors of sustained amenorrhea from pulsed intravenous cyclophosphamide in premenopausal women with SLE. J Rheumatol2002; 29: 2129—2135.
19.
Blumenfeld Z., Shapiro D., Shteinberg M.,Avivi I., Nahir M.Preservation of fertility and ovarian function and minimizing gonadotoxicity in young women with systemic lupus erythematosus treated by chemotherapy. Lupus2000; 9: 401—405.
20.
Haubitz M., Ehlerding C., Kamino K., Koch KM, Brunkhorst R.Reduced gonadal toxicity after IV cyclophosphamide administration in patients with nonmalignant diseases. Clin Nephrol1998 ; 29: 19—23.
21.
Roubinian J. , Talal N., Siiteri PK, Sadakian JASex hormone modulation of autoimmunity in NAB/NZW mice. Arthritis Rheum1979; 22: 1162—1169.
22.
Steinberg AD , Melez KA, Raveche ES et al. Approach to the study of the role of sex hormones in autoimmunity. Arthritis Rheum1979; 22: 1170—1176.
23.
Cooper GS, Dooley MA, Treadwell EL et al. Hormonal, environmental and infectious risk factors for developing systemic lupus erythematosus. Arthritis Rheum1998; 41: 1714—1724.
24.
Grimaldi CM , Cleary J., Dagtas AS, Moussai D., Diamond B.Estrogen alters thresholds for B cell apoptosis and activation. J Clin Invest2002; 109: 1625—1633.
25.
Cutolo M., Sulli A., Capellino S. et al. Sex hormones influence on the immune system: basic and clinical aspects in autoimmunity. Lupus2004; 13: 635—638.
26.
Lahita RG, Bradlow HL, Ginzler E., Pang S., New M.Low plasma androgens in women with systemic lupus erythematosus. Arthritis Rheum1987; 30: 241—248.
27.
Folomeev M. , Dougados M., Beaune J. et al. Plasma sex hormones and aromatase activity in tissues of patients with systemic lupus erythematosus. Lupus1992; 1: 191—195.
28.
Jara LJ, Lavalle C., Espinoza LRDoes prolactin have a role in the pathogenesis of systemic lupus erythematosus . J Rheumatol1992; 19: 1333—1336.
29.
Kovacs EJ, Messingham KA, Gregory MSEstrogen regulation of immune responses after injury. Mol Cell Endocrinol2002; 193: 129—135.
30.
Doria A., Ghirardello A., Iaccarino L. et al. Pregnancy, cytokines and disease activity in systemic lupus erythematosus. Arthritis Rheum2004; 51: 989—995.
31.
Garovich M. , Agudelo C., Pisko E.Oral contraceptives and systemic lupus erythematosus . Arthritis Rheum1980; 23: 1396—1398.
32.
Chapel TA, Burns REOral contraceptives and exacerbation of lupus erythematosus. Am J Obstet Gynecol1971; 110: 366—369.
33.
Jungers P., Dougados M., Pelissier C. et al. Influence of oral contraceptive therapy on the activity of systemic lupus erythematosus. Arthritis Rheum1982; 25: 618—623.
34.
Sanchez-Guerrero J., Karlson EW, Liang MH, Hunter DJ, Speizer FE, Colditz GAPast use of oral contraceptives and the risk of developing systemic lupus erythematosus. Arthritis Rheum1997; 40: 804—807.
35.
Kay DR, Bole GG Jr, Ledger WJAntinuclear antibodies, rheumatoid factor and C-reactive protein in serum of normal women using oral contraceptives. Arthritis Rheum1971; 14: 239—248.
36.
Julkunen HAOral contraceptives in systemic lupus erythematosus: side-effects and influence on the activity of SLE. Scand J Rheumatol1991; 20: 427—433.
37.
Petri M., Kim M., Kalunian K. et al. Combined oral contraceptives in women with systemic lupus erythematosus . N Engl J Med2005; 353: 2550—2558.
38.
Sanchez-Guerrero J., Uribe AG, Jiménez-Santana L. et al. A trial of contraceptive methods in women with systemic lupus erythematosus. N Engl J Med2005; 353: 2539—2549.
39.
Somers E., Magder LS, Petri M.Antiphospholipid antibodies and incidence of venous thrombosis in a cohort of patients with systemic lupus erythematosus. J Rheumatol2002; 29: 2531—2536.
40.
RosendaalFr, Van Hylckama Vlieg A, Tannis BC, Helmerhorst FM. J Thromb Haemost2003; 1: 1371—1380.
41.
Silver RM, Draper ML, Scott JR, Lyon JL, Reading J., Branch DWClinical consequences of antiphospholipid antibodies: an historic cohort study . Obstet Gynecol1994; 83: 372—377.
42.
Shah N., Khamashta MA, Atsumi T., Hughes GROutcome of patients with anticardiolipin antibodies: a 10 year follow-up of 52 patients. Lupus1998; 7: 3—6.
43.
Lakasing L. , Khamashta M.Contraceptive practices in women with systemic lupus erythematosus and/or antiphospholipid syndrome: what advice should we be giving? J Fam Plann ReprodHealth Care2001; 27: 7—12.
44.
Asherson RA , Harris EN, Hughes Grv, Farquharson RGComplications of oral contraceptives and antiphospholipid antibodies. Arthritis Rheum1988; 31: 575—576.
45.
Bloemenkamp Kwm , Rosendaal FR, Helmerhorst FM, Buller HR,Vandenbroucke JPEnhancement by factor V Leiden mutation of risk of deep-vein thrombosis associated with oral contraceptives containing a third-generation progesterone. Lancet1995 ; 346: 1593—1596.
46.
Gomes MP, Deitcher SRRisk of venous disease associated with hormonal contraceptives and hormone replacement therapy: a clinical review. Arch Intern Med2004; 164: 1965—1966.
47.
Edwards CP, Hertweck SP, Perlman SE et al. A prospective study evaluating the effects of Depo Provera on bone mineral density in adolescent females: a preliminary report [abstract] . J Pediatr Adolesc Gynecol1998; 11: 201.
48.
Busen NH, Britt RB, Rianon N.Bone mineral density in a cohort of adolescent women using depot medroxyprogesterone acetate for one to two years. J Adolesc Health2003; 32: 257—259.
49.
Lara-Toxe E., Edwards CP, Pelman S., Hetweile P.Prospective study evaluating bone mineral density in adolescent females using Depo-Provera (DMPA). Paper presentation, May 17, 2003.
50.
Miami, FL, USA: North American Society for Pediatric and Adolescent Gynecology, 2003. 50 Berenson AB, Radecki CM, Grady JJ, Rickert VI, Thomas A.A prospective, controlled study of the effects of hormonal contraception on bone mineral density. Obstet Gynecol2001; 98: 576—582.
51.
Scholes D., Lacroix AZ, Ott SM, Ichikawa LE, Barlow WEBone mineral density in women using depot medroxyprogesterone acetate for contraception. Obstet Gynecol1999; 93: 233—238.
52.
Clark MK, Sowers MR, Nichols S., Levy B.Bone mineral density changes over two years in first time users of depotmedroxyprogesterone acetate. Fertil Steril2004; 82: 1580—1586.
53.
Lakshminarayanan S.,Walsh S., Mohanraj M., Rothfield N.Factors associated with low bone mineral density in female patients with systemic lupus erythematosus. J Rheumatol2001; 28: 102—108.
54.
Bultink Iem , Lems WF, Kostense PJ, Dijkmans BA,Voskuyl AEPrevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus . Arthritis Rheum2005; 54: 2044—2050.
55.
Recker RR, Davies KM, Hinders SM, Heaney RP, Stegman MR, Kimmel DBBone gain in young adult women. JAMA1992; 268: 2403—2408.
56.
Geusens PP, de Nijs Rnj, Lems WF et al. Prevention of glucocorticoid osteoporosis: a consensus document of the Dutch society for Rheumatology. Ann Rheum Dis2004; 63: 324—325.
57.
Sambrook PNHow to prevent steroid induced osteoporosis . Ann Rheum Dis2005; 64: 176—178.
58.
Ramsey-Goldman R., Dunn JE, Huang CF et al. Frequency of fractures in women with systemic lupus erythematosus. Arthritis Rheum1999; 42: 882—890.
59.
Cromer BABone mineral density in adolescent and young adult women on injectable or oral contraception. Curr Opin Obstet Gynecol2003; 15: 353—357.
60.
Liu SL, Lebrun CMEffect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review. Br J Sports Med2006; 40: 11—24.
61.
Tharnprisarn W., Taneepanichskul S.Bone mineral density in adolescent and young Thai girls receiving oral contraceptives compared with depot medroxyprogesterone acetate: a cross-sectional study in young Thai women. Contraception2002; 66: 101—103.
62.
Lloyd T., Taylor DS, Lin HM, Matthews AE, Eggli DF, Legro RSOral contraceptive use by teenage women does not affect peak bone mass: a longitudinal study. Fertil Steril2000; 74: 734—738.
63.
MacDougall J., Davies MC, Overton CE et al. Bone density in a population of long term oral contraceptive pill users does not differ from that in menstruating women. Br J Fam Plann1999; 25: 96—100.
64.
American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis.Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheum2001; 44: 1496—1503.
