Hormone Replacement Therapy in Systemic Lupus Erythematosus

Contraindications

Hormone Replacement Therapy (HRT) is contraindicated in patients with active Systemic Lupus Erythematosus (SLE) disease, positive antiphospholipid (aPL) antibodies, and increased thrombotic risk, particularly in patients with positive aPL antibodies, as recommended by the European League Against Rheumatism (EULAR) 1

HRT should be reserved for the management of severe and disabling vasomotor menopausal symptoms in SLE patients with stable/inactive disease and negative aPL antibodies, as recommended by EULAR 1
HRT has been shown to be effective for vasomotor and other hypoestrogenism symptoms in selected SLE patients, according to EULAR 1

Regular blood pressure monitoring is recommended for patients on HRT, as well as close monitoring for disease activity, thrombotic events, and cardiovascular complications, as recommended by EULAR 1
HRT should be used for the shortest possible duration needed to control severe symptoms, as recommended by EULAR 1
Before considering HRT, thorough evaluation of thrombotic risk factors, including presence of aPL antibodies, history of previous thrombosis, and other cardiovascular risk factors (hypertension, diabetes, smoking), is necessary, as recommended by EULAR 1

Non-hormonal alternatives, such as SSRIs/SNRIs, gabapentin, pregabalin, and clonidine, may be considered for vasomotor symptoms
Behavioral therapies may also be considered for vasomotor symptoms