Do you recommend avoidance of vaginal estrogen in patients with SLE?   

It depends on the age. The SELENA study demonstrated that BCPs in premenopausal women did not lead to flares or increased disease activity though the risk of increased clotting is an issue for APL+ folks. Post-menopausal women treated with HRT had an increase in mild flares compared to those not on ...

@Gary Gilkeson, can you clarify what you meant by 'it depends on their age?' The combined hormone birth control pills (triphasic ethinyl estradiol at a dose of 35 μg plus norethindrone at a dose of 0.5 to 1 mg) nor the HRT (0.625 mg of conjugated estrogen daily, plus 5 mg of medroxyprogesterone ...