Patients with systemic autoimmune and rheumatic diseases face elevated risks of adverse pregnancy and perinatal outcomes, driven not only by disease activity and medication exposure but also by gaps in sexual and reproductive health (SRH) care. This narrative review proposes a framework for integrating SRH into routine rheumatology practice, emphasizing patient-centered, autonomy-supportive care, early and ongoing assessment of reproductive goals, and coordination with other specialties. The authors argue that improving access to high-quality SRH care—alongside optimized disease control—may help improve reproductive outcomes and reduce inequities.