Contraception for adolescents with chronic rheumatic diseases

Author(s)

Benito Lourenço ^[1] ; Katia T. Kozu ^[2] ; Gabriela N. Leal ^[3] ; Marco F. Silva ^[4] ; Elisabeth G.C. Fernandes ^[5] ; Camila M.P. França ^[6] ; Fernando H.C. Souza ^[7] ; Clovis A. Silva

Affiliation

^[1] Universidade de São Paulo. Faculdade de Medicina. Unidade do Adolescente - Brasil

^[2] Universidade de São Paulo. Faculdade de Medicina. Unidade de Reumatologia Pediátrica - Brasil

^[3] Universidade de São Paulo. Faculdade de Medicina. Unidade de Radiologia - Brasil

^[4] Universidade de São Paulo. Faculdade de Medicina. Unidade de Reumatologia Pediátrica - Brasil

^[5] Universidade de São Paulo. Faculdade de Medicina. Unidade de Reumatologia Pediátrica - Brasil

^[6] Universidade de São Paulo. Faculdade de Medicina. Unidade de Reumatologia Pediátrica - Brasil

^[7] Universidade de São Paulo. Faculdade de Medicina. Divisão de Reumatologia - Brasil

• Document type: Journal article
• Source: REVISTA BRASILEIRA DE REUMATOLOGIA; v. 57, n. 1, p. 73-81, 2017-02-00.

Abstract

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. (AU)

• FAPESP's process: 11/12471-2 - Ovarian reserve, antibody anti-corpus luteum and lower genital tract infection in adult women with systemic lupus erythematosus, Behçet's syndrome and Takayasu's arteritis
• Grantee: Clovis Artur Almeida da Silva
• Support Opportunities: Regular Research Grants
• FAPESP's process: 14/14806-0 - Evaluation of ovarian reserve, antibody anti-corpus luteum, cervicovaginal cytology, lower genital tract infections, metabolomics and ovulatory dysfunction in women with juvenile idiopathic arthritis
• Grantee: Clovis Artur Almeida da Silva
• Support Opportunities: Regular Research Grants