Contraception in autoimmune diseases.

Giuseppe Benagiano, Marisa Benagiano, Paola Bianchi, Mario Milco D'Elios, Ivo Brosens

Journal: Best practice & research. Clinical obstetrics & gynaecology 2020;60():111-123

PMID: 31160225

Full Text on Elsevier Science View on PubMed

Abstract

Autoimmune diseases (AIDs) affect women and men with a 2:1 ratio, which suggests that hormonal contraceptives play a role in their clinical course. Combined oral contraceptives have complex, sometimes contradictory, effects on AIDs; they can worsen the situation in women with systemic lupus erythematosus and with anti-phospholipid syndrome, conditions in which they are contraindicated. Early studies indicated a positive effect on rheumatoid arthritis (RA), whereas more recent trials failed to do so, possibly because of the lowering of oestrogen content. Evidence of effects on multiple sclerosis (MS) is conflicting: risk may vary depending on the progestin used. Minor adverse effects may exist on inflammatory bowel diseases, and no significant effect was found on autoimmune thyroid diseases. Women can become sensitised to sex hormones. Progestin-only contraceptives may be used, although copper-releasing intra-uterine devices represent the best option. Finally, several organisations have issued guidelines for contraceptive use in women with AIDs.

Address: Department of Obstetrics, Gynaecology and Urology, Policlinico Umberto I°, Sapienza University of Rome, Rome, Italy.; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.; Surgical and Medical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy. Electronic address: [email protected].; Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.

DOI: 10.1016/j.bpobgyn.2019.05.003

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MeSH Terms: Autoimmune Diseases, Contraception, Contraceptive Devices, Contraceptives, Oral, Combined, Contraceptives, Oral, Hormonal, Female, Humans