Family planning and contraception in women of reproductive age with systemic lupus erythematosus: a narrative review.

Abstract

Purpose: Systemic lupus erythematosus primarily affects women of reproductive age and is associated with increased maternal and foetal risks. Effective family planning is essential to prevent unplanned pregnancies and optimise outcomes. This narrative review aims to analyse the impact of SLE and its treatments on menstrual function, fertility, and contraceptive safety.

Materials and methods: A comprehensive review of the literature was conducted to evaluate the effects of SLE and commonly prescribed immunosuppressive therapies on reproductive health. The literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science from 2015 to 2025.

Results: SLE and its treatments significantly influence menstrual cycles and fertility potential. Cyclophosphamide and methotrexate were identified as agents with marked gonadotoxic effects. Regarding contraception, oestrogen-containing methods pose substantial risks, particularly in women with antiphospholipid syndrome. In contrast, long-acting reversible contraceptives and progestin-only methods demonstrated favourable safety and efficacy and are recommended as first-line choices. Barriers to contraceptive access and adherence were also recognised as major challenges.

Conclusions: Individualised reproductive care is essential to support autonomy and improve maternal-foetal outcomes in women with SLE. Expanding access to safe contraceptive methods and addressing adherence barriers remain priorities to optimise reproductive health in this population.