Use of exogenous estrogens in systemic lupus erythematosus

Objective: To review the current literature on the safety of using exogenous estrogens in patients with systemic lupus erythematosus (SLE).

Method: A MEDLINE search for articles published between 1970 and 2000 regarding the relationship between estrogens and SLE was performed. Emphasis was put on human studies, treatment trials, and epidemiologic surveys.

Results: The use of exogenous estrogens in healthy women increases the risk of SLE development. For patients with established SLE, a hypoestrogenemic state appears to be protective against severe flares, whereas exogenous estrogen administration or hyperestrogenemia induced by hormonal manipulation may exacerbate the disease in certain individuals. Both the use of oral contraceptives and the use of hormonal replacement therapy (HRT) increase the chance of venous thromboembolism. The presence of antiphospholipid antibodies may aggravate the risk of thrombosis in SLE. In retrospective studies, HRT appears to be well tolerated in postmenopausal SLE patients.

Conclusions: There are no prospective data that show a deleterious effect of exogenous estrogens on disease activity in human SLE. Oral contraceptives may be considered for patients with SLE in the absence of active nephritis or antiphospholipid antibodies. The slight increase in venous thromboembolic risk should not be the chief deterrent to the use of HRT in postmenopausal SLE patients, considering its various health benefits.