Lupus and its effects on women

Lupus is not a fun disease. To those who suffer from its most serious form, systemic lupus, this can be an understatement. More than 16,000 Americans develop lupus every year and up to 1.5 million are living with this disease.

Lupus is what we call an autoimmune disease. In a person who has lupus, antibodies, the body’s soldiers against infection, suddenly turn into traitors. These auto-antibodies, as they are called, start attacking normal tissues, setting up areas of inflammation that lead to the symptoms of lupus.

Those symptoms are as varied as the tissues the auto-antibodies attack. If the muscles are attacked, they ache. If the joints are attacked, arthritis ensues. If the skin is attacked, there is often a rash. People with lupus often suffer from extreme fatigue, pain, kidney problems, and sun or light sensitivity.

No one knows what causes lupus. There is most likely a genetic component, but only 10 percent of lupus sufferers have a close family member (parent or sibling) with lupus. There are environmental factors at play as well. Infections are often triggers of lupus, as are certain antibiotics and other drugs.

The fact that lupus is 10 to 15 times more common in females than males has made doctors think that estrogen is somehow involved. Women often have flares in their disease activity around the time of their menstrual periods and during pregnancy. But is estrogen the culprit? No one knows.

Could the estrogen in birth control pills make lupus worse? Some early studies suggested it did, and so doctors were reluctant to prescribe the pill to women with lupus.

Pregnancies in women with lupus are considered high risk. So they need to plan their pregnancies carefully. In order to do that, they need effective birth control, and birth control pills are among the most effective.

Some women with lupus have a condition that makes them poor candidates for birth control pills. They have auto-antibodies that make their blood clot too easily. Since birth control pills increase (slightly) a woman’s chance of having a serious blood clot in the legs or even the lungs, it makes sense to keep the pills away from those women.

But what about the rest of the women who have lupus without the blood clotting auto-antibodies? Now we have two studies, recently published in the New England Journal of Medicine, that tell us birth control pills are OK in these women and don’t lead to an increase in lupus flares.

The two studies looked at disease activity over one year’s use of birth control pills. The most rigorous study was our gold standard, double blind (neither the women nor their doctors knew what they were using), placebo controlled study involving 183 women who were randomly assigned to receive either the pill or placebo. Needless to say, they were all told to use an alternate, barrier method of birth control.

The researchers looked at numbers of flares of disease and found that birth control pills were not associated with an increase in either severe or mild-moderate flares in the women taking them. Their data also showed that there were no increase in blood clots in the pill group over the year of the study. (Women with the blood clotting auto-antibodies were excluded from this study.)

There are other reasons besides birth control that women with lupus may look to the pill. They may use it to control menstrual-cycle related flares. Women with lupus are often on long-term steroid therapy, and this makes them more prone to osteoporosis. The estrogen in the birth control pill can help to keep their bones strong.

Women with lupus are less likely to use birth control pills than their healthy peers. This likely reflects the prescribing practices of their doctors. With the publication of these two studies, women and their doctors can rest easy when they are thinking of using the pill. For whatever reason.