What is your first choice contraceptive agent for women with SLE?

In general, I recommend either IUD (progesterone or copper) or nexplanon due to the safety profile as well as efficacy. Progesterone IUDs can be safely used for all lupus patients as well as those with APS. Copper can as well but would use caution in patients with APS on therapeutic anticoagulation due to risk for excessive bleeding.

Oral combined contraception is relatively safe if lupus is well controlled and if they do not have a history of APS or clots. I avoid the estrogen patch given the higher risk for clotting and may exacerbate lupus.

Depo injections can be used as long as no history of clots or APS. The risk for clots is equivalent to oral combined contraception. It can also have a negative effect on bone mineral density which is ...