Contraception in Rheumatic Diseases

Family planning and contraceptive care are integral to the overall health of people with autoimmune rheumatic diseases (AIRDs) and pregnancy potential. Hormonal contraception contains varying forms and dosages of progestin, with or without estrogen. Guidelines suggest that people with active systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), and those with moderate-to-high-titer antiphospholipid antibodies (aPL) avoid estrogen-containing contraception. Progestin-only and nonhormonal contraception options are safe for all individuals with AIRDs. Apart from the type of AIRDs and aPL profile, other factors that inform contraception recommendations and decision-making include concomitant medication use, comorbidities, past experiences, and personal preferences. Quality improvement efforts to optimize contraceptive care are required, as well as a framework for person-centered contraceptive counseling in the context of rheumatology. Effective contraceptive care delivery for people with AIRDs requires a multidisciplinary, individualized approach.