The risk of exogenous estrogens for developing systemic lupus erythematosus and disease activity is controversial. Women users of oral contraceptives (18) or menopause hormonal therapy are at an increased risk of developing systemic lupus erythematosus than non-users (3,19). While a high rate of flares in women taking combined oral contraceptives has been reported (6), recently, we and the investigators of the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) group have demonstrated that estrogen containing oral contraceptives did not increase the risk of activity exacerbation (20,21). Hormone therapy was safe, well tolerated, and did not increase the risk of lupus flares in observational studies (22-24); however, the SELENA group detected a slight increase in the risk of developing mild/moderate, but not severe flares (25).