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There are different types of lupus, but the word “lupus” is often used to refer to systemic lupus erythematosus (SLE), the most common form of the disease. All types of lupus are autoimmune diseases that cause your body’s immune system to attack organs and tissues.
Although lupus predominantly affects women during their childbearing years, sexual and reproductive health is still one of the most understudied areas when it comes to lupus research. Because lupus can affect so many organs and systems, your symptoms can manifest in many different ways, including fatigue, rash, hair loss, and kidney disease. These symptoms and their treatment can have a significant impact on sexual and reproductive health.
To make appropriate treatment decisions and maintain your quality of life, it is important to understand how lupus can affect your sexual health and fertility. Here are common effects that lupus can have on sexual and reproductive health.
Read: Lupus Frequently Asked Questions >>
Lupus can cause puberty to start later
People diagnosed with lupus in childhood may, on average, begin puberty later, although researchers aren’t sure why this happens. Some theories are:
- Nutrient deficiencies caused by the disorder
- Long-term treatments with corticosteroids
- The inflammatory process of lupus
Lupus can also take a toll on the body, and when symptoms are more severe, it can cause children with lupus to enter puberty later than their peers.
Lupus can cause menstrual problems
Lupus can cause symptoms such as heavy bleeding, missed periods or irregular cycles.
This could be because lupus can attack the ovaries, which regulate your hormone levels. Lupus flare-ups, in which symptoms appear suddenly or become worse or more bothersome, may occur due to increased estrogen levels that occur right after your period.
Another cause of irregular menstrual periods in lupus could be corticosteroid treatments or immunosuppressive medications used to treat the disease. These medications can cause the ovaries to not function properly.
Lupus can increase your risk of vaginal infections
If you live with lupus, vaginal infections such as candidiasis or bacterial vaginosis (BV) may occur more frequently. This is because the condition and the medications you take to treat it can weaken the immune system. And infections can become more common if your body can’t fight them effectively.
For candidiasis, sometimes an over-the-counter fungal treatment can cure the infection, but sometimes prescription treatments are necessary. BV must be treated with a prescription antibiotic. Therefore, be sure to talk to your doctor.
Lupus can increase your risk of cervical cancer
The human papillomavirus (HPV) can cause cervical cancer. HPV and early cancerous lesions may be more common in women with lupus. This may be related to lupus or the immunosuppressive medications used to treat it. Regular Pap tests with your gynecologist are important for prevention.
Lupus can cause vaginal dryness
Lupus can affect how your ovaries control estrogen levels. Lower estrogen levels can cause symptoms such as vaginal dryness, irritation and pain during intercourse.
If you suffer from vaginal dryness, lubricants are an option to make sexual activities more comfortable. Make sure you use a lubricant that does not contain glycerin and has the right pH level (between 4.8 and 4.5) so that it does not cause yeast infections.
Adding estrogen as a therapeutic option may be helpful in increasing estrogen levels, which may reduce symptoms. But this may not be safe for all forms of lupus. Some studies show that estrogen-based hormone therapies can trigger lupus flare-ups, worsen the disease, or increase the risk of blood clots. It is important to discuss the risks and benefits of estrogen and the safest route of its administration (topical, vaginal, or oral) with your rheumatologist if deemed safe.
Lupus can cause fertility problems
Fertility problems can occur from lupus or its treatments.
About three in ten women with lupus have antiphospholipid antibodies (AAF). These antibodies can increase your risk of blood clots, which may make it more difficult for you to get and stay pregnant. Lupus can also cause irregular menstrual periods, which can make it difficult to determine the best time to become pregnant.
Cyclophosphamide, a lupus drug used for more severe forms of the disease, may also affect your fertility because it stops your ovaries from secreting eggs each month.
You can freeze your eggs for later use if your lupus is under control and you are taking medications that are safe during pregnancy. Other treatments such as in vitro fertilization (IVF) may be helpful in getting you pregnant if you are having difficulty getting pregnant.
Lupus can cause complications during pregnancy
You can get pregnant and have a healthy pregnancy if you live with lupus, but having lupus increases your risk of complications during pregnancy. Good planning can reduce these risks. Therefore, it is important that you inform your rheumatologist and your gynecologist about your pregnancy plans so that they can work together to reduce your risk.
The risk of complications during pregnancy with lupus is higher if you:
- High blood pressure
- Heart, lung or kidney disease
- History of cardiovascular accidents
- History of preeclampsia
These conditions carry an increased risk of preeclampsia, miscarriage, or premature birth.
Lupus flare-ups can also occur during pregnancy due to fluctuating hormone levels. It is therefore important that you have regular check-ups with your rheumatologist and gynecologist during your pregnancy.
Don’t be afraid to ask questions about lupus
Fertility, sexual health, and pregnancy are common concerns for people with lupus.
But different symptoms affect each person in different ways.
Sometimes it can be difficult to determine whether your symptoms are affecting your reproductive and sexual health and whether there is anything you can do about it. Don’t be afraid to talk about your concerns and ask questions of your care team so you can get answers.
This educational resource was created with support from Merck.