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Lupus and hormones!

Q. I have SLE. When I was pregnant I felt tired and weak and achey. These symptoms returned when I was fitted with the contraceptive coil. Could it be that hormones are causing flares?

SLE predominately affects women, which strongly suggests that female hormones are linked to the disease. However, two recent studies suggest that the oral contraceptive pill and coils do not, in general, cause lupus flares. If your coil does not have any hormones then it is unlikely to be the cause of your symptoms.

Q. Prior to a period my joints ache more and I feel more tired, is this hormones affecting my lupus?

It is well recognised that lupus may be more symptomatic pre-menstrually. This is often difficult to treat but sometimes if the periods can be regulated with a contraceptive pill, this may be useful. Recent studies suggest that the pill is unlikely to cause flares of lupus.

Q. I was wondering what was the current treatment for menopause symptoms in lupus patients and if there are any recommended alternative treatments to HRT?

A study in the last few months suggests that HRT may increase the risk of mild to moderate lupus flares. HRT should only be used for short periods of time and should be avoided in patients with a risk of blood clots, and especially if they have antiphospholipid (sticky blood) antibodies. Some women find supplements and alternative treatments useful but there are no clinical trials in this area.

Q. I have heard that lupus often remits in women after the menopause. Is this true?

This is often the case. Many women who reach the menopause notice an improvement in their lupus symptoms.

Q. Is it safe to use the emergency contraceptive pill if I have SLE which is now in remission but which in the past has had renal involvement?

The emergency contraceptive pill should be relatively safe in SLE as it is a "one-off" treatment. In women with SLE who have antiphospholipid (sticky blood) antibodies there may be a slight increase in the risk of blood clots. The emergency contraceptive pill however may well be safer than having an unplanned pregnancy.

Q. What is the current view on combined oral contraceptives for people with lupus?

The current view on this is changing in light of two recent studies. Both studies suggest that providing the woman does not have antiphospholipid antibodies, the low dose combined and oral contraceptive should not significantly increase the risk of a lupus flare. In the presence of antiphospholipid (sticky blood) antibodies there is an increased risk of blood clots with the combined oral contraceptive.

Q . I have lupus and would like to have a baby at some time In the future. Is there any reason why I cannot do so, is my lupus likely to flare with the hormonal changes? Also is there anything I should do prior to becoming pregnant to prevent my lupus from flaring?

It is very important that your plans for pregnancy are discussed with your specialist. Experience has shown that if SLE is quiescent at the time of conception then the outlook for both mother and baby are relatively good. There are also some antibodies that may increase the risk of miscarriage or skin rashes and heart problems in the baby and these will need to be checked prior to starting a pregnancy.

Some lupus clinics, including our own, have dedicated 'lupus in pregnancy' clinics to discuss these issues. It is very important that you do not stop your lupus treatments prior to pregnancy until you have discussed this with your specialist.

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