Use of exogenous estrogens in systemic lupus erythematosus*

https://doi.org/10.1053/sarh.2001.22498Get rights and content

Abstract

Objective: To review the current literature on the safety of using exogenous estrogens in patients with systemic lupus erythematosus (SLE). Method: A MEDLINE search for articles published between 1970 and 2000 regarding the relationship between estrogens and SLE was performed. Emphasis was put on human studies, treatment trials, and epidemiologic surveys. Results: The use of exogenous estrogens in healthy women increases the risk of SLE development. For patients with established SLE, a hypoestrogenemic state appears to be protective against severe flares, whereas exogenous estrogen administration or hyperestrogenemia induced by hormonal manipulation may exacerbate the disease in certain individuals. Both the use of oral contraceptives and the use of hormonal replacement therapy (HRT) increase the chance of venous thromboembolism. The presence of antiphospholipid antibodies may aggravate the risk of thrombosis in SLE. In retrospective studies, HRT appears to be well tolerated in postmenopausal SLE patients. Conclusions: There are no prospective data that show a deleterious effect of exogenous estrogens on disease activity in human SLE. Oral contraceptives may be considered for patients with SLE in the absence of active nephritis or antiphospholipid antibodies. The slight increase in venous thromboembolic risk should not be the chief deterrent to the use of HRT in postmenopausal SLE patients, considering its various health benefits. Semin Arthritis Rheum 30:426-435. Copyright © 2001 by W.B. Saunders Company

Section snippets

Methods

A MEDLINE search for articles published between 1970 and 2000 using the keywords “estrogen,” “lupus,” “menopause,” “flare,” and “thromboembolism” was performed. Both human and animal studies, as well as epidemiologic surveys, were reviewed and presented under the following headings: 1) Effects of estrogens on the immune system and SLE; 2) Endogenous estrogen, disease activity, and prognosis of SLE; 3) Exogenous estrogens and the risk of SLE development; 4) Indications of estrogen therapy in

Effects of estrogens on the immune system and SLE

Estrogens exhibit a number of stimulatory actions on the immune system. Administration of physiologic concentrations of 17β-estradiol enhanced differentiation of B cells and in vitro immunoglobulin production by peripheral blood mononuclear cells (PBMC) in response to pokeweed mitogen stimulation in normal subjects (32). Moreover, 17β-estradiol (at concentrations of 10−10 to 10−8 mol/L) also increased spontaneous in vitro production of immunoglobulins (IgG and IgM) by normal PBMC in a

Conclusions

Whether the benefits of estrogen treatment outweigh its possible deleterious effect on disease activity remains an unanswered question. Based on the currently available information, combination low-dose estrogen OCs may be considered for SLE patients without definite contraindications. Table 4 shows the absolute and relative contraindications to OC use in women (71).

Table 4: Absolute and Relative Contraindications for Use of OC Pills in Women

Absolute contraindications
 Pregnancy
 Past of current

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    Address reprint requests to Dr Chi Chiu Mok, MBBS, MRCP, Senior Registrar, Department of Medicine & Geriatrics, Tuen Mun Hospital, Tsing Choon Koon Road, New Territories, Hong Kong. E-mail: [email protected]

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