Contraceptive use, counseling given and occurrence of venous thrombus embolism (VTE) in adolescent systemic lupus erythematosus patients (SLE)

Purpose: The purpose of this study was to determine the contraceptive needs among SLE patients. The secondary aim was to evaluate side effects associated with contraceptive use such as VTE and weight gain.Methodology: Retrospective chart review involving females (age) with a diagnosis of SLE, identified by ICD-9 codes between the years 2000-2015. Antiphospholipid (APLA) status was recorded. Contraceptive needs, type of method used and side effects will be reviewed. Demographics, SLE year of diagnosis, sexual history, pubertal history and whether counseling was provided if they were sexually active was recorded. Descriptive statistics were utilized.Results: According to the Center for Disease Control (CDC), 46.8% of high school students surveyed in 2013 have been sexually active. Of those surveyed, 34% had sexual intercourse within the past 3 months; 40.9% of whom did not use a condom during their last sexual encounter. Counseling is important for all teens, but can be especially important for patients with SLE given the types of medications used for treatment can be teratogenic and SLE inherently increases the risk for VTE. The current CDC medical eligibility for contraceptive use provide guidance among different patient populations. Among patients with SLE and who are APLA positive, estrogen containing contraceptives are contraindicated. For this reason progestin only methods are typically utilized in sexually active adolescents with SLE and include the progestin only pill, injection, implant and the intrauterine device. These methods are a category 3, meaning the risk may outweigh the benefits. The occurrence of these risks have not been documented in the adolescent SLE population. A recent study demonstrated a 3.6 fold increase of VTE among those who used depo-medroxyprogesterone acetate compared to non-users of hormonal contraceptive methods, however, this study only included women 18-50 years of age with other comorbidities and did not focus on SLE patients. Over 75 SLE adolescent patients were included in our study. Preliminary results show no increase risk VTE with use of progestin containing options in SLE patients with and without APLA status. This is important for women's health to broaden the spectrum of contraceptive options for patients with SLE.