A recent article published in the Journal of Arthritis Care and Research found that women who were currently taking oral contraceptives or had just started taking the pill, particularly if the dosage of estrogen was that seen in older formulations, had a higher prevalence of being diagnosed with systemic lupus. The researcher from Magill University in Montreal, Canada reported that in women with a particular genetic predisposition, a higher dose of estrogen in first and some second generation birth control pills may trigger the onset of symptoms associated with systemic lupus. This effect was not seen in women who were using lower dose formulations utilizing less than 50 micrograms of estrogen. There has been a belief that there may be a hormonal effect that is causal in the development of systemic lupus erythematosus. Because lupus is diagnosed in a ratio of 9:1 in women versus men, it is believed that there may be a hormonal mechanism that turns on a heightened immune response leading to the symptoms of lupus in genetically susceptible individuals. The authors also suggested a dose related effect, in that as the estrogen content of the pill increased, the diagnoses of lupus increased in the population of women studied.
The authors looked at the records of a UK registry following the health of more than 1.7 million women ages 18 to 45 over an eight year period who were using combined estrogen and progesterone containing oral contraceptives. They found 786 women diagnosed with lupus during the study period. Smoking, drinking and other autoimmune disorders such as type 1 diabetes and thyroiditis were diagnosed more frequently. All current users of birth control pills were at an increased risk of developing lupus but the increase was not statistically significant. There appears to be an estrogen mediated effect on the lymphocytes and this may explain the dose-related response in which increased doses of estrogen are associated with an increased prevalence of lupus. One reassuring fact was that previous users of birth control pills did not exhibit an increased incidence of lupus.
The take home message is that women should talk with their healthcare providers about using a low-dose estrogen pill when using an oral contraceptive. The other point to remember is to alert your doctor of a family history of lupus or any other autoimmune condition in your family when having your yearly check-up so that he/she has the opportunity to take that into consideration when prescribing not only birth control pills but any medication. The more information the healthcare provider has about you, the chance of making an good informed decision about your healthcare management is increased. Read more.
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