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Autoimmune Illness and Birth Control

Medically Reviewed by Nivin Todd, MD on June 08, 2022

Having an autoimmune disease during your childbearing years, such as lupus or multiple sclerosis (MS), increases your health risks if you get pregnant. You likely can still have a safe pregnancy with your health care provider’s guidance. It’s best to plan it, though. This means effective contraception is key in the meantime or if you don’t want to get pregnant at all.

Pregnancy Risks With Autoimmune Illness

Symptoms of some autoimmune illnesses, such as rheumatoid arthritis (RA) or MS, can sometimes seem to improve during pregnancy. But most don’t. Pregnancy also can affect different autoimmune diseases – and those who have them – in different ways. Some include:

  • If you have lupus, you’ll have higher chances of having preterm labor or fetal death than the general population. Prepregnancy counseling and monitoring throughout can help you have a safe pregnancy.
  • Antiphospholipid syndrome, a rare blood-clotting disorder, can cause stillbirth or miscarriage. It also can lead to preeclampsia – high blood pressure caused by pregnancy – and a smaller-than-average baby.
  • Systemic scleroderma can increase your chances of having preeclampsia, preterm labor, and kidney problems.
  • Sjogren’s syndrome is linked with a higher risk of miscarriage. Certain autoantibodies that can come with the condition also can cause heart problems for the baby.
  • Myasthenia gravis, which causes muscle weakness, can get more intense with pregnancy. Antibodies that come with it can cross the placenta, too.
  • If you have MS, you may be using disease-modifying therapies, which are linked with risks to the baby. Your health care team will likely want to flush them from your body before you get pregnant.
  • RA symptoms can improve during pregnancy, especially during the second and third trimesters. But if the disease has already harmed your lower spine and hip joints, delivery may be more difficult.

Easy Contraception Use Is Key

It doesn’t matter how effective a birth control method looks on paper – if you have a hard time using it, odds are you won’t, or you'll have trouble using it correctly. For example, if you have MS, you might have a hard time swallowing birth control pills or placing barrier methods or vaginal rings.

The most effective birth control methods for “real world” use is the one that’s simplest for you. With LARC (long-acting, reversible contraception) methods such as an intrauterine device (IUD) or an implant, for instance, once your doctor places it, you don’t have to do anything else to make it work.

Contraception Risks

It’s crucial to talk to your doctor about the right birth control for you. They’ll think about your autoimmune illness and how it affects you. For example, some with lupus can safely take hormonal contraceptives with estrogen. But for those who have a risk of blood clots, using estrogen can be harmful.

Other things your doctor will consider include how hormonal contraceptives could interact with meds you take for your condition. If you can’t take estrogen, the progestin-only pill or IUD might be a good option. If you have lupus and take warfarin, progestin can quell heavy bleeding during your period.

Your doctor also can run special tests to make sure the method you choose is safe. You might need to try a few different methods before hitting the “right one.”

Safe Doesn’t Always Mean It Works Better

Sometimes a contraceptive can be safe to use – like barrier methods – but not work as well as other types of birth control. For example, while condoms and diaphragms can keep sperm from reaching the egg and protect against STDs as well, they’re not as effective in preventing pregnancy as other methods.

Correcting Past Mindsets

Some former beliefs about contraceptives and autoimmune illnesses, such as fears about estrogen, have been studied further and modified. But dated info can lead people to not use effective contraception.

For example, a survey of 86 women with lupus showed 22% didn’t use birth control consistently. This included those who were taking meds that increased chances of birth defects. Meanwhile, more than half relied on less-reliable barrier methods.

LARC Methods Are the Most Effective

There are two types of LARC:

The IUD is a small plastic device shaped like a “T.” Your doctor inserts it into your uterus. It stays in place until you want to get pregnant. The hormonal IUD reaches the end of its effectiveness between 3 to 7 years. You can also get it removed for another reason. The hormonal IUD releases progestin, a form of the hormone progesterone. The copper IUD doesn’t have hormones. It lasts for up to 10 years.

The birth control implant is a matchstick-sized, flexible, plastic rod. Your doctor will insert it under the skin of your upper arm. It releases progestin and can be used for up to 3 years.

The CDC has called LARCs possibly the best contraception choice  for those who might face high-risk pregnancies. There are many reasons for this:

  • IUDs and birth control implants last a long time. They'll keep you from getting pregnant for at least several years.
  • They work better than any other contraceptive method. Fewer than 1 in 100 will get pregnant the first year of using LARC.
  • Over time, LARC is 20x more effective than other methods, including the pill, the patch, or the vaginal ring.
  • They can be removed at any time if you want to get pregnant or try a different method.
  • You can use an IUD safely if you take immunosuppressive meds.

LARCs can have side effects, such as spotting at first or headaches. Risks are rare, but they can happen. That’s why it’s key to discuss with your doctor the best choice for you and keep other options in mind.

Show Sources

SOURCES:

Cleveland Clinic: “High-Risk Pregnancy.”

NYU Langone Health: “Types of Autoimmune Diseases in Pregnancy.”

Immunological Investigations: A Journal of Molecular and Cellular Immunology: “Autoimmune Disease During Pregnancy and the Microchimerism Legacy of Pregnancy.”

Merck Manual Consumer Version: “Autoimmune Disorders During Pregnancy.”

Multiple Sclerosis: “Contraception for Women with Multiple Sclerosis: Guidance for Healthcare Providers.”

HSS: “Lupus and Contraception: Essentials for Patients.”

Lupus Foundation of America: “Using Birth Control When You Have Lupus.”

UpToDate: “Patient Education: Barrier and Pericoital Methods of Birth Control (Beyond the Basics).”

American College of Rheumatology: “Birth Control for People With Rheumatic Diseases.”

The American College of Obstetricians and Gynecologists: “Long-Acting Reversible Contraception (LARC): Intrauterine Device (IUD) and Implant,” “Progestin-Only Hormonal Birth Control: Pill and Injection.”

CDC: “Morbidity and Mortality Weekly Report: U.S. Medical Eligibility Criteria for Contraceptive Use, 2016.”

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