Can rheumatoid arthritis affect my fertility at 39?

Question

Hello Doctor,

I am a 39-year-old woman who suffers from rheumatoid arthritis (RA). I was diagnosed with this disease 3 years ago and am now taking methotrexate and some kind of biological drug that helps me alleviate pain and inflammation associated with RA. At present, I am having some reproductive health issues that may be connected with my disease and medications I take. My husband and I are planning to conceive for about a year, and I wonder whether my medications have some impact on my fertility.

Also, I have noticed that my symptoms of RA worsen in the week before my period. Moreover, I am worried about my future pregnancy, because I know that I will have to stop taking methotrexate. My periods became irregular after starting my RA treatment.

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 do I handle this?
What medicines can I take while pregnant, and when do I need to change things?
What effect does pregnancy have on RA symptoms and activity?
Is there a connection between my irregular periods and my RA or the chronic inflammation?

Please help me.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query, and I understood your problem.

Rheumatoid arthritis and its treatment may impact fertility; however, a lot of women successfully conceive and have normal pregnancies after careful planning. 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 the 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.