Summary of recommendations for contraceptives in SLE/APS patients

Clinical presentation	Copper IUD	LNG IUD	Progesterone-only pill	DMPA	COC	Vaginal ring	Patch
SLE, low disease activity and (–) aPL	Effective, Long-acting		No increase flare	Risk of osteoporosis with prolonged use	No increase flare	Similar estrogen level to COC, no data	Higher estrogen levels than COC - avoid
SLE, active disease (–) aPL	Effective, Long-acting		No increase flare	Risk of osteoporosis with prolonged use	No studies - avoid
SLE stable on immunosuppressive medication (–) aPL	Effective, Long-acting, No infection data but likely low-risk		No increase flare	Risk of osteoporosis with prolonged use	Check for medication interactions
SLE with renal impairment, (–) aPL	Effective, Long-acting		No increase flare	Risk of osteoporosis with prolonged use	Avoid drospirenone-containing COC due to risk of hyperkalemia
SLE with (+) aPL	Effective, Long-acting	Low/no increase thrombosis	Low/no increase thrombosis	Low/uncertain risk thrombosis	Increased risk of thrombosis - avoid
SLE with thrombosis/on anticoagulation	Increase menstrual bleeding	Low/no increase thrombosis; decreases menstrual bleeding/amenorrhea	Low/no increase thrombosis	Low/uncertain risk thrombosis	Increased risk of thrombosis - avoid

NOTE: Etonogestrel implant not included due to lack of data.

SLE: systemic lupus erythematosus; APS: antiphospholipid syndrome; IUD: intrauterine device; LNG: levonorgestrel; DMPA: depot medroxyprogesterone acetate; COC: combined oral contraceptive; vaginal ring: combined hormonal vaginal ring; patch: combined hormonal patch; aPL: antiphospholipid antibody.

Graphic 98708 Version 3.0

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Summary of recommendations for contraceptives in SLE/APS patients