Can rheumatoid arthritis affect my fertility at 39?

Question

Hello, Doctor,

I am a 39-year-old woman with rheumatoid arthritis (RA), diagnosed three years ago. I am currently on Methotrexate and a biologic medication, which have helped control my joint pain and inflammation significantly. However, I am concerned about how my condition and treatments affect my reproductive health. My husband and I have been trying to conceive for about a year, and I'm wondering if my medications could be affecting my fertility.

Additionally, I have noticed that my RA symptoms tend to fluctuate with my menstrual cycle, my joints are often more painful and stiff in the week before my period. I am also worried about what would happen if I do get pregnant. I know I'll need to stop Methotrexate, but I am concerned about my RA flaring during pregnancy and how that might affect the baby. My periods have also become more irregular since starting my RA medications. Please tell me,

Can rheumatoid arthritis medications affect fertility and my ability to conceive?
Why do my RA symptoms worsen around my menstrual cycle?
How can I manage this?
What medications are safe to continue during pregnancy, and when should I make changes?
How does pregnancy typically affect rheumatoid arthritis symptoms and disease activity?
Could my irregular periods be related to my RA or the chronic inflammation?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Rheumatoid arthritis (RA) and its treatments can indeed affect your reproductive health, but with the right planning many women are able to conceive and have healthy pregnancies. Some RA medications such as Methotrexate interferes with fertility and are unsafe in pregnancy. So they must be discontinued well before conception, usually at least three months in advance, while other biologics and disease-modifying drugs may be safer to continue depending on the specific agent and your disease activity.

Your RA symptoms worsening before your period are likely related to hormonal fluctuations in estrogen and progesterone that can influence immune activity and inflammation, which is a common experience in women with autoimmune diseases, and symptom tracking combined with supportive measures like

Gentle exercise.
Heat therapy.
Possibly short-term adjustments in medication can help manage this.

When planning pregnancy, medications such as Hydroxychloroquine (a disease-modifying antirheumatic drug), sulfasalazine, and some biologics like certain TNF (tumor necrosis factor) inhibitors are generally considered safe. But these decisions should always be individualized with your rheumatologist and obstetrician.

Interestingly, many women find that RA disease activity improves during pregnancy due to immune system shifts that promote tolerance, although flares can occur especially in the postpartum period, so monitoring and proactive management are essential.

Irregular periods can sometimes be related to the following issues,

Chronic inflammation.
Stress.
Medication effects.

Family planning in autoimmune disease involves careful timing of medication adjustments, ensuring disease is well controlled before conception, discussing safe contraception if delaying pregnancy, and planning close follow-up throughout pregnancy and after delivery to balance your health with the best outcomes for the baby.

I hope this information helps you.

Feel free to ask further queries.

Thank you.