Reproductive Health in Rheumatology: Making 'Early and Regular' Work in Practice

Reproductive health is increasingly recognised as a core aspect of rheumatology care, particularly for patients of reproductive age living with chronic inflammatory conditions. Both the newly updated EULAR recommendations and the 2020 American College of Rheumatology guideline call for reproductive health to be addressed 'early and regular' or 'early and often' in clinical encounters. However, the practical implementation of this guidance remains a challenge. In daily practice, discussions about fertility, contraception, and family planning are often delayed, inconsistent, or omitted entirely, especially for male, trans, and nonbinary patients. This viewpoint outlines a practical approach to integrating reproductive health into routine rheumatology care using 2 complementary strategies: the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model and a communication approach referred to as 'Inform and Acknowledge'. The PLISSIT model provides a scalable framework for initiating and tailoring reproductive health conversations, while 'Inform and Acknowledge' offers a rhythm for maintaining those discussions over time, even when they are not immediately relevant. These strategies are designed to be flexible, time-sensitive, and inclusive of diverse reproductive identities and needs. The article also highlights structural barriers, including limited consultation time and lack of training, and calls for more implementation research to support integration of reproductive care into real-world rheumatology practice. By shifting from reactive, risk-focused conversations to proactive, informed planning, clinicians can support patients in making timely and empowered reproductive health decisions. Making reproductive health routine is not just an ethical imperative-it is part of providing complete, patient-centered rheumatologic care.