Contraception in autoimmune diseases. (October 2019)

• Record Type: Journal Article
• Authors: Benagiano, Giuseppe; Benagiano, Marisa; Bianchi, Paola; D'Elios, Mario Milco; Brosens, Ivo
• Is Part Of: Best practice & research. Volume 60(2019)
• Page Start: 111
• Page End: 123
• Publication Date: 2019-10
• Subjects: Autoimmune diseases -- Steroid hormones -- Hormonal contraception -- Intrauterine devices -- Medical eligibility criteria; Gynecology -- Periodicals; Obstetrics -- Periodicals; Genital Diseases, Female; Obstetrics; Gynecology; Obstetrics; Periodicals; 618.05
• DOI: 10.1016/j.bpobgyn.2019.05.003
• Languages: English
• ISSNs: 1521-6934

Abstract

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. Highlights: Hormonal contraceptives may positively or negatively influence Autoimmune Diseases. Contraceptive guidelines exist for women with a few Autoimmune Disease.