[Question of the month: Behcet disease and contraception]

Behcets disease is rare in women. Contraception is advisable when treatment involves drugs such as thalidomide colchicine and less frequently immunosuppressors. Behcets disease also entails some risk of venous thrombosis. The question arises of what contraceptive method to prescribe for a patient with Behcets disease. Eight physicians responding to this question agreed that combined oral contraceptives should be avoided due to the thrombotic risk. Progestin-only pills may be an acceptable choice in most cases. IUDs are suggested for multiparas not receiving corticoids. IUDs should generally be avoided in nulliparas but may be considered in rare cases when other methods are poorly tolerated if the woman is not receiving corticoids or nonsteroidal antiinflammatories. The diaphragm condom and similar methods may be the best choice in some cases. One practitioner suggested that treatment with colchicine does not automatically impose the need for contraception since normal pregnancies have been reported in women treated with the drug. A small minority would consider combined OCs as a last resort because of the need to avoid pregnancy at all costs.