In the future, cross-disciplinary guidelines may help clarify various providers’ roles and responsibilities for both family planning and recommendations, says Dr. Birru-Talabi. The good news is that there are many contraception choices right now, and most are safe for women with rheumatic diseases.
“We might be a little more cautious about estrogen-containing contraceptives among with women with antiphospholipid antibody syndrome or SLE with antiphospholipid antibodies. However, the highest estrogen state possible is pregnancy, and this certainly exposes a woman to more estrogen than the pill, for example,” she says. Intrauterine devices (IUDs) don’t seem to increase pelvic inflammatory disease or sexually transmitted infection risk in women who use immunosuppressant medications, “so women shouldn’t fear contraception,” she says. “I think most women are willing to discuss the risks and benefits of any particular medication, including birth control.” Contraception methods that don’t contain estrogen include the Depo-Provera shot, IUDs, subdermal implants and the progestin-only pill.
High rates of unintended pregnancies highlight that a functional, intact framework for family planning for patients with rheumatic diseases is needed, she says. Rheumatologists should discuss patients’ reproductive goals at the time of diagnosis and present themselves as an informative resource for their patients—both women and men.
“We don’t have a good perception of the risks of various diseases or drugs on male reproduction. However, most drugs appear to be safe, and most children of fathers with rheumatic diseases tend to do well. Nonetheless, we need to follow up on these observations and assumptions with real studies and data so we can better educate male patients about risks.”
Susan Bernstein is a freelance medical journalist based in Atlanta.
References
- Finer LB, Zolna MR. Declines in unintended pregnancy in the United States: 2008–2011. New Eng J Med. 2016 Mar;374:843–852.
- Yazdany J, Trupin L, Kaiser R, et al. Contraceptive counseling and use among women with systemic lupus erythematosus: A gap in health care quality? Arthritis Care Res (Hoboken). 2011 Mar;63(3):358–365.
- Ferguson S, Trupin L, Yazdany J, et al. Who receives contraception counseling when starting new lupus medications? The potential roles of race, ethnicity, disease activity and quality of communication. Lupus. 2016 Jan;25(1):12–17.
- Birru Talabi M, Clowse ME, Schwarz EB, et al. Family planning counseling for women with rheumatic diseases. Arthritis Care Res (Hoboken). 2018 Feb;70(2):169–174.
- Chakravarty E, Clowse ME, Pushparajah DS, et al. Family planning and pregnancy issues for women with systemic inflammatory diseases: patient and physician perspectives. BMJ Open. 2014 Feb 5;4(2):e004081.
- Flint J, Panchal S, Hurrell A, et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding, Part I: Standard and biologic disease-modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford). 2016 Sep;55(9):1693–1697.
