Thursday, August 8, 2013

Birth Control Methods and Their Effects on Women With Chronic Health Conditions

The most important thing for you, if you have a chronic condition, is to have an understanding of birth control methods and how they can affect your health. Some of these methods can present specific concerns for certain rheumatic conditions. If you have antiphospholipid syndrome or antiphospholipid antibodies in your blood, lupus or RA, here is what is known about the concerns and the appropriate birth control methods.

Antiphospholipid antibodies and antiphospholipid syndrome: APL or antiphospholipid antibodies are proteins that affect the balance in the blood between clotting and bleeding and are a risk factor for blood clots. APS or antiphospholipid syndrome, is an autoimmune disorder that is characterized by antiphospholipid antibodies, blood clotting, and miscarriages and the syndrome can happen alone or with lupus, even though you have the antibodies you may not have lupus.

If you have antiphospholipid antibodies you are more likely to develop blood clots if you have another risk factor for blood clotting such as a severe illness, surgery, prolonged bed rest, malignancy, or pregnancy or it can be a lifestyle risk factor such as smoking or using combination contraceptives. That's why this second risk factor can be one of the variants in the blood that makes clotting possible. When you have lupus and antiphospholipid antibodies you are more likely to have other medical risk factors for a stroke or heart attack, like migraines, atherosclerosis or clogged arteries, or elevated cholesterol levels.

Contraceptives with estrogen are know to increase the risk of blood clots and when you have moderate to high antiphospholipid antibodies you should stay away from combination hormonal contraceptives. If you have low or borderline levels of the antiphospholipid antibodies, it may depend on whether you have had other risk factors for blood clots, to determine if you should stay clear from the combination hormonal contraceptives. Progesterone-only contraception is a good alternative for you if you have antiphospholipid antibodies and are unable to safely take estrogen. This method is also an effective way to decrease the heavy menstrual flow if you are on blood-thinning medications like warfarin, also known as Coumadin, which is often used to treat APS, Antiphospholipid syndrome.

Systemic lupus erythematosus: It was thought for many years that estrogen increased disease activity in lupus. This assumption was based on the findings in laboratory animals, and the fact that lupus is found mostly in women, 4 out of 5 people with lupus are women, and the reports of birth control pills and pregnancy where women said their lupus got worse. There are early reports that suggested there was an increase risk of lupus flares with the use of contraceptives containing estrogen. But, there are more recent studies that were better-designed, using large numbers of participants and standardized methods of measuring flares that found that estrogen-containing contraceptives are safe in some women with lupus.

And there were two randomized clinical trials published at the end of 2005 that found combination birth control pills don't significantly increase the risk of flares in women with inactive or stable, moderate lupus. The Safety of Estrogens in Lupus Erythematosus National Assessment, or SELENA, trial included 183 women with inactive or stable, moderate lupus and compared the effects of a standard combination birth control pill with the effects of an inactive placebo pill. Women who had active lupus, a history of blood clots, or antiphospholipid antibodies couldn't take participant in the study and the number and severity of the lupus flares showed no difference in the two groups. There was another study of 162 women with stable mild-to-moderate lupus that also found no adverse effects on flare rates whether the women used a combination pill, a progesterone-only pill or a copper IUD.

Based on these studies, it would appear that combination pills are safe for you if you have inactive or stable, moderate lupus and don't have antiphospholipid antibodies. Remember, though, that you may not even be able to tell how active your lupus is and often lupus activity can only be detected through blood test or other tests. So if you have lupus and you want to use a combination pill, your rheumatologist must be involved in the decision making. Since about 1/3 of the women with lupus have antiphospholipid antibodies, you have lupus you should be screened for the antibodies before starting a combination birth control pill.

It seems that it would be smart for you if you have lupus to avoid the contraceptive patch, Ortho Evra, given the recent FDA warning that it increases the risk of blood clots above that of combination pills. There's also the birth control pills that contain drospirenone, Yasmin, Yaz, that are more likely to elevate blood levels of potassium, an important consideration for you if you have lupus-related kidney problems. The safety of IUDs, if you are taking immunosuppressive drugs to treat your lupus, is not certain, because the drugs and the IUDs can raise the risk of infection. If you have active lupus, barrier methods or progesterone-only contraceptives are your options. Depo-Provera injections may be a problem if you are taking corticosteroids, because both the Depo-Provera and the corticosteroids increase the risk of bone loss.

Rheumatoid arthritis: There are some who believe that if you have RA you might actually benefit from treatment with estrogen-containing birth control pills because your symptoms improve during pregnancy. But, there's little research into using the pill to treat RA and research does suggest that women with RA have normal estrogen levels but lower than normal androgen levels, so hormonal therapy attempts have focused on supplementing androgens (androgens are primarily male sex hormones, but women have small amounts of them), with mixed results and no clear benefit. Postmenopausal estrogen therapy has also been studied in women with RA but showed no effect on the activity of the RA, and although there are no grounds for saying that combination hormonal contraceptives reduce the activity in Ra, there's no evidence that suggest their use would make a flare more likely to happen. Combination pills or the patch, may be effective and convenient for you if you have RA, but there is a concern that the risk of blood clots from the patch is higher than the risk from the pill. Inserting a vaginal ring or a diaphragm may be difficult if you have severe RA and like with lupus, it's not sure how safe IUDs are if you are taking immunosuppressive drugs such as ethotrexate, corticosteroids, or cyclosporine to treat their RA. There are no studies that have addressed this question specifically with newer RA medicines such as the biologics, among them Enbrel, Remicade and Humira.

There are other concerns as well and they are the hormone containing contraceptives can interact with other medicines, and this can reduce your medicine's effectiveness or increase its side effects. Some of these medicines are used to treat arthritis and related conditions. Some anticonvulsants like anti-seizure medications that are used to treat seizures, headaches, or chronic pain disorders may decrease the effectiveness of birth control pills. There are also, corticosteroids, warfin, and cyclosporine that can interact with the contraceptives even though the interactions are weak. Other medications that are used to treat other health conditions, some antibiotics, may also interact with hormone containing contraceptives and if you are using one of these contraceptives you should always remind your doctor of that fact when your doctor prescribes you new medications.

When you have rheumatic conditions and you have to stay in bed for a while, maybe because of a flare-up of the condition, or after surgery you should stop using combination birth control pills, the patch and the vaginal ring. Also, and especially if you have antiphospholipid antibodies, your doctor should give you low doses of a blood-thinning medicine. If you are planning elective surgery, you should talk to your doctor about stopping you combination hormonal contraceptive two months in advance, because estrogen's effects on blood clotting takes up to six weeks to reverse.

There are so many different types of birth control available to you today that if you have a rheumatic condition you can choose a safe and effective method. There are also many factors that have to be taken into consideration and it's essential that you, your gynecologist, and your rheumatologist work together to decide which of these methods is best for you.

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