Design and created by Guideline Central in participation with the American College of Rheumatology.
American College of Rheumatology
Publication Date: Feb 23, 2020
Page Last Updated: May 5, 2026
Stable disease with assisted reproductive technology:
| a Recommendation numbers, shown in brackets, allow for cross-referencing with supplementary appendices. For more detailed/complete recommendations, see text or Supplementary Appendix 7 (on the ACR website at https://www.rheumatology.org/Practice-Quality/Clinical-Support/ Clinical-Practice-Guidelines/Reproductive-Health-in-Rheumatic-Diseases). b Highly effective contraceptives are long-acting reversible contraceptives including progestin or copper intrauterine device (IUD) and progestin implant. Effective contraceptives are estrogen-progestin contraceptives (oral, patch, or vaginal ring) and progestin-only (oral, depot medroxyprogesterone acetate [DMPA]). c General indication for hormone replacement therapy: Current recommendations suggest limiting hormone replacement therapy use in healthy postmenopausal women and using the lowest dose that alleviates symptoms for the minimum time necessary. Benefit-risk balance is most favorable for severe vasomotor symptoms in women <60 years old or within 10 years of menopause onset. |
| Quality of Evidence | Interpretation |
|---|---|
| High-quality evidence | Studies that provide high confidence in the effect estimate. New data from future studies are thought unlikely to change the effect. |
| Moderate-quality evidence | Studies that provide confidence that the true effect is likely to be close to the estimate but could be substantially different. |
| Low-quality evidence | Studies that provide limited confidence about the effect. The true effect may be substantially different from the estimate. |
| Very low-quality evidence | Studies that provide very little certainty about the effect. The true effect may be quite different from the estimate. |
| Strength of Recommendation | Interpretation |
|---|---|
| Strong recommendation | Action should be favored in almost all patients, usually requiring high-quality evidence, high confidence that future research will not alter the conclusion, AND an assessment that the desirable effects of the intervention outweigh the undesirable effects. Should not be taken to imply that the intervention has large clinical benefits. |
| Conditional recommendation | Action should be followed in only selected cases, often limited by low-quality evidence, OR when the desirable and undesirable consequences of an intervention are more balanced, OR if patients’ preferences for the intervention are thought to vary widely. |
Sammaritano, L.R., Bermas, B.L., Chakravarty, E.E., Chambers, C., Clowse, M.E.B., Lockshin, M.D., Marder, W., Guyatt, G., Branch, D.W., Buyon, J., Christopher‐Stine, L., Crow‐Hercher, R., Cush, J., Druzin, M., Kavanaugh, A., Laskin, C.A., Plante, L., Salmon, J., Simard, J., Somers, E.C., Steen, V., Tedeschi, S.K., Vinet, E., White, C.W., Yazdany, J., Barbhaiya, M., Bettendorf, B., Eudy, A., Jayatilleke, A., Shah, A.A., Sullivan, N., Tarter, L.L., Birru Talabi, M., Turgunbaev, M., Turner, A. and D'Anci, K.E. (2020), 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol, 72: 529-556. doi:10.1002/art.41191
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).
D060728 - Reproductive Health
D009140 - Musculoskeletal Diseases
D012216 - Rheumatic Diseases
D060728 - Reproductive Health
D009140 - Musculoskeletal Diseases
D012216 - Rheumatic Diseases
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