Contraceptives for People with Rheumatic or Musculoskeletal Disease

Pregnancy brings particular risks and complications for people with rheumatic and musculoskeletal conditions. They may develop fibromyalgia, lupus, psoriatic arthritis, rheumatoid arthritis, and scleroderma during pregnancy.

In this article, midwife and women’s health practitioner Robin Watkins discusses what contraceptive methods are safe and effective for people with these conditions. Both the diseases and their treatment can contribute to side effects and reduce the effectiveness of certain contraceptive methods. For example:

• Contraceptive methods with estrogen (the combination pill, patch, ring, and shot) carry additional risks for people who have antiphospholipid antibodies on a blood test.
• The patch carries special risks for people with lupus and a negative antiphospholipid antibody test.
• The shot is associated with particular side effects for people with an increased risk of osteoporosis or are taking steroid medications.
• Taking mycophenolate mofetil or mycophenolic acid can reduce the effectiveness of hormonal contraceptive methods.

According to the American College of Rheumatology guidelines, most birth control methods are safe for people with rheumatic and musculoskeletal diseases, including lupus. And anyone with a rheumatic or musculoskeletal disease, regardless of diagnosis or how severe your condition is, can safely use any type of IUD; the implant; progestin-only pills; behavioral methods, like withdrawal; and barrier methods, like condoms and diaphragms... All types of EC are safe for all people with rheumatic or musculoskeletal diseases.

SOURCE: Bedsider • AUTHOR: Robin Watkins, CNM, WHNP-BC • LAST UPDATED: October 14, 2021