According to the Center for Disease Control, 46.8% of high school students surveyed in 2013 have been sexually active. Of those surveyed 34% had sexual intercourse within the past 3 months; of whom 40.9% did not use a condom during their last sexual encounter. Reproductive health counseling is important for all teens, but is crucial for adolescents with active systemic lupus erythematosus(SLE) who may be prescribed teratogenic drugs and have an inherent risk for VTE. The current CDC medical eligibility for contraceptive use (MEC) provides guidance among different patient populations. Among antiphospholipid antibody positive (APLA) SLE patients, estrogen containing contraceptives are contraindicated. For this reason progestin only methods are typically utilized in sexually active adolescents with SLE and include the progestin only pill, injection, implant and intrauterine device. Although preferred, these progestin only methods are category 3, meaning the risk may outweigh the benefits. The occurrence of progestin only method risks has not been documented in the adolescent SLE population. A recent study demonstrated a 3.6 fold increase of VTE among those who used depo-medroxyprogesterone acetate (DMPA) compared to non-users of hormonal contraceptive methods, however this study only included women 18-50 years with other comorbidities and did not focus on adolescents with SLE.

Utilizing a large multi-ethnic single institution cohort we set out to: A) determine past contraceptive use and provision of contraceptive counseling among adolescent females with SLE, B) to identify the type/MEC category of medication use among SLE adolescents and if counseling was provided about potential medication teratogenic risks, C) determine if VTE or weight gain occurred while on a contraceptive method and D) identify human papillomavirus (HPV) immunization status in adolescent females with SLE.

Methods:

A retrospective chart review of ICD-9 code identified SLE in females <21 years between 2000- 2015 seen in both pediatric rheumatology and gynecology clinic. Descriptive statistics were reported.

Results:

We identified 87 menarchal females age 9-17. Sexual activity was reported in 46.51% of teens, with only 20% reporting consistent condom use. Twenty-four patients (28.24%) declined contraceptive hormones despite counseling. Two patients started on a combined estrogen-progestin contraception option. The remaining teens chose progestin only options. BMI increased an average of 2.68 one year after contraception was started. No VTEs were reported in any patients while using hormonal contraception, including DMPA. The HPV vaccine was completed by 66.3% of the teens, while 16.3% had never received the vaccine and the status of 17.4% was unknown.

Conclusion:

Sexual activity rates in our SLE cohort approximated national figures, while condom use was significantly lower. No increase risk of VTE with progestin-only options in SLE patients irrespective of APLA. Although a significant average increase in BMI after one year on contraception, this was confounded by concurrent steroid. Only 66% received the HPV vaccine prompting our inclusion of reproductive health issues in QA projects.