Autoimmune disease can take a number of different forms, including rheumatoid arthritis, lupus, multiple sclerosis, type 1 diabetes, and around 75 other, less well-known diseases. These diseases often stem from a genetic predisposition, but they also need an environmental factor to take hold.
Although these environmental triggers are poorly understood, some women claim that contraceptives, such as IUDs and birth control pills, directly caused their autoimmune disease. Out of the estimated 24 million Americans who suffer from these diseases, 80% are women. So is it possible contraceptives play a role?
What the experts say
Dr. Lisa Sammaritano, Associate Professor of Clinical Medicine at the Hospital for Special Surgery and Weill-Cornell Medical College in New York, explains that various parts of our immune systems are meant to fight off disease and infections. But sometimes the immune system can actually cause inflammation within the body. The underlying reason for this is not completely understood. But Sammaritano says it’s believed to be the result of the immune system mistaking parts of the body for external infectious organisms.
Sammaritano explains that autoimmune diseases are, “…not true genetic disorders in the way that, say, sickle cell is or other things…or cystic fibrosis—where there is an identified gene abnormality, and that is passed on to offspring or not passed on to offspring.”
So if you’re the child of someone with an autoimmune disease you’re at an increased risk of also having an autoimmune disease but it’s not a certainty. So what environmental factors further increase the risk?
“That could be an infection that triggers the immune system and then doesn’t let it quiet back down again, as it normally would. Or other things… For example, we think of sunlight, UV radiation, as a possible trigger for systemic lupus. So there are all kinds of suggestions about what kind of environmental triggers might be important for different autoimmune diseases,” says Sammaritano.
Assistant Professor of Medicine at the University of Colorado-Denver, Dr. Kristen Demoruelle explains that exogenous estrogen from oral contraceptives has been associated with an increased risk of one autoimmune disease, lupus. But, again, it’s hard to come to any definitive conclusions beyond that without more extensive research.
“No studies have shown a causality between hormonal contraceptives and autoimmune diseases. But there have been some studies that have found an increased or decreased risk for developing certain autoimmune diseases with hormonal contraceptives. For example, there’s been a few studies in lupus that have suggested that oral contraceptive pills may increase the risk of developing lupus. On the other hand, oral contraceptive pills look like they may decrease the risk of developing other autoimmune diseases,” says Demoruelle.
So what does that mean in terms of autoimmune diseases being triggered by IUDs? Demoruelle’s study in 2014, presented to the American College of Rheumatology, found that women using IUDs may be at increased risk for producing antibodies linked to rheumatoid arthritis. Furthermore, case reports presented to the World Allergy Organization have linked autoimmune progesterone dermatitis to use of an IUD. But studies haven’t yet come back with enough evidence for researchers to say there is a definitive causal relationship.
To that end, Sammaritano says she’s seen side effects that may be from IUDs. But she can’t say with any certainty that the contraceptive causes autoimmune disease.
A first-hand account
That’s what makes cases like Kristy Griffin’s so hard to explain. Griffin, a woman who primarily suffered from Hashimoto’s disease, claims the use of an IUD caused her to contract Sjogren’s disease.
“They inserted that [IUD], and I was back within a week. One week. Something was absolutely, horribly wrong,” says Griffin.
Her reported symptoms included being unable to get out of bed and barely able to move her joints.
“At the time I thought that the hormone levels had… caused a flare up of my Hashimoto’s. Because the joint pain was always something that had been a trigger for me before if I had a flare up with the Hashimoto.”
After visiting more than one doctor who told Griffin IUDs could not cause those symptoms, she tested positive for antibodies for Sjogren’s syndrome–another autoimmune disease that Griffin says is sometimes called ‘lupus’ evil sister.’
Her rheumatologist said the IUD had to come out right away. Soon after, Griffin’s condition improved.
So where does that leave women like Kristy? She says her rheumatologist was aware of a potential connection to autoimmune disease, and diagnosed it immediately. To her, the causal relationship was absolutely a reality.
But experts like Demoruelle and Sammaritano caution that too little is currently known for them to begin advising against specific methods of contraception. Especially IUDs, which have the benefit of being a long-acting reversible contraceptive–generally accepted as the most effective form of birth control.
- Dr. Lisa Sammaritano, Associate Professor of Clinical Medicine, Hospital for Special Surgery and Weill-Cornell Medical College
- Dr. Kristen Demoruelle, Assistant Professor of Medicine, University of Colorado-Denver
- Kristy Griffin, Hashimoto and Sjogren’s disease sufferer