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MTX Contraception Advice — SCE Rheumatology MCQ

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EasyRheumatology PharmacologyMTX Contraception AdviceSCE Rheumatology

A 35-year-old woman with rheumatoid arthritis is receiving weekly low-dose methotrexate. She is not currently pregnant and asks what contraception advice she should follow. Which is the most appropriate advice?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Use effective contraception during treatment and for at least 6 months after stopping methotrexate

The correct answer is C. Methotrexate is contraindicated in pregnancy for non-oncological indications because it is embryotoxic and teratogenic and is associated with miscarriage and congenital abnormalities. The UK SmPC advises women to use effective contraception throughout treatment and for at least 6 months after the final dose. Contraception is not limited to barrier methods: methotrexate does not itself reduce the effectiveness of hormonal contraception, although vomiting or severe diarrhoea may compromise oral contraceptive protection. Disease remission does not remove the reproductive risk, and contraception must not be stopped immediately after methotrexate withdrawal or after only 1 month. Pregnancy occurring during treatment or within the post-treatment interval requires prompt specialist review.

Reference: electronic Medicines Compendium. Methotrexate 2.5 mg Tablets, Summary of Product Characteristics, sections 4.4 and 4.6. Updated 30 October 2024. https://www.medicines.org.uk/emc/product/9945/smpc