Contraception and Lupus

Why Family Planning Matters in Lupus

If you have lupus and are a woman, it is important for you to think about contraception and family planning. Getting pregnant when your lupus is active or if your lupus has caused problems with your kidneys, heart and lungs can lead to complications for both you and your baby and can lead to poorer outcomes.

Also, some medicines used to treat lupus may harm a developing baby. These may cause birth defects, miscarriage, or mean that ending the pregnancy is necessary. That’s why using reliable contraception is essential if:

• Your lupus is active.
• You’re taking medicines that aren’t safe in pregnancy.
• You do not want an unplanned pregnancy.

Medicines That Are Unsafe During Pregnancy

Some lupus medications may harm a baby if taken during pregnancy. These include:

• Belimumab (only used in rare cases).
• Cyclophosphamide (only used in rare cases).
• Leflunomide
• Mepacrine
• Methotrexate
• Mycophenolate Mofetil
• Mycophenolic Acid (Myfortic)
• Rituximab (only used in rare cases).
• Voclosporin

There may be other non-lupus medicines that are also not safe in pregnancy.

Never routinely stop your medication without speaking to your lupus team first.

• If you're planning a pregnancy, talk to your lupus team before stopping any medication.
• If you become pregnant unexpectedly while on these medicines, stop the medication and contact your lupus team immediately. The lupus team contact details are at the bottom of this leaflet.

Planning a Pregnancy

To give yourself and your baby the best chance of a healthy pregnancy:

• Plan ahead with your lupus team — ideally six to 12 months before trying to conceive.
• Talk to your lupus team to make sure your condition is stable.
• Your lupus team may need to change your medications to ones that are safe in pregnancy and this can take time.

Contraception Options for Women with Lupus

Using contraception helps prevent unplanned pregnancies. There are safe and effective options for women with lupus. Your lupus team can help you choose what’s best for you. The effectiveness of contraceptives varies, and depending on how your lupus affects you, might affect how safe certain methods are.

Best options for women with lupus: Long-Acting Reversible Contraception (LARC)

These do not rely on daily use and the chance of becoming pregnant with these methods are less than 1% per year which make them the best options and most reliable type of contraception:

Contraceptive Implant (Sub-dermal Implant)

• A small rod placed under the skin of your upper arm.
• Releases a hormone called progestogen.
• Works for years.
• Will need replacing at year three.
• No vaginal exam needed.
• May change your bleeding pattern (e.g., irregular or no periods).
• Can be removed before three years if planning a pregnancy – can take three months for menstrual cycle (periods) to return to normal.

Intrauterine Devices (IUDs or Coils)

• Placed inside the womb.
• Two types:
  • Copper Coil (non-hormonal).
  • Hormonal Coil (e.g., Mirena, Levosert, Kyleena, Jaydess).
• Fitted during a simple procedure with a speculum and inserter.
• Works for up to four years.
• Will need replacing at year four.
• May affect your bleeding pattern (periods).
• Can be removed before four years if planning a pregnancy – fertility returns to normal the first menstrual cycle (period).

Other less effective options for women with lupus:

• Progesterone-Only Pill (Minipill).
• Taken daily.
• Suitable for women with lupus as does not contain oestrogen.
• Slightly less effective than LARC with a 4% to 8% chance of becoming pregnant per year with typical use.
• Can be affected by missed doses, illness (e.g., vomiting), or other medications.

Avoid These Methods

Oestrogen-containing contraceptives are not recommended for women with lupus, as it can cause lupus to flare, increase the risk of developing blood clots and other complications. These include:

• Combined contraceptive pill.
• Contraceptive injection.
• Contraceptive patch.
• Vaginal ring.

Barrier and Natural Methods

• Condoms: Least effective (15–20% chance of pregnancy per year) but protect against STIs.
• Fertility awareness methods (monitoring menstrual cycle): Not reliable for women with lupus.

Choosing the Right Method

The best contraception for you depends on:

• Whether you have antiphospholipid antibodies (which increase blood clot risk).
• Your lupus activity level.
• Your medical history and current medications.
• Your personal preferences.

Talk to your lupus team to find the safest and most effective option for you.

For further detailed contraception information please check out the sexual health clinics websites below.

Where to access Contraception

Check with your GP surgery as some offer contraceptive implant and intrauterine device fitting. Progesterone-only pill (Minipill) is also available from your GP surgery.

Your local sexual health clinic can offer you the following:

• Coil fittings
• Implant fittings
• Contraception
• Emergency contraception.
• Sexually transmitted Infection testing.
• Pregnancy testing
• Vaccines

Most local sexual health clinics offer bookable appointments, and some offer a walk-in service – please check their websites below for details.

Sexual Health clinics

Axess Service Merseyside and Cheshire - https://www.axess.clinic/

• Clinics in Liverpool, Knowsley, East Cheshire, Warrington, Runcorn, and Widnes.

Sefton Sexual Health Services - https://seftonsexualhealth.nhs.uk

• Clinics in Bootle, and Southport.

St Helen’s Sexual Health Services - https://www.sexualhealthsthelens.nhs.uk/

• Clinic in St Helen’s.

Wirral Sexual Health Services - https://www.sexualhealthwirral.nhs.uk

• Clinics in Birkenhead, Eastham, and Wallasey.

Chester and Cheshire West Sexual Health Services - https://www.thesexualhealthhub.co.uk/services-near-you/cheshire-west-and-chester/

• Clinics in Chester, Ellesmere Port, Winsford, Neston, and Northwich.
• Lancashire and West Lancashire Sexual Health Services – https://lancashiresexualhealth.nhs.uk/find-nearest-centre/
• Wigan and Leigh Sexual Health Services - https://sectrum-sexualhealth.org.uk/our-clinics/wigan-leigh-clinic/

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