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Contraception in Women with Rheumatologic Disease and After Organ Transplantation

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Female and Male Contraception

Part of the book series: Trends in Andrology and Sexual Medicine ((TASM))

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Abstract

The management of reproductive health issues in patients with rheumatic diseases differs from that in healthy persons. Clinicians caring for these patients must often discuss with and counsel their patients about contraception and pregnancy planning, and they must collaborate with other specialists in the fields of rheumatology. Pregnancy in women with rheumatic disease may lead to serious maternal or fetal adverse outcomes; accordingly, contraception, tailored to the individual patient with emphasis on safety and efficacy, should be encouraged.

Women of fertile ages with rheumatologic disease often underutilize effective contraception (Schwarz and Manzi. Arthritis Rheum 59:863–6, 2008; Yazdany et al. Arthritis Care Res (Hoboken) 63:358–65, 2011; Østensen et al. J Rheumatol 34:1266–9, 2007; Mendel et al. Rheumatology (Oxford) 58(7):1259–1267, 2019). Not only an unwanted pregnancy by itself constitute a problem for the woman. There is also a great need for effective contraception in women with rheumatic disease in order to avoid disease related consequenses of an unplanned pregnancy, which includes worsening disease activity that may threaten maternal organ function or life, adverse pregnancy outcomes (pregnancy loss, severe prematurity, and growth restriction), and teratogenesis (Sammaritano et al. Arthritis Rheumatol 72(4):529–556, 2020). A close collaboration between gynecologists and rheumatologists seems to be crucial in order to offer optimal contraception and optimize the prerequisites for a realistic and acceptable reproductive life plan (Sammaritano et al. Arthritis Rheumatol 72(4):529–556, 2020; Östensen. Curr Opin Rheumatol 26(3):302–7, 2014).

Most female transplant patients are sexually active, and ovulation and menstruation usually resume within months after transplant surgery. Coordination of sexual and reproductive health care between other specialists and staff dealing with contraceptive counselling and/or prescription may minimize unintended pregnancy and optimize the safety of intended pregnancy among transplant patients.

This chapter is divided into two parts: the first dealing with rheumatic diseases and the second part focusing on contraception after organ transplantation.

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References

  1. Schwarz EB, Manzi S. Risk of unintended pregnancy among women with systemic lupus erythematosus. Arthritis Rheum. 2008;863–6(12):59.

    Google Scholar 

  2. Yazdany J, Trupin L, Kaiser R, Schmajuk G, Gillis JZ, Chakravarty E, Schwarz EB. Contraceptive counseling and use among women with systemic lupus erythematosus: a gap in health care quality? Arthritis Care Res (Hoboken). 2011;63:358–65.

    Article  Google Scholar 

  3. Østensen M, von Esebeck M, Villiger PM. Therapy with immunosuppressive drugs and biological agents and use of contraception in patients with rheumatic disease. J Rheumatol. 2007;34:1266–9.

    PubMed  Google Scholar 

  4. Mendel A, Bernatsky S, Pineau CA, St-Pierre Y, Hanly JG, et al. Use of combined hormonal contraceptives among women with systemic lupus erythematosus with and without medical contraindications to oestrogen. Rheumatology (Oxford). 2019;58(7):1259–67.

    Article  CAS  Google Scholar 

  5. Sammaritano LR, Bermas BL, Chakravarty EE, Chambers C, Clowse MEB, et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol. 2020;72(4):529–56.

    Article  Google Scholar 

  6. Östensen M. Contraception and pregnancy counselling in rheumatoid arthritis. Curr Opin Rheumatol. 2014;26(3):302–7.

    Article  Google Scholar 

  7. Eriksson JK, Neovius M, Ernestam S, Lindblad S, Simard JF, Askling J. Incidence of rheumatoid arthritis in Sweden: a nationwide population-based assessment of incidence, its determinants, and treatment penetration. Arthritis Care Res (Hoboken). 2013;65(6):870–8.

    Article  Google Scholar 

  8. Farr SL, Folger SG, Paulen ME, Curtis KM. safety of contraceptive methods for women with rheumatoid arthritis: a systematic review. Contraception. 2010;82:64–71.

    Article  Google Scholar 

  9. Mansour R, Azrielant S, Watad A, Tiosano S, Yavne Y, et al. Venous thromboembolism events among RA patients. Mediterr J Rheumatol. 2019;1:38–43.

    Article  Google Scholar 

  10. Ogdie A, McGill K, Shin DB, Takeshita J, Jon Love T, et al. Risk of venous thromboembolism in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a general population-based cohort study. Eur Heart J. 2018;39:3608–14.

    Article  Google Scholar 

  11. Ungprasert P, Sirvaki N, Spanuchart I, Thongprayoon C, Knight EL. Risk of venous thromboembolism in patients with rheumatoid arthritis: a systematic review and meta-analysis. Clin Rheumatol. 2014;33:297–304.

    Article  Google Scholar 

  12. Holmqvist ME, Neovius M, Eriksson J, Mantel Ä, Wållberg-Jonsson S, et al. Risk of venous thromboembolism in patients with rheumatoid arthritis and association with disease duration and hospitalization. JAMA. 2012;308:1350–6.

    Article  CAS  Google Scholar 

  13. Ungprasert P, Sirvali N, Kittanmongkolchai W. Risk of venous thromboembolism in patients with Sjögren’s syndrome: a systematic review and meta-analysis. Clin Exp Rheumatol. 2015;33:746–50.

    PubMed  Google Scholar 

  14. Vosse D, de Vlam K. Osteoporosis in rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol. 2009;27:S62–7.

    CAS  PubMed  Google Scholar 

  15. Gupta A, Pipe SG, Towheed T, Anastassiades T. Is rheumatoid arthritis a risk factor for fractures: a systematic review of observational studies. Curr Rheumatol Rev. 2020;16:29–37.

    Article  Google Scholar 

  16. Blavnsfeldt AG, de Thurah A, Thomsen MD, Tarp S, Langdahl B, Hauge EM. The effect of glucocorticoids on bone mineral density in patients with rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials. Bone. 2018;114:172–80.

    Article  CAS  Google Scholar 

  17. Committee on Gynecologic Practice Long-Acting Reversible Contraception Working Group. Committee opinion no. 642: increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy. Obstet Gynecol. 2015;126:e44–8.

    Article  Google Scholar 

  18. Clark M, Sowers M, Levy B, Nichols S. Bone mineral density loss and recovery during 48 months in first- time users of depot medroxyprogesterone acetate. Fertil Steril. 2006;86:1466–74.

    Article  CAS  Google Scholar 

  19. Virkus RA, Løkkegaard EC, Bergholt T, Mogensen U, Langhoff-Roos J, Lidegaard Ø. Venous thromboembolism in pregnant and puerperal women in Denmark 1995–2005. A national cohort study. Thromb Haemost. 2011;106(2):304–9.

    CAS  PubMed  Google Scholar 

  20. Jungers P, Dougados M, Pelissier L, Kuttenn F, Tron F, et al. Influence of oral contraceptive therapy on the activity of systemic lupus erythematosus. Arthritis Rheum. 1982;25:618.

    Article  CAS  Google Scholar 

  21. Sánchez-Guerrero J, Uribe AG, Jiménez-Santana L, Mestanza- Peralta M, Lara-Reyes P, Seuc AH, et al. A trial of contraceptive methods in women with systemic lupus erythematosus. N Engl J Med. 2005;353:2539–49.

    Article  Google Scholar 

  22. Petri M, Kim MY, Kalunian KC, Grossman J, Hahn BH, Sammaritano LR, et al. Combined oral contraceptives in women with systemic lupus erythematosus. N Engl J Med. 2005;353:2550–8.

    Article  CAS  Google Scholar 

  23. World Health Organization. Medical eligibility criteria for contraceptive use. 5th ed; 2015. https://apps.who.int/iris/bitstream/handle/10665/181468/9789241549158_eng.pdf?sequence=9

    Google Scholar 

  24. Guazzelli CA, Torloni MR, Sanches TF, et al. Contraceptive counseling and use among 197 female kidney transplant recipients. Transplantation. 2008;86:669–72.

    Article  Google Scholar 

  25. Chittka D, Hutchinson JA. Pregnancy after renal transplantation. Transplantation. 2017;101:675–8.

    Article  Google Scholar 

  26. Jabiry-Zieniewicz Z, Bobrowska K, Kaminski P, et al. Low-dose hormonal contraception after liver transplantation. Transplant Proc. 2007;39:1530–2.

    Article  CAS  Google Scholar 

  27. French VA, Davis JS, Sayles HS, et al. Contraception and fertility awareness among women with solid organ transplants. Obstet Gynecol. 2013;122:809–14.

    Article  Google Scholar 

  28. Brown DP, Chapman JR. Care of transplant recipients in primary practice. Transplantation. 2016;100:474–6.

    Article  Google Scholar 

  29. Pietrzak B, Bobrowska K, Jabiry-Zieniewicz Z, et al. Oral and transdermal hormonal contraception in women after kidney transplantation. Transplant Proc. 2007;39:2759–62.

    Article  CAS  Google Scholar 

  30. Paternoster DM, Riboni F, Bertolino M, et al. The contraceptive vaginal ring in women with renal and liver transplantation: analysis of preliminary results. Transplant Proc. 2010;42:1162–16.

    Article  CAS  Google Scholar 

  31. Ramhendar T, Byrne P. Use of the levonorgestrel-releasing intrauterine system in renal transplant recipients: a retrospective case review. Contraception. 2012;86:288–9.

    Article  CAS  Google Scholar 

  32. Huguelet PS, Sheehan C, Spitzer RF, et al. Use of the levonorgestrel 52 mg intrauterine system in adolescent and young adult solid organ transplant recipients: a case series. Contraception. 2017;95:378–81.

    Article  CAS  Google Scholar 

  33. Stringer EM, Kaseba C, Levy J, et al. A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus. Am J Obstet Gynecol. 2007;197:144.e1.

    Article  Google Scholar 

  34. Wu YY, Tang L, Leukemia WMH. Risk of venous thromboembolism: a meta-analysis and systematic review of 144 studies comprising 162,126 patients. Sci Rep. 2017;7(1):1167.

    Article  Google Scholar 

  35. Murphy J, McKenna M, Abdelazim S, et al. A practical guide to gynecologic and reproductive health in women undergoing hematopoietic stem cell transplant. Biol Blood Marrow Transplant. 2019;25:e331–43.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Biomedical and Clinical Sciences, Linköping University, Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Linköping University and Örebro University, Örebro, Sweden

    Jan Brynhildsen

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  1. Jan Brynhildsen
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Correspondence to Jan Brynhildsen .

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Editors and Affiliations

  1. Department of Medical and Surgical Science, University of Bologna, Clinic of Gynecology and Physiopathology of Reproduction, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    Maria Cristina Meriggiola

  2. Department of Women’s and Children’s Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden

    Kristina Gemzell-Danielsson

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Brynhildsen, J. (2021). Contraception in Women with Rheumatologic Disease and After Organ Transplantation. In: Meriggiola, M.C., Gemzell-Danielsson, K. (eds) Female and Male Contraception. Trends in Andrology and Sexual Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-70932-7_19

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  • DOI: https://doi.org/10.1007/978-3-030-70932-7_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-70931-0

  • Online ISBN: 978-3-030-70932-7

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