Women's Issues & Lupus
Q. I am an African American woman who is having significant hair loss. I have scarring and itching. I was wondering ... would I be able to relax my hair? Or what hair treatment can I use to braid my hair or weave my hair? I am bothered by the hair loss.
A. The less manipulation, the better. Any treatments that could irritate the scalp may lead to further itching and scarring. A braid or hair weave should be fine, although minimizing pulling on the hair is best. Thus a tight braid should be avoided. Another option is a wig and there are some elegant options available. Sometimes insurance will cover this if the hair loss if for a medical condition.
Q: Can you tell me the risk a woman with lupus has with having sex with a man with herpes simplex ... genital and/or oral?
A: Lupus itself and the immunosuppressive medicines used to treat lupus increase the chance of infections, including viral infections such as herpes. Evidence suggests that lupus patients have a particular problem with herpetic viral infections. Several things including sunlight exposure and stress can also set off a herpetic viral reactivation.
Q: Is it true that flare ups are more rare after menopause?
A: Estrogen is important in the pathogenesis of lupus; this is why lupusis more common in women than in men--but the role of estrogen in a patient who has established lupus is not as clear. Lupus is not cured by menopause, and most patients continue to need lupus medicines after menopause. If hormone therapy is given after menopause, there is a slight increase in mild to moderate lupus flares.
Q: What is the best form of birth control for someone with lupus?
A: There can never be one "best" method for all women with lupus, just as there is not a "best" method for other women. If the family has been completed, the husband may choose vasectomy or the wife tubal ligation. Progesterone methods -- either oral or Depo-Provera -- are fine. But Depo-Provera has been limited to two years, because longer courses may lead to osteoporosis. Oral contraceptives can be given if there are no antiphospholipid antibodies (which increase the risk of blood clots) and stable lupus.
Q: My lupus is in remission. I want to have a breast augmentation that I have been putting off for a long time. Will this surgery cause any problems with my lupus?
A: It is usually ok for people with lupus to have a breast augmentation procedure as long as they are medically cleared for the procedure. You need to discuss fully with your physician the procedure and your current health status. You should avoid having the procedure while you are having a flare. Be aware that any surgical procedure can cause a lupus flare, so you need appropriate ongoing monitoring from a knowledgeable physician. Some people with lupus can have problems with wound healing, especially if they have "vasculitis" in the skin. Similarly if you are on prednisone or other corticosteroids, this too can impair wound healing. Additionally, if you have used prednisone during the last 18 months, you might need to take some "stress" steroid doses prior to the procedure. The primary physician treating your lupus will be able to discuss these issues and any others that could be important in your particular case such as use of other immune suppressants, active infections, low platelet counts etc. It is strongly advised that your lupus doctor clear you for the surgery.
Q: I have recently been diagnosed with lupus SLE. I have more frequently noticed very light vaginal bleeding after intercourse. Is this normal for lupus patients?
A: This can be normal for anyone but could also signal a problem with the cervix, clotting factors, or an infection. It could also be related to whatever birth control method you are using. Postcoital bleeding is not usually associated with your SLE unless you are on some sort of medication that would affect clotting factors (heparin, Plaquenil, prednisone, etc.). Either way, you should see your gynecologist or family doctor for a pelvic examination and Pap smear.