Which Hormones and Contraception for Women with APS? Exogenous Hormone Use in Women with APS - PubMed

Purpose of review: Use of exogenous estrogen carries significant risk for patients with prothrombotic disorders including those with antiphospholipid antibody (aPL) and antiphospholipid syndrome (APS). This review summarizes current knowledge of contraceptive and other hormone therapies for aPL-positive and APS women and highlights knowledge gaps to guide future research.

Recent findings: Studies support very low risk for most progestin-only contraceptives in patients with increased thrombotic risk, but suggest increased VTE risk with depot-medroxyprogesterone acetate. Highest efficacy contraceptives are intrauterine devices and subdermal implants, and these are recommended for women with aPL/APS. Progestin-only pills are effective and low risk. Perimenopausal symptoms may be treated with nonhormone therapies in aPL/APS patients: vasomotor symptoms can improve with nonhormonal medications and cognitive behavioral therapy, and genitourinary symptoms often improve with intravaginal estrogen that has limited systemic absorption.

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

1. 1. •• Sammaritano LR, Bermas BL, Chakravarty E, Chambers C, Clowse ME, Lockshin MD, et al. 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Care Res. 2020;72(4):461–88 This guideline presents recommendations regarding contraception, fertility preservation, assisted reproductive technology, pregnancy assessment and management, hormone replacement therapy and medication use before, during and after pregnancy. The recommendations are directed towards patients with any rheumatic disease, but specific recommendations are provided for patients with SLE, APS and anti-Ro and La antibodies where relevant.
2. 1. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera RH, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295–306.
3. 1. Schwartz EB, Manzi S. Risk of unintended pregnancy among women with systemic lupus erythematosus. Arthritis Rheum. 2008;59(6):863–6.
4. 1. Yazdany J, Trupin L, Kaiser R, et al. Contraceptive counseling and use among women with systemic lupus: a gap in health care quality? Arthritis Care Res. 2011;63(3):358–65.
5. 1. Birru Talabi M, Clowse ME, Blalock SJ, Moreland L, Siripong N, Borrero S. Contraception use among reproductive-age women with rheumatic diseases. Arthritis Care Res. 2019;71(8):1132–40.