Is oral birth control (OBC) safe for patients with Sjogren's syndrome?

Oral Birth Control Safety in Sjögren's Syndrome

Oral birth control is generally safe for patients with Sjögren's syndrome who do not have positive antiphospholipid antibodies (aPL). For those with Sjögren's syndrome who test positive for aPL, progestin-only contraceptives or IUDs should be used instead of combined estrogen-progestin contraceptives.

Contraceptive Recommendations Based on aPL Status

For Sjögren's Patients WITHOUT Positive aPL:

• Combined estrogen-progestin contraceptives can be safely used in patients with stable, low disease activity 1
• No increased risk of disease flare has been demonstrated with estrogen-progestin pills in stable Sjögren's syndrome 1

For Sjögren's Patients WITH Positive aPL:

• Strongly avoid combined estrogen-progestin contraceptives due to increased thromboembolism risk 1, 2
• Recommended alternatives:
  • Levonorgestrel IUD (first choice)
  • Copper IUD (first choice)
  • Progestin-only pills 1, 2

Special Considerations in Sjögren's Syndrome

Disease Activity Impact

• For patients with moderate or severe disease activity:
  • Avoid combined estrogen-progestin contraceptives
  • Use progestin-only or IUD contraceptives instead 1

Thrombotic Risk

• The risk of venous thromboembolism (VTE) in healthy women taking combined estrogen-progestin contraceptives is 3-6 times higher than baseline 1, 2
• Progestin-only pills show no increased thrombosis risk (RR 0.90,95% CI 0.57-1.45) 1, 2
• Levonorgestrel IUD also shows no increased thrombosis risk (RR 0.61,95% CI 0.24-1.53) 1, 2

Pregnancy Considerations

• Women with Sjögren's syndrome experience more pregnancy complications than women without the disease 3, 4
• Complications include pregnancy-induced hypertension, fetal growth restriction, thromboembolic events, and preterm delivery 3
• The most serious risk is congenital heart block in babies of mothers with anti-SSA/Ro and anti-SSB/La antibodies 3, 4

Contraindications and Cautions

• Avoid transdermal estrogen-progestin patch in all Sjögren's patients as it results in greater estrogen exposure than oral methods 1
• Avoid depot medroxyprogesterone acetate (DMPA) in aPL-positive patients due to concerns about thrombogenicity 1, 2
• Miltefosine (used for leishmaniasis treatment) specifically states that female patients should not rely on hormonal contraception if experiencing vomiting/diarrhea 1

Practical Recommendations

1. Screen all Sjögren's patients for aPL before prescribing contraceptives
2. For aPL-negative patients with stable disease:
   • Any contraceptive method can be used, including combined oral contraceptives
3. For aPL-positive patients or those with moderate/severe disease:
   • Use IUDs (levonorgestrel or copper) or progestin-only pills
4. All patients should be counseled about emergency contraception options

Common Pitfalls to Avoid

• Failing to test for aPL before prescribing combined hormonal contraceptives
• Prescribing combined hormonal contraceptives to patients with moderate/severe disease activity
• Not recognizing that vaginal dryness is common in Sjögren's syndrome (52.9% vs 28.3% in controls) 5 and may affect contraceptive choice and sexual function
• Overlooking that Sjögren's patients may have more gynecological problems including episodes of amenorrhea and menorrhagia/metrorrhagia 5

By carefully considering disease activity and aPL status, appropriate contraceptive choices can be made for women with Sjögren's syndrome to minimize risks while providing effective birth control.