Contraception for Women with Rheumatologic Disease

Abstract

Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are two of the most common rheumatologic diseases diagnosed in women. Both SLE and RA frequently start in women of reproductive age and have significant implications for pregnancy. Use of contraceptive methods in these conditions has been controversial in the past due to concerns regarding potential worsening of disease activity, increased risk for cardiovascular complications, or infection with certain methods in the setting of immunosuppressive treatment. The primary risks from use of hormonal contraceptives in women with SLE involve thrombogenic risks, particularly in those women with positive antiphospholipid antibodies. The best available evidence does not indicate a risk of worsening disease activity in women with inactive or stable active SLE who use hormonal contraceptives. Therefore, with the exception of women at increased risk for thrombosis due to the presence of antiphospholipid antibodies, the benefits of contraception outweigh the risks for most women with SLE. All contraceptive methods appear safe for most women with RA, with the exception of use of progestin-only injectables in women with the greatest risk of osteoporosis. Overall, risks of contraceptive use in women with rheumatologic diseases must be weighed against the risks of unplanned pregnancy during a period of severe disease activity or while on teratogenic medications.