Gender differences in autoimmune disease.

https://fhop.ucsf.edu/sites/fhop.ucsf.edu/files/custom_download/CHOICE%20project%20to%20promote%20LARC.pdf

The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60609-6.pdf

Contraception and health

CDC created U.S. Medical Eligibility Criteria for Contraceptive Use 2010 from guidance developed by the World Health Organization (WHO) and finalized the recommendations after consultation with a group of health professionals who met in Atlanta Georgia during February 2009. This guidance comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions. The majority of the U.S. guidance does not differ from the WHO guidance and covers >60 characteristics or medical conditions. However some WHO recommendations were modified for use in the United States including recommendations about contraceptive use for women with venous thromboembolism valvular heart disease ovarian cancer and uterine fibroids and for postpartum and breastfeeding women. Recommendations were added to the U.S. guidance for women with rheumatoid arthritis history of bariatric surgery peripartum cardiomyopathy endometrial hyperplasia inflammatory bowel disease and solid organ transplantation. The recommendations in this document are intended to assist health-care providers when they counsel women men and couples about contraceptive method choice. Although these recommendations are meant to serve as a source of clinical guidance health-care providers should always consider the individual clinical circumstances of each person seeking family planning services.

U S. Medical Eligibility Criteria for Contraceptive Use 2010: adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use 4th edition.

Objective To develop an evidence-based guideline on contraception, assisted reproductive technologies (ART), fertility preservation with gonadotoxic therapy, use of menopausal hormone replacement therapy (HRT), pregnancy assessment and management, and medication use in patients with rheumatic and musculoskeletal disease (RMD). Methods We conducted a systematic review of evidence relating to contraception, ART, fertility preservation, HRT, pregnancy and lactation, and medication use in RMD populations, using Grading of Recommendations Assessment, Development and Evaluation methodology to rate the quality of evidence and a group consensus process to determine final recommendations and grade their strength (conditional or strong). Good practice statements were agreed upon when indirect evidence was sufficiently compelling that a formal vote was unnecessary. Results This American College of Rheumatology guideline provides 12 ungraded good practice statements and 131 graded recommendations for reproductive health care in RMD patients. These recommendations are intended to guide care for all patients with RMD, except where indicated as being specific for patients with systemic lupus erythematosus, those positive for antiphospholipid antibody, and/or those positive for anti-Ro/SSA and/or anti-La/SSB antibodies. Recommendations and good practice statements support several guiding principles: use of safe and effective contraception to prevent unplanned pregnancy, pre-pregnancy counseling to encourage conception during periods of disease quiescence and while receiving pregnancy-compatible medications, and ongoing physician-patient discussion with obstetrics/gynecology collaboration for all reproductive health issues, given the overall low level of available evidence that relates specifically to RMD. Conclusion This guideline provides evidence-based recommendations developed and reviewed by panels of experts and RMD patients. Many recommendations are conditional, reflecting a lack of data or low-level data. We intend that this guideline be used to inform a shared decision-making process between patients and their physicians on issues related to reproductive health that incorporates patients' values, preferences, and comorbidities.

/pdf/2020-american-college-of-rheumatology-guideline-for-the-4uocu8bavx.pdf

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus

BACKGROUND:: HIV-infected women need access to safe contraception. We hypothesized that women using depomedroxyprogesterone acetate (DMPA) contraception would have faster HIV disease progression than women using oral contraceptive pills (OCPs) and nonhormonal methods. METHODS:: In a previously reported trial we randomized 599 HIV-infected women to the intrauterine device (IUD) or hormonal contraception. Women randomized to hormonal contraception chose between OCPs and DMPA. This analysis investigates the relationship between exposure to hormonal contraception and HIV disease progression [defined as death becoming eligible for antiretroviral therapy (ART) or both]. RESULTS:: Of the 595 women not on ART at the time of randomization 302 were allocated to hormonal contraception of whom 190 (63%) initiated DMPA and 112 (37%) initiated OCPs. Women starting IUD OCPs or DMPA were similar at baseline. Compared with women using the IUD the adjusted hazard of death was not significantly increased among women using OCPs [1.24; 95% confidence interval (CI) 0.42-3.63] or DMPA (1.83; 95% CI 0.82-4.08). However women using OCPs (adjusted hazard ratio (AHR) 1.69; 95% CI 1.09-2.64) or DMPA (AHR 1.56; 95% CI 1.08-2.26) trended toward an increased likelihood of becoming eligible for ART. Women exposed to OCPs (AHR 1.67; 95% CI 1.10-2.51) and DMPA (AHR 1.62; 95% CI 1.16-2.28) also had an increased hazard of meeting our composite disease progression outcome (death or becoming ART eligible) than women using the IUD. CONCLUSION:: In this secondary analysis exposure to OCPs or DMPA was associated with HIV disease progression among women not yet on ART. This finding if confirmed elsewhere would have global implications and requires urgent further investigation.

Inutu Matongo

Papers

A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus

HIV disease progression by hormonal contraceptive method: secondary analysis of a randomized trial.