Best (and Worst) Birth Control for People With Arthritis 

By Linda Rath | Jan. 11, 2022

For women with a rheumatic condition, almost any type of birth control is better than none. And as long as you don’t have lupus, there are plenty of options, though some do a better job of preventing pregnancy than others. That’s a critical consideration for people with a rheumatic disease because an unintended pregnancy can lead to poor outcomes for both mom and baby.

Options If You Don’t Have Lupus

• Barrier methods, such as condoms, diaphragms and cervical caps. These nonhormonal contraceptives physically block sperm from reaching the uterus during sex and have few if any side effects. Women allergic to latex can look for alternatives like polyurethane condoms and silicone diaphragms. Barrier methods are moderately effective, preventing pregnancy in 76 to 88 of every 100 women who use them. The cervical cap is only 68% effective for those who previously have given birth vaginally.
• Hormonal birth control, such as the pill, patch or vaginal ring. These contain progestin (a synthetic form of the hormone progesterone) and estrogen. The amount of estrogen is lower than in the past, reducing but not eliminating the chance of health problems and side effects for those taking them. All hormonal contraceptives increase the risk of blood clots and high blood pressure and can cause weight gain, headaches and mood swings. Hormonal birth control is about 91% effective, meaning that for every 100 women who use it, nine will have an unintended pregnancy.
• Long-acting reversible contraceptives such as intrauterine devices (IUDs) and progestin implants. These are the best options for women with rheumatic conditions. They last for several years, so there’s no need to remember to take a pill every day or to use a condom. They’re also about 99% effective, resulting in one unplanned pregnancy for every 100 women.
• Sterilization, including vasectomies for men and tubal ligation or salpingectomy (removal of fallopian tubes) for women. These procedures are meant to be permanent but can sometimes be reversed. They are nearly 100% effective at preventing pregnancy.

Other Factors to Consider

• Convenience. Whether you can buy the birth control over the counter, like condoms, or do you need a prescription or fitting by a provider.
• Cost. Under the Affordable Care Act (ACA), most insurance plans, including policies purchased through state exchanges, cover FDA-approved prescription birth control for women. Exceptions include short-term health plans and plans from employers that have religious or moral objections to birth control. Medicaid also covers birth control but not necessarily every FDA-approved method. Check with your state’s Medicaid office to find out what’s available where you live. Over-the-counter female birth control, like spermicide, is free with a prescription.
• Your own and your partner’s preferences. Be sure you both understand the health consequences of an unintended pregnancy, including potential worsening of your arthritis and related health problems.
• Potential side effects, including potentially serious ones affecting both mom and fetus.
• Drug interactions. The disease-modifying antirheumatic drug (DMARD) mycophenolate mofetil (CellCept) can reduce estrogen and progesterone levels and make birth control pills less effective. If you take this drug, use an IUD or two other forms of birth control, like the pill and a condom. And if you take methotrexate, a common arthritis drug, you should stop it before you become pregnant and talk to your doctor about it.

Options With Lupus

You may be able to use some forms of birth control that contain estrogen if your disease activity is low and you test negative for antiphospholipid (aPL) antibodies. If you’re aPL-positive, combined estrogen-progestin birth control isn’t for you because of an increased risk of blood clots – already a danger for anyone with lupus. Women with lupus should avoid the estrogen patch, which has higher consistent levels of estrogen than birth control pills and may make active lupus worse.

Women with lupus have four estrogen-free choices: a copper or progestin-containing IUD, a subdermal progestin implant or a progestin-only pill (mini-pill). IUDs and implants require a one-time placement, last for several years and are effective methods of birth control, with pregnancy occurring in fewer than one out of 100 women in the first year of use. IUDs have been linked to a serious infection called pelvic inflammatory disease, but current research suggests the risk is less than 1%.

• IUDs. There are two types of IUDs, hormonal and nonhormonal.
  • A hormonal IUD is a T-shaped piece of plastic that’s placed in the uterus, where it releases progestin. It prevents pregnancy by interfering with ovulation and creating thicker cervical mucus that blocks sperm. Depending on the brand, a hormonal IUD lasts from three to five years. It can also prevent periods, a big plus for many women.
  • A copper (nonhormonal) IUD releases copper ions, which are toxic to sperm. It can stay in place up to a decade. Copper IUDs are your best bet if you want to avoid hormones altogether, but they can cause heavy periods, which may be a deal-breaker for some.
• Subdermal (under-the-skin) implant. A provider places this just under the skin in the upper arm. It releases a type of progestin called etonogestrel that works much like the progestin in hormonal IUDs. One drawback of the implant is that it can cause unexpected bleeding and spotting.
• Progestin-only pill. Sometimes called the “mini pill” because it doesn’t contain estrogen, it also has less progestin than a regular birth control pill. It has a higher failure rate than other estrogen-free options, with up to 13 of 100 women becoming pregnant in the first year they use it.  Another drawback: It must be taken at the same time every day to be effective.

Birth Control After Sex

All types of emergency contraception are safe for women with rheumatic conditions, including:

• Levonorgestrel-containing “morning-after” pills like Plan B, Take Action and My Choice. Generics usually cost less and are just as effective as name-brand pills. They are available at local pharmacies, family planning clinics and from Planned Parenthood without a prescription or ID. They work best when taken within three days of unprotected sex for those who weigh less than 155 pounds.
• ella. This morning-after pill is more effective than Plan B, but requires an online or provider prescription. ella is 85% effective at preventing pregnancy if taken no more than five days after unprotected sex, but sooner is better. It may not work as well for those who weigh more than 195 pounds.
• IUDs, including Paragard, Mirena and Liletta. An IUD is the most effective type of emergency contraception as well as a great form of long-term birth control. It lowers the chance of pregnancy by 99.9% provided it’s placed within five days of unprotected sex. Left in place, it will continue protection for seven to 12 years, depending on the type. Another plus: An IUD is effective for women of any weight.