Birth control options for people with rheumatic or musculoskeletal diseases

We talked to experts on birth control and rheumatic and musculoskeletal diseases for all the details

If you are one of the more than 54 million adults in the U.S. living with a rheumatic disease, like lupus or rheumatoid arthritis, thinking about your birth control options might be more complicated because of your condition or your medications.

There are many rheumatic and musculoskeletal diseases and conditions including fibromyalgia, lupus, psoriatic arthritis, rheumatoid arthritis, and scleroderma. Here’s a complete list. If you have a rheumatic or musculoskeletal disease, many doctors recommend that you plan pregnancies since getting pregnant could worsen your condition, increase the chance that you have pregnancy complications like a miscarriage or early delivery, and some medications used to treat rheumatic and musculoskeletal diseases are not safe to take during pregnancy. If you have a rheumatic or musculoskeletal disease and don’t want to get pregnant right now, there are some key details you need to know about the safety and effectiveness of birth control.

What birth control methods can I safely use with a rheumatic or musculoskeletal disease?

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.

There are two ways that rheumatic and musculoskeletal diseases or their treatment might affect your birth control—by increasing the side effects of your method or decreasing how effective your method is at preventing pregnancy.

The only restrictions on birth control methods are if you have lupus; have antiphospholipid antibodies on a blood test (or aren’t sure of your results); are at an increased risk of osteoporosis because of your disease or your medications; or are taking the medications mycophenolate mofetil or mycophenolic acid.

What birth control methods are safe to use if I have antiphospholipid antibodies?

People who have antiphospholipid antibodies should not use methods with the hormone estrogen, like the combination pill, patch, or ring, and should consider not using the shot. That’s because both estrogen-containing birth control and the shot increase the risk of blood clots, as does having antiphospholipid antibodies.

According to Mehret Birru Talabi, MD, Assistant Professor of Medicine in the Division of Rheumatology and Clinical Rheumatology at the University of Pittsburgh, “the shot may increase the risk of blood clots—less so than estrogen-containing contraception but maybe more so than the progestin-only pill. Long story short, the shot is probably safe for most people with an autoimmune disorder but at this point, probably isn’t the best option for people w​hose diseases are associated with increased risk of blood clots.”

What birth control methods are safe to use if I have lupus?

People with lupus who have a negative antiphospholipid antibody test can use the pill and ring but should not use the patch. “The patch gives a higher constant level of estrogen than the pills currently on the market and there’s a theoretic concept that estrogen might make active lupus worse, so the guidelines recommend against using the patch for people with an increased risk of a blood clot from very active lupus,” says Megan Clowse, MD, MPH, Associate Professor of Medicine in the Division of Rheumatology and Immunology, and founder of lupuspregnancy.org.

What birth control methods are safe to use if I have an increased risk of osteoporosis?

If you have an increased risk of osteoporosis because of your disease or if you are taking steroid medications, like prednisone, you should consider a method other than the shot because of additional bone health risk (although research has not shown that any bone health risk because of the shot is permanent).

What medications for rheumatic or musculoskeletal disease might affect my birth control?

If you are taking mycophenolate mofetil or mycophenolic acid, which are used to treat some rheumatic or musculoskeletal diseases, there is a concern that they may decrease the effectiveness of some hormonal birth control methods, like the patch, ring, and combination pill.

For people who are taking mycophenolate-containing medications, like Myfortic or CellCept, which are not safe to use in pregnancy, experts recommend using either a highly effective method, like an IUD or implant, or doubling up on methods, such as by using both condoms and birth control pills at the same time in order to decrease your chances of getting pregnant.

Is emergency contraception (EC) safe for people with rheumatic and musculoskeletal diseases?

All types of EC are safe for all people with rheumatic or musculoskeletal diseases. That means that anyone with a rheumatic or musculoskeletal disease can use EC pills, like levonorgestrel (Plan B and generic) or ulipristal acetate (ella), as well as a copper IUD (Paragard) or a hormonal IUD with 52mg of the hormone levonorgestrel (Liletta or Mirena) for EC.

What’s the bottom line?

Most birth control is safe if you have a rheumatic or musculoskeletal disease. If you have a negative test for antiphospholipid antibodies, don’t have lupus, are not at an increased risk of osteoporosis, and are not taking mycophenolate-containing medications there are no restrictions on birth control methods for you.

Written by Robin Watkins, CNM, WHNP-BC

Robin Watkins is the Director, Health Care at Power to Decide. Robin is a midwife and women’s health nurse practitioner focused on helping other providers learn how to offer high-quality sexual and reproductive health care. Robin provides clinical care at a community health center in Washington, DC. When she is not talking sex, placing IUDs, or asking One Key Question, you can find her riding her bike on the streets of DC or eating ice cream for dinner.

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