Dr. Clowse and colleagues have developed a program called HOP-STEP, which stands for Healthy Outcomes in Pregnancy with SLE Through Education of Providers. The program has three steps: 1) ask 2) discuss and 3) share.
In the Ask step, providers should inquire what type of contraception a patient is using and what planning the patient is or is not doing with regard to pregnancy. A simple question to ask is, “Do you want to be pregnant in the next 12 months?”
The Discuss step should be a personalized, supportive conversation replete with accurate information to guide decisions. Dr. Clowse and colleagues have developed discussion guides for this conversation that can be printed and used with patients. Easy-to-use HOP-STEP guides on birth control in lupus and other rheumatic diseases exist. Rheumatologists can use these guides to assist in complex discussions for which they may feel inadequately prepared or uncomfortable.
Share: The written guides are also helpful for patients and family members because they can be brought home from the clinic and read more than once. Much of this information can then be made available to other providers. Patients can be asked to take these guides to their OB/GYN to make sure all specialists are on the same page.
Fast Facts
Dr. Clowse shared several pearls with regard to reproductive counseling. For example, progesterone-only birth control pills are very safe, but they are less effective than other forms of contraception that don’t require the frequent oral administration of a medication.
It is important to encourage patients to use more than one form of birth control at a time, such as an intrauterine device (IUD) as well as condoms.
Emergency contraception, such as Plan B, is progesterone only and, thus, is safe; no prescription is needed, and it does not cause an abortion if the patient is already pregnant.
Patients may answer the question “Is my lupus well controlled?” differently than their clinician might, given what control of lupus means to them. To a rheumatologist, disease control often has to do with measuring inflammatory markers, looking for proteinuria or signs of organ involvement, and ensuring that there is no ongoing need for corticosteroids. However, for a patient, symptoms such as fatigue and myalgias that are common in lupus may still be present and, therefore, may indicate to the patient that their disease is active even when it would be safe for them to become pregnant.
