Prevalence and Counseling Practices of Contraceptive Use Among Women With Systemic Lupus Erythematosus at a Tertiary Center in Saudi Arabia

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that mainly affects women of reproductive age. Management often involves immunosuppressive therapies, such as azathioprine and cyclophosphamide, which carry teratogenic risks. Effective contraceptive counseling is therefore essential, yet data on counseling provision and contraceptive use among women with SLE in Saudi Arabia are limited. Objective: This study aimed to evaluate the prevalence, patterns, and counseling practices of contraceptive use among women with SLE who were prescribed potentially teratogenic medications at a tertiary center in Riyadh, Saudi Arabia. Additionally, the study examined associations between contraceptive use patterns and key demographic and clinical factors, including educational level, parity, disease duration, and pregnancy risk status. Methods: This cross-sectional study collected data from electronic health records and conducted phone interviews with women aged 18-45 years with SLE who were receiving azathioprine or cyclophosphamide. Demographics, disease characteristics, contraceptive counseling, and usage patterns were analyzed using descriptive and inferential statistics. Participants were recruited from the outpatient immunology clinics of tertiary hospitals in the central region of Riyadh, Saudi Arabia. Results: Of the 399 women included in the study, 209 (54.6%) were considered at risk of becoming pregnant. Only 17.2% reported consistent contraceptive use in the past three months, while 64.2% reported intermittent use. Notably, 90.1% of non-users were still prescribed teratogenic medications. Intrauterine devices were the most common method of contraception (38.7%), followed by barrier methods (17.3%). Although 55.3% received contraceptive counseling at the time of diagnosis, less than 40% reported receiving counseling in the past year. Although educational level was found to significantly influence contraceptive behaviors, most non-users were college-educated women. Disease duration was associated with increased use of barrier methods. Conclusion: The findings reveal that, despite high teratogenic exposure, many Saudi women with SLE lack consistent contraceptive use and ongoing counseling. Compounding this issue, many participants reported an absence of structured, ongoing contraceptive counseling within their care pathways. These findings underscore an urgent need to integrate routine, protocol-driven reproductive health services into standard lupus care. Tailored interventions, including repeated counseling at key disease junctures and accessible contraceptive services, are essential to mitigate the risk of unplanned pregnancies, optimize maternal and fetal outcomes, and address a significant gap in the comprehensive care of this vulnerable population.