The Autoimmune Connection: Essential Information for Women on Diagnosis, Treatment, and Getting On With Your Life by Rita Baron-Faust, Jill Buyon
Authors: Rita Baron-Faust, Jill Buyon
Ads: Link
that afterward most women with RA not only go back to a fully active state but also usually get worse. So we’re talking about my choice of having another child or being able to walk, and move, and work. And to me the choice was very clear. That was the choice I was presented with—to put off childbearing until I had this disease under control. And by then, I was in my middle forties. We did try again and were not successful. And then I was 45 and I was trying in-vitro, and the drugs almost put me back in an active state. It was a real risk taking them, but we really wanted another child. So that’s part of the cost of this disease.
How RA Can Affect You Over Your Lifetime
As Kathleen Turner found, rheumatoid arthritis (and the drugs used to treat it) can profoundly affect a woman’s life during her childbearing years.
Menstruation and Fertility
Women with inflammatory arthritis, such as RA, often have reduced fertility (“reduced ovarian reserves”), 31 and studies find at least one-third may having trouble conceiving.
The medications you take to control your RA can also affect the menstrual cycle and your ability to become pregnant.
Recent studies show that higher doses of glucocorticoids can reduce the “pulses” of luteinizing hormone (LH) from the pituitary gland needed to trigger ovulation. Prednisone may also affect the function of the endometrium, where a fertilized egg is implanted. 32
NSAIDs like celecoxib may also interfere with ovulation, implantation, and formation of the placenta by dampening prostaglandins. 33
Cyclophosphamide may cause infertility, especially if taken for periods of greater than one year and if a woman is over age 35. Methotrexate is absolutely contraindicated in women trying to conceive. Contraception is advised for women taking this drug. Because of the potential for birth defects, some drugs may need a “washout” period before trying to conceive.
With Arava, contraception is required while taking the drug (for men who are taking the drug as well). If you want to become pregnant and have taken the drug within the past two years, you (and/or your partner) must undergo a specific drug elimination procedure. You’ll be given 8 grams of cholestyramine three times a day for 11 consecutive days, and then blood levels of Arava will be measured with two blood tests 14 days apart until they are below a specific level (0.02 milligrams per liter of blood).
“We stop drugs that are likely to cause trouble like methotrexate. How long the washout period should be can become a guess. For methotrexate, most people would say three to six months for a washout period,” remarks Dr. Pisetsky.
Women with RA are more likely to have had fertility treatments, but the effects of those drugs in women with RA have not been well studied. The highdoses of hormones needed to stimulate the production of multiple eggs by the ovary may make RA symptoms worse.
Pregnancy and Breastfeeding
As we mentioned before, your symptoms will likely improve during pregnancy but could recur within the first eight weeks after delivery. After six to eight months, you’ll return to whatever level of disease severity you had before you became pregnant.
The major issue when you contemplate pregnancy is the effect of medications. The U.S. Food and Drug Administration (FDA) classifies drugs according to whether studies or case reports show risks to the fetus, such as birth defects, and whether those risks outweigh the benefits to the mother. Some drugs demonstrate no risks, while others cannot be used during pregnancy because they’ve been shown to cause harm. For many newer drugs, such as biological agents, animal studies have not shown harm to a fetus, but there are no data at all or no well-controlled studies of pregnant women—or animal studies have shown adverse effects, but well-done human studies have not.
Then there are medications that may have demonstrated adverse effects in animal studies, but there are no
How RA Can Affect You Over Your Lifetime
As Kathleen Turner found, rheumatoid arthritis (and the drugs used to treat it) can profoundly affect a woman’s life during her childbearing years.
Menstruation and Fertility
Women with inflammatory arthritis, such as RA, often have reduced fertility (“reduced ovarian reserves”), 31 and studies find at least one-third may having trouble conceiving.
The medications you take to control your RA can also affect the menstrual cycle and your ability to become pregnant.
Recent studies show that higher doses of glucocorticoids can reduce the “pulses” of luteinizing hormone (LH) from the pituitary gland needed to trigger ovulation. Prednisone may also affect the function of the endometrium, where a fertilized egg is implanted. 32
NSAIDs like celecoxib may also interfere with ovulation, implantation, and formation of the placenta by dampening prostaglandins. 33
Cyclophosphamide may cause infertility, especially if taken for periods of greater than one year and if a woman is over age 35. Methotrexate is absolutely contraindicated in women trying to conceive. Contraception is advised for women taking this drug. Because of the potential for birth defects, some drugs may need a “washout” period before trying to conceive.
With Arava, contraception is required while taking the drug (for men who are taking the drug as well). If you want to become pregnant and have taken the drug within the past two years, you (and/or your partner) must undergo a specific drug elimination procedure. You’ll be given 8 grams of cholestyramine three times a day for 11 consecutive days, and then blood levels of Arava will be measured with two blood tests 14 days apart until they are below a specific level (0.02 milligrams per liter of blood).
“We stop drugs that are likely to cause trouble like methotrexate. How long the washout period should be can become a guess. For methotrexate, most people would say three to six months for a washout period,” remarks Dr. Pisetsky.
Women with RA are more likely to have had fertility treatments, but the effects of those drugs in women with RA have not been well studied. The highdoses of hormones needed to stimulate the production of multiple eggs by the ovary may make RA symptoms worse.
Pregnancy and Breastfeeding
As we mentioned before, your symptoms will likely improve during pregnancy but could recur within the first eight weeks after delivery. After six to eight months, you’ll return to whatever level of disease severity you had before you became pregnant.
The major issue when you contemplate pregnancy is the effect of medications. The U.S. Food and Drug Administration (FDA) classifies drugs according to whether studies or case reports show risks to the fetus, such as birth defects, and whether those risks outweigh the benefits to the mother. Some drugs demonstrate no risks, while others cannot be used during pregnancy because they’ve been shown to cause harm. For many newer drugs, such as biological agents, animal studies have not shown harm to a fetus, but there are no data at all or no well-controlled studies of pregnant women—or animal studies have shown adverse effects, but well-done human studies have not.
Then there are medications that may have demonstrated adverse effects in animal studies, but there are no
Similar Books
