Women with rheumatic diseases want rheumatologists involved in sexual, reproductive health
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Women aged 18 to 45 years with rheumatic diseases want rheumatologists to play an active role in their sexual and reproductive health, according to findings from a series of interviews published in Arthritis Care & Research.
“Despite their different diseases, many women had many of the same preferences for their reproductive health care,” Mehret Birru Talabi, MD, PhD, of the University of Pittsburgh, told Healio Rheumatology. “They wanted rheumatologists to initiate conversations about reproductive health care at their first visit and revisit the topic over time. They wanted clear and complete information about their personal reproductive risks as related to their diseases and medications.”
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“They wanted their reproductive goals to be respected,” she added. “They also wanted their rheumatologists and obstetrician-gynecologists to collaborate and discuss their care, as they often felt like intermediaries between these providers.”
To examine the views of young women with rheumatic diseases regarding their sexual and reproductive health needs, in the context of rheumatologic care, Birru Talabi and colleagues conducted a series of semi-structured qualitative telephone interviews. Participants were recruited from two outpatient rheumatology clinics affiliated with a large academic medical institution in western Pennsylvania.
The researchers limited the inclusion criteria to women aged 18 to 45 years who had previously received care at one of the two rheumatology clinics, with at least one confirmed diagnosis of either systemic lupus erythematosus, rheumatoid arthritis, spondyloarthritis, undifferentiated connective tissue disease, Sjögren’s syndrome, systemic sclerosis, inflammatory myopathies or vasculitis. They recorded and transcribed interviews of 30 total participants. Using these transcripts, the researchers developed a codebook to help conduct a thematic analysis of the participants’ answers.
According to the researchers, participants provided statements that generally fell into one of four themes. First, women want rheumatologists to initiate conversations about sexual and reproductive health, and revisit those conversations regularly over time. Second, the participants called for clear and complete information regarding the fetal, pregnancy and infertility risks associated with their diseases and DMARDs. Third, they said they want to be treated holistically, with sexual and reproductive health addressed in the context of their life circumstances and personal values, in addition to their rheumatic diseases.
Lastly, the participants expressed they often feel like intermediaries between their rheumatologists and obstetriciangynecologists, and that they would prefer providers to communicate directly with each other instead.
“Women care deeply about their reproductive health,” Birru Talabi said. “The clinical significance of our findings is that women want rheumatologists to play an active role in their reproductive health care through counseling as well as coordination of care with obstetrician-gynecologists.”
She added that the American College of Rheumatology guidelines for the management of reproductive health in rheumatic and musculoskeletal diseases is an important resource for rheumatologists to help provide counseling to patients.
“Our prior qualitative study with rheumatologists suggested that rheumatologists preferred for patients to initiate reproductive health conversations,” Birru Talabi said. “But in the context of our findings, it is important to note that some patients do not feel comfortable bringing the topic up with their rheumatologists, even if they have specific questions or concerns.”
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