SLE Contraception with aPL — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

EasySLE & Antiphospholipid SyndromeSLE Contraception with aPLSCE Rheumatology

A 40-year-old woman with systemic lupus erythematosus has persistently positive lupus anticoagulant. She has no other contraindications to contraception. According to the UK Medical Eligibility Criteria for Contraceptive Use, which contraceptive method is category 4 (an unacceptable health risk)?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Combined hormonal contraception

Combined hormonal contraception, including the combined pill, patch and vaginal ring, is contraindicated. Positive antiphospholipid antibodies, particularly lupus anticoagulant, confer increased arterial and venous thrombotic risk; adding an oestrogen-containing contraceptive creates an unacceptable health risk. UKMEC therefore classifies combined hormonal contraception as category 4 in SLE with positive antiphospholipid antibodies. The copper IUD is category 1, with no restriction attributable to the antibody status. The levonorgestrel IUS, progestogen-only implant and progestogen-only pill are category 2: their advantages generally outweigh theoretical or established risks. They should not be described as universally risk-free, because suitability still depends on individual factors, concurrent medicines and patient preference.

Reference: Faculty of Sexual & Reproductive Healthcare. FSRH Guideline: Combined Hormonal Contraception, Appendix 2—SLE with positive antiphospholipid antibodies, January 2019, amended October 2023. https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-guideline-combined-hormonal-contraception-october-2023.pdf