This was a cross-sectional study of women of reproductive age with systemic lupus erythematosus (SLE) being treated at Bahiana School Rheumatology Service in Brazil. The study aimed to assess the prevalence of contraceptive counselling and use. An interview was performed, and the results were analysed before and after the SLE diagnosis. Eighty-five women were included; the mean age of the group was 32.98 ± 8.39 years. Before SLE diagnosis, most of the patients had used some contraceptive method; mainly oral contraceptives (54%) or hormone injections (21%). After SLE diagnosis, 53% of patients did not use any contraceptive method. Among the remaining patients who continued using contraceptives, 22% used condoms, 11% used combined oral contraceptives and 7% used hormone injections. Although 62% of the patients regularly visited the gynaecologist, 56% were unaware of which contraceptive method could be used safely. Thus, a better contraceptive counselling of women of a reproductive age should be performed after SLE diagnosis. Impact Statement What is already known on this subject? Women diagnosed with SLE have inadequate counselling about family planning. What the results of this study add? Brazilian women with SLE have a low prevalence of contraceptive use after their diagnosis and are exposed to having high-risk pregnancies. What the implications are of these findings for clinical practice and/or further research? The results we found highlight the importance of continued medical educational programmes and establish questions for further studies in order to investigate the interventions used to improve the contraceptive use for women diagnosed with SLE.

Objective To determine whether users of the non‐fundal levonorgestrel‐releasing intrauterine system (LNG‐IUS) present with unfavorable bleeding patterns more frequently than fundal LNG‐IUS users. Methods A prospective cohort was conducted from June, 2016 to January, 2018 involving women aged 18–45 years who wished to use the LNG‐IUS as contraception and had no contraindications, endometrial polyps, submucosal myomas, irregular menstrual cycle, or anticoagulant use. Two study groups comprised women using fundal insertion and non‐fundal insertion LNG‐IUS. Bleeding was evaluated using a diary and pictogram chart. Results Of the 92 women who participated in the study, those with non‐fundal LNG‐IUS insertion sustained bleeding at rates greater than 83% (31) in the first 3 months of use, and 58% (14) at 6 months, versus 51% (22) at 3 months and 33% (19) at 6 months in those with fundal insertion (P=0.002 at 3 months; P=0.037 at 6 months). Blood loss in the non‐fundal LNG‐IUS group was higher than in the fundal LNG‐IUS group according to pictograms drawn by participants. Conclusion Women with non‐fundal LNG‐IUS placement had a higher frequency of sustained bleeding and blood loss volume according to self‐reported charts than those with fundal LNG‐IUS placement.