Contracepção em doenças auto-imunes

Although the increasing knowledge of the involvement of estrogens in the patology of the auto-imune diseases, we are still using oral contraceptives in these diseases as if they were the inicial higher dose pills. The finding of estrogens receptors in imunne cells, the influence of estrogens in the cytokines production and the expression of protooncogenes involved in apoptosis are all new discoveries of how estrogens act in the immune system. In Rheumathoid Arthritis the oral contraceptives may be protective of the disease despite its higher incidence in women. In Systemic Lupus Erythematosus oral contraceptives with high dose estrogens were reported to induce lupus flares or increase the thrombotic risk in this patients. Nowadays, the low dose pills may be allowed in lupus patients in remission or with moderate activity of the disease without antiphospholipids antibodies, without previous thromboembolic episodes, or renal disease and being non-smokers and normotensive. There are other contraceptive alternatives such as injectable contraception, oral and implantable progestins, intra-uterine device, tubal ligation and vasectomy.