How Birth Control May Raise Lupus Risk

Birth control pills may not be a safe option if you have or are at risk for lupus. Not only can birth control pills increase your risk of developing the disease, but they can also make existing lupus more active.

This article will examine lupus and birth control, safe options, possible side effects, and when you should see your healthcare provider.

Lupus and Birth Control

Anyone can develop lupus, but most diagnoses are in biological females between the ages of 15 and 44. This is the time considered the childbearing years.

Research suggests people with lupus are less likely to use birth control than those without it. This practice may be a holdover from the years when the medical community warned against estrogen-containing birth control pills. Those pills can increase the severity of the disease and lead to blood clots. However, people with lupus now have safe alternatives to the pill.

Because of the risk that an unplanned pregnancy poses to you and your unborn child if you have lupus, it’s a good idea to talk about your birth control options with your healthcare provider.

Safe Birth Control Options

Some people with lupus have antibodies in their immune system that make their blood clot too efficiently. These are called antiphospholipid (APL) antibodies.

The presence of antiphospholipid antibodies changes the risks of hormonal birth control options. So does a condition called proteinuria, which involves high urinary protein levels. Having high or low disease activity also affects risk.

Hormonal Pills and Injections

Older, traditional pills and injected contraceptives pose more of a risk than the newer minipill. The risks don’t apply to everyone with lupus, though. Safety information includes:

• Traditional pills are not safe for those with APL antibodies or highly active lupus. These pills taken daily contain estrogen and progestin. They’re considered safe for others with lupus.
• The minipill is safe for most people with lupus. These pills contain just progestin and are taken daily.
• Injected forms are not safe for those with APL antibodies or proteinuria. You get injections of progestin-only contraceptives, such as Depo-Provera, every three months.

Side Effects

Side effects include weight gain, breast tenderness, nausea, and dizziness, as well as:

• Estrogen-containing pills: Bleeding/spotting between periods, water retention, mood swings, high blood pressure, and diarrhea
• Progestin-only pills: Irregular periods, headache, acne, and increased hair growth
• Hormonal injections: Irregular menstrual bleeding, skipped periods, thinning of bones, slow return to fertility, and injection-site reactions
  

IUDs, Implants, Rings, and Patches

Hormone-releasing intrauterine devices (IUDs), rings, patches, and arm implants all are effective contraception methods. But not all of them are considered safe if you have lupus. These birth control methods involve:

• Hormonal IUD is safe for most people with lupus. A healthcare provider places it in your uterus, and it releases a constant low dose of the hormone levonorgestrel. It’s effective for five to seven years.
• Implants are safe for most people with lupus. A provider places subdermal (under the skin) implants in the upper arm. They release etonogestrel (a type of progestin) continuously for three years or longer.
• The ring is safe for those with low clot risk and low disease activity. It uses both estrogen and progestin. You place it yourself (similar to inserting a tampon) and leave it in for three weeks.
• The patch is not recommended for anyone with lupus. It releases estrogen and progesterone through your skin, and it is changed once a week

Side Effects

Breast tenderness, headache, and weight gain are side effects. Other symptoms include:

• IUDs: Abdominal or pelvic pain, vaginal discharge, nausea, nervousness, vulvovaginitis (inflammation of the genitalia), heavy menstrual periods, and back pain
• Implants: Irregular or skipped periods, spotting, acne, and depression
• Rings: Can include irregular periods, nausea, headache, dizziness, breast tenderness, mood changes, vaginal irritation, infections, or discharge, changes in vision, and inability to wear contact lenses, though side effects are rare
  

Barrier Methods

Birth control methods that use a physical barrier to keep the egg and sperm apart are called barrier methods. These include:

• Condoms
• Diaphragms
• Sponges
• Cervical caps

All of these methods are safe to use by nearly everyone with lupus. However, these methods are less effective than others at preventing pregnancy. It is sometimes recommended that you use spermicide with a barrier.

An added bonus of condoms is that they help protect against sexually transmitted infections (STIs). Most birth control methods do not.

Side Effects

Side effects vary by type of barrier method. With diaphragms, sponges, and cervical caps, there is an increased risk of contracting HIV from a partner who's HIV positive. Other symptoms include:

• Condoms: Decreased sexual sensation, latex allergy, and they may break or leak, which lowers their effectiveness at preventing pregnancy
• Diaphragms: When used with spermicide, an increased risk of urinary tract infection and toxic shock syndrome if left in for more than 24 hours
• Sponges: Allergies to polyurethane or sulfites in the sponge and, rarely, toxic shock syndrome
• Cervical caps: Vaginal irritation or odor and increased risk of toxic shock syndrome if used during your period
• Spermicide: Vaginal burning and irritation, and allergic reactions

Because of the increased risk of getting human immunodeficiency virus (HIV), spermicides alone are only recommended if you have one sexual partner and you’re both at low risk of contracting HIV.

Tubal Ligation

If you’re not planning any future pregnancies, you might choose a tubal ligation. This procedure is also known as “getting your tubes tied.” Nowadays women who desire tubal ligation surgery are often offered bilateral salpingectomy, which involves removing both tubes. This type of surgery reduces the risk of certain gynecological cancers.

The tubes in question are the fallopian tubes that carry eggs from your ovaries to your uterus. During surgery, they’re blocked or cut to keep your eggs from getting to a place where they can be fertilized.

Tubal ligation is permanent birth control, also called sterilization. A further procedure can sometimes reverse it, but it may be more difficult to get pregnant afterward.

Side Effects

Even as minor surgery, tubal ligation has some risks. These include:

• Bleeding from the incision
• Internal bleeding
• Infection
• Damage to nearby organs
• Side effects from anesthesia
• Ectopic pregnancy (a fertilized egg that implants outside the uterus)

People who have had a tubal ligation still have a small risk of getting pregnant.

Vasectomy

A vasectomy is an option for your male partner. It’s also considered permanent birth control, but it can sometimes be reversed.

This procedure prevents the sperm from getting into the semen that’s ejaculated during a male orgasm. It’s the most effective form of birth control other than complete abstinence.

Side Effects

Again, as with any surgery, vasectomy comes with some risks, including:

• Sperm granuloma (inflammatory reaction to sperm that may leak under the skin, causes a small bump)
• Short-term bleeding, swelling, and bruising
• Pain and swelling at the surgical site during the first year after the surgery
• Infection

The vas deferens is the duct that sperm travels through to reach the urethra. It’s severed during a vasectomy. Rarely, the vas deferens repairs itself, which can lead to pregnancy.

When to See a Healthcare Provider

If you have lupus and are in your childbearing years, you should discuss birth control with your healthcare provider. It’s important for you to avoid unplanned pregnancies, especially if you’re on medication that’s linked to birth defects or other problems.

If you have lupus and suspect you’re pregnant, call your healthcare provider right away. Also, get an appointment with an obstetrician-gynecologist (ob-gyn) who specializes in high-risk pregnancies.

Summary

Not all forms of birth control are safe with lupus. Unplanned pregnancies should be avoided due to some lupus treatments’ risk of causing birth defects. Don't use hormonal birth control with estrogen if you have high disease activity, APL antibodies, or proteinuria. Barrier methods and permanent sterilization pose no special risk for people with lupus. Side effects are possible regardless of the method.

A Word From Verywell

Pregnancy can be complicated when you have a medical condition and take treatments that can cause problems. Careful family planning and open lines of communication with your healthcare provider can help you avoid an unplanned pregnancy or have a healthy outcome when one does occur.