Finding prince charming can be a daunting task. When you finally find the one, true love, you want to start a family. It may not be so easy because there is this big shadow over your head called lupus.
Now, let me tell you some good news. Women with lupus can have children. There are certain steps that you would have to take prior to conception. It will be so worth it because you will have a healthy pregnancy and be able to take care of your future baby.
Have a look at my video where I interview a rheumatologist who specializes in pregnancies with lupus. This is part one of three in the Pregnancy and lupus series. We are having a closer look at the preparation for pregnancy.
Can lupus cause infertility in women? Although it may be difficult for a woman with SLE to become pregnant during a severe flare, women who have lupus have normal fertility rates.
“Women should receive counselling about fertility
If you wish to have a baby, either now or in the future, you should discuss general and disease-related risk factors with your doctor. Your lupus (especially lupus nephritis), your age, the drugs you take for your lupus, certain lifestyle exposures (such as tobacco use or alcohol consumption) may affect your ability to get pregnant. There may be lifestyle changes you can make to improve your fertility, such as limiting how much alcohol you drink, or stopping smoking.”
“Women with lupus should be counselled about the use of effective contraception
Your doctor should talk to you about your contraceptive options, including the pill, a coil, or an implant. Using contraceptives is especially important to prevent unwanted pregnancies when your disease is very active or when you are taking drugs that could be dangerous for a fetus. A combined pill may not be suitable if you have APS, or if your doctor thinks you are at high risk of developing blood clots. In such cases, the progesterone-only pill and a coil may be suitable options.”
The most effective oral contraceptives are those that contain a combination of the female hormones estrogen and progestin. In addition to helping to prevent pregnancy, they can also lower the risks of getting certain gynecological cancers, including uterine, enometrial and ovarian cancers. However, they can potentially cause blood clots, worsen migraines, worsen liver disease or increase the risk of developing breast cancer. Studies show that the „newer“ OCPs that contain lower amounts of estrogen are generally safe in most women who have well-controlled lupus without increasing the risk for lupus flare.
However, one never knows with our disease. Have a look at the list below when oral contraceptives are contraindicated.
Women who have lupus who should not take oral contraceptive pills:
Have active moderate to severe lupus
Test positive for antiphospholipid antibodies
Have had blood clots in the past
Have had a stroke before
Have poorly controlled hypertension
Have atrial fibrillation
Have had coronary artery disease or a heart attack before
Experience migraine headaches
Have Raynaud’s Phenomenon (although this is not for certain)
Have nephrotic syndrome (a complication of lupus nephritis that increases the risk of getting blood clots)
Have had breast cancer in the past
Have very high cholesterol (increases the chance of blood clots)
Have cirrhosis of the liver or liver cancer (to include hepatic adenoma)
In 2017 the European Alliance of Associations for Rheumatology (EULAR) introduced EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. These 12 recommendations move away from undue caution against pregnancy for women with lupus. On the contrary, health professionals are encouraged to open this topic with their patients provided that the individual risks for each one of them are discussed. The recommendations were developed by a multidisciplinary team of medical specialties, other healthcare providers and patient representatives. They are based on scientific evidence or expert opinions of the members of task force themselves. For the next 12 days, I will tell you more about each recommendation. Please share these posts so that women with lupus and/or APS know about them.
“Women should receive counselling and advice before they decide to have a baby
Very severe or flaring lupus, or having APS can have very serious consequences for a pregnant woman and her baby. This should be discussed before a woman decides to have a baby. Each woman’s risks, such as her type of lupus and her individual treatment regime, should be assessed to help develop the best strategy for a safe pregnancy.”