‘Contraception is really important’: Lupus poses unique reproductive health challenges
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AUSTIN, Texas — Although reproductive health represents a unique challenge in patients with lupus, success is possible with careful planning and consideration, said a presenter at the 2023 Rheumatology Nurses Society annual conference.
Lupus impacts women at a disproportionate rate vs. men, and the challenges associated with reproductive health in women are present throughout the patient's lifetime, according to Cuoghi Edens, MD, FAAP, of the University of Chicago.
“Lupus, throughout the lifespan, has some really unique and sexual reproductive health aspects and challenges,” Edens told attendees during the meeting. “And to me, that is across the life spectrum, not just in young people or women of childbearing age.”
All patients with lupus should make the best use of contraceptives as possible to reduce the chances of an unplanned pregnancy, she added.
“To me, contraception is really important in the care of patients with systemic lupus,” Edens said. “I always wish there was a better term, because there are so many other uses of these interventions and medications other than just preventing pregnancies.
“They do prevent pregnancy, though, which is really great for our lupus patients because it allows them to have really excellent pregnancy timing,” she added. “Pregnancy timing is good, because planned pregnancies in lupus have better success for both moms and babies.”
Contraceptives can also help patients with lupus manage symptoms that can exacerbate disease flares, as well as anemia brought on by heavy periods, lightening the flow of menses if patients are receiving anticoagulation therapy.
Meanwhile, some patients with lupus, especially those with severe involvement implicating vital organs, should avoid pregnancy altogether, Edens said.
The preferred method of birth control for patients with lupus depends on their specific disease manifestation. Physicians can help patients choose the optimal therapy by accounting for disease activity, levels of protein in the urine, whether patients are positive for antiphospholipid antibodies, blood clot history and how compliant patients are with their regular medications.
“The American College of Rheumatology, as well as the American College of Obstetrics and Gynecology, recommend the long-acting reversible contraceptives as first-line,” Edens said.
These methods, which include implants and IUDs, are great for patients with lupus because they are effective at preventing pregnancy and do not require a reminder for use, she added. In addition, they are safe for patients at a high risk for blood clots.
“I think that there is a lot of misinformation that these are not safe for patients that have had blood clots or who have antiphospholipid antibodies, but that is really the opposite of what is true,” Edens said. “There has been very little to no data to show that these long-acting reversible contraceptives, that have progesterone only, increase the risk of blood clots.”
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Edens C. Living with lupus: Common reproductive health topics. Presented at: Rheumatology Nurses Society annual conference; August 2-5, 2023 (hybrid meeting).
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