Contraception for adolescents with chronic rheumatic diseases

Abstract

Contraception is an important issue and should be a matter of concern in every medical visit of adolescent and young patients with chronic rheumatic diseases. This narrative review discusses contraception methods in adolescents with juvenile systemic lupus erythematosus (JSLE), antiphospholipid syndrome (APS), juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM). Barrier methods are safe and their use should be encouraged for all adolescents with chronic rheumatic diseases. Combined oral contraceptives (COC) are strictly prohibited for JSLE and APS patients with positive antiphospholipid antibodies. Reversible long-acting contraception can be encouraged and offered routinely to the JSLE adolescent patient and other rheumatic diseases. Progestin-only pills are safe in the majority of rheumatic diseases, although the main concern related to its use by adolescents is poor adherence due to menstrual irregularity. Depot medroxyprogesterone acetate injections every three months is a highly effective contraception strategy, although its long-term use is associated with decreased bone mineral density. COC or other combined hormonal contraceptive may be options for JIA and JDM patients. Oral levonorgestrel should be considered as an emergency contraception method for all adolescents with chronic rheumatic diseases, including patients with contraindication to COC.

Sexual function in female juvenile idiopathic arthritis patients

“…Our study reinforces that JIA adolescents should be systematically screened for sexual function and contraception use frequently, thus reinforcing prevention on sexually transmitted infections and pregnancy [24].…”

“…The median of DAS28 was 2 (1.05-4.14) and 38% of JIA patients has DAS28 > 2.3. (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) vs. 17 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) years, p = 0.158] were similar in JIA patients and healthy controls. No differences were evidenced in frequencies of dysmenorrhea (62% vs. 60%, p = 0.859), menorrhagia (24% vs. 20%, p = 1.000) and premenstrual syndromes (67% vs. 75%, p = 0.538) in both groups (Table 1).…”

Epidemiology and management practices for childhood-onset systemic lupus erythematosus patients: a survey in Latin America

“…Regarding reproductive health, condom was the most often prescribed contraceptive method despite the high rate of nonadherence reported by LAPR. The recommendation of supervised injection or implant progesterone contraceptive in day hospital [34,35] combined with condom should be reinforced to avoid the high rate of pregnancies reported by LAPR.…”

Managing Antiphospholipid Syndrome in Children and Adolescents: Current and Future Prospects

“…Contraceptive counseling should be included in all medical visits for adolescents and young patients with APS, since APS in pregnancy has high maternal and fetal morbidities [ 9 , 93 , 94 ]. Estrogen-containing oral contraceptives increase the risk of thrombosis and are strictly prohibited for adolescents and adults with APS [ 9 ].…”

“…Compared with adults, children and adolescents generally have fewer concomitant prothrombotic risk factors such as arterial hypertension, smoking, dyslipidemia, atherosclerosis, and use of estrogen-containing oral contraceptives [ 9 ]. In addition, non-thrombotic clinical manifestations are frequently reported in pediatric APS and may be present even before the vascular thrombotic events [ 2 ].…”