Use of combined hormonal contraceptives among women with systemic lupus erythematosus with and without medical contraindications to oestrogen

Research output: Contribution to journalArticle


Objectives. To assess the prevalence of combined hormonal contraceptives (CHCs) in reproductive-age women with SLE with and without possible contraindications and to determine factors associated with their use in the presence of possible contraindications. Methods. This observational cohort study included premenopausal women ages 18-45 years enrolled in the SLICC Registry ≤15 months after SLE onset, with annual assessments spanning 2000-2017. World Health Organization Category 3 or 4 contraindications to CHCs (e.g. hypertension, aPL) were assessed at each study visit. High disease activity (SLEDAI score >12 or use of >0.5 mg/kg/day of prednisone) was considered a relative contraindication. Results. A total of 927 SLE women contributed 6315 visits, of which 3811 (60%) occurred in the presence of one or more possible contraindication to CHCs. Women used CHCs during 512 (8%) visits, of which 281 (55%) took place in the setting of one or more possible contraindication. The most frequently observed contraindications were aPL (52%), hypertension (34%) and migraine with aura (22%). Women with one or more contraindication were slightly less likely to be taking CHCs [7% of visits (95% CI 7, 8)] than women with no contraindications [9% (95% CI 8, 10)]. Conclusion. CHC use was low compared with general population estimates (>35%) and more than half of CHC users had at least one possible contraindication. Many yet unmeasured factors, including patient preferences, may have contributed to these observations. Further work should also aim to clarify outcomes associated with this exposure.


  • Arielle Mendel
  • Sasha Bernatsky
  • Christian A. Pineau
  • Yvan St-Pierre
  • John G. Hanly
  • Murray B. Urowitz
  • Ann E. Clarke
  • Juanita Romero-Diaz
  • Caroline Gordon
  • Sang Cheol Bae
  • Daniel J. Wallace
  • Joan T. Merrill
  • Jill Buyon
  • David A. Isenberg
  • Anisur Rahman
  • Ellen M. Ginzler
  • Michelle Petri
  • Mary Anne Dooley
  • Paul Fortin
  • Dafna D. Gladman
  • Kristján Steinsson
  • Rosalind Ramsey-Goldman
  • Munther A. Khamashta
  • Cynthia Aranow
  • Meggan MacKay
  • Graciela Alarcón
  • Susan Manzi
  • Asad A. Zoma
  • Ronald F. Van Vollenhoven
  • Manuel Ramos-Casals
  • Giuillermo Ruiz-Irastorza
  • Sam Lim
  • Kenneth C. Kalunian
  • Murat Inanc
  • Diane L. Kamen
  • Christine A. Peschken
  • Søren Jacobsen
  • Anca Askanase
  • Jorge Sanchez-Guerrero
  • Ian N. Bruce
  • Nathalie Costedoat-Chalumeau
  • Evelyne Vinet
External organisations
  • McGill University Health Center
  • Dalhousie University
  • University of Toronto
  • University of Calgary
  • Instituto Nacional de Ciencias Médicas y Nutrición
  • University of Birmingham
  • City Hospital, Birmingham
  • Hanyang University
  • Oklahoma Medical Research Foundation
  • University College London
  • State University of New York Downstate Medical Center
  • Johns Hopkins University School of Medicine
  • University of North Carolina
  • Centre hospitalier universitaire de Québec
  • National University Hospital of Iceland
  • Northwestern University Feinberg School of Medicine
  • Feinstein Institute for Medical Research
  • University of Alabama
  • Allegheny Health Network
  • Hairmyres Hospital
  • Karolinska Institutet
  • Hospital Clínic of Barcelona
  • University of the Basque Country
  • Emory University
  • University of California, San Diego
  • Medical University of South Carolina
  • University of Manitoba
  • University of Copenhagen
  • Columbia University
  • University of Manchester
  • Cochin Hospital
  • Toronto Western Hospital
  • University of California, Los Angeles
  • Cedars-Sinai Medical Center
  • New York University
  • Istanbul University
  • Copenhagen University Hospital
  • Mount Sinai Hospital of University of Toronto
  • Central Manchester University Hospitals
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Obstetrics, Gynecology and Reproductive Medicine


  • Anti-phospholipid syndrome, Contraception, Epidemiology, Systemic lupus erythematosus
Original languageEnglish
Pages (from-to)1259-1267
Number of pages9
JournalRheumatology (United Kingdom)
Issue number7
Publication statusPublished - 2019 Jul
Publication categoryResearch