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Patients Aren't Telling us About Unprotected Sex!

June 10 2015 5:16 PM ET via RheumReports RheumReports

A good session tonight at 2015 EULAR was on contraception in patients with rheumatic diseases who are of childbearing age, a topic that might be neglected by rheumatologists but that is quite relevant for many reasons. Many of our patients see their rheumatologist more often than their primary care doctor, putting us in the position of needing to know at least the basics.

Research shows that contraception is underutilized in women with rheumatic diseases. Up to 23% report having unprotected sex regularly. Reasons behind this include misconceptions about fertility, lack of understanding about teratogenicity of medications, fear of how hormones could impact their disease, and simple reluctance to take any more medications.

Many forms of contraception are available to choose from. Clinical take-aways from this session included:

  • 2 RCTs of estrogen-based oral contraception in lupus suggest no risk of flare or thrombosis BUT the studies excluded patients with active disease, antiphospholipid antibody and those with previous thrombosis.

  • Meta-analysis of progestin-containing pills, including the mini-pill, showed no increased risk of thrombosis.

  • A safe option to consider is long-acting reversible contraception in the form of an intrauterine device. It has an added bonus of requiring a MD to insert, providing an opportunity for cervical cancer screening that our patients may otherwise not have.

We know that unplanned pregnancy in situations where our patients' disease is not optimally controlled or when they are taking teratogenic medications can have serious negative consequences. Contraception is yet another conversation worth having with our patients!


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About the Author

Dr. Shelly Dunne
Dr. Shelly Dunne

Dr. Shelley Dunne is a graduate of Memorial University of Newfoundland School of Medicine. She completed her training in Internal Medicine and a fellowship in Rheumatology at the University of Toronto. She has been in private practice since 1998 and is currently a consulting rheumatologist at the Toronto East General Hospital.

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