Overview

Systemic lupus erythematosus (SLE) is an autoimmune disease of uncertain aetiology that can affect multiple organ systems. The disease is more prevalent in women, with a female:male ratio of about 10:1 in most studies. In some populations SLE incidence is highest in women of reproductive age, while in others the highest age-specific incidence rates in women are seen after age 40 years.1 Globally, reported estimated prevalence rates in women range from 35/100 000 in a white subpopulation in the UK2 to 694/100 000 in an African American subpopulation in the USA.3 In general, a higher disease burden is found in non-white subpopulations worldwide.

Unfortunately, despite the complications that an unintended pregnancy can cause for a woman with SLE, many women with SLE are not counselled regarding contraceptive use or are counselled against contraceptive use based on concerns that contraceptives will adversely affect their disease. A recent study found that among a cohort of women with SLE and at risk of unintended pregnancy, including many on teratogenic medications, 59% reported no contraceptive counselling within the past year and 53% relied solely on barrier contraceptive methods.4

Recommendations

In the 2009 update of the World Health Organization Medical Eligibility Criteria for Contraceptive Use (WHOMEC),5 SLE was included for the first time as a condition. Recommendations were made by a working group of global family planning experts on the safety of contraceptive method use by women with SLE, based on a systematic review of the evidence (Table 1).6 Each medical condition/contraceptive method combination is classified as …