Menstrual function, menopause, and hormone replacement therapy in women with systemic lupus erythematosus
- Bonnie L Bermas, MD
Bonnie L Bermas, MD
- Associate Professor of Medicine
- Harvard Medical School
Systemic lupus erythematosus (SLE) occurs frequently in women of childbearing age. The relationships between SLE and menstrual function, menopause, and hormone replacement therapy are discussed in this topic review. Issues related to pregnancy in women with SLE,pregnancy in patients with impaired renal function, and hormonal contraception in women with SLE are presented in detail elsewhere. (See "Pregnancy in women with systemic lupus erythematosus" and "Pregnancy in women with underlying renal disease" and "Approach to contraception in women with systemic lupus erythematosus".)
Menstrual irregularities are common in women with systemic lupus erythematosus (SLE):
●Menstrual irregularity, especially oligomenorrhea, is a common clinical feature in women with SLE. As an example, among 94 women with SLE under the age of 45 without exposure to alkylating agents, oligomenorrhea occurred in 54 percent. Menstrual irregularities were associated with higher levels of prolactin, higher disease activity, and lower levels of progesterone . These observations suggest that SLE activity may result in hormonal abnormalities that may contribute to menstrual irregularity.
●Menorrhagia has been noted in 12 to 15 percent of patients [2,3]. Thrombocytopenia, antiphospholipid antibodies, and the use of glucocorticoids and/or nonsteroidal antiinflammatory drugs (NSAIDs) may contribute to the heavy menstrual flow.
●Temporary or even permanent early (or premature) amenorrhea has been noted in 17 to 24 percent of patients. Two major mechanisms have been identified: There is an association of SLE with autoimmune ovarian injury and with the administration of immunosuppressive agents (especially cyclophosphamide [CYC]) [4,5]. A retrospective review of women treated for lupus nephritis illustrated the importance of total drug exposure with CYC . Sustained early amenorrhea developed in none of 16 treated only with pulse glucocorticoids, 2 of 16 treated with seven monthly pulses of CYC, and 9 of 23 treated with 15 or more monthly pulses of CYC. Amenorrhea began within the first seven months in one-half of affected patients, occurring earlier in women over the age of 25. The amenorrhea was usually permanent, with recovery occurring only in women receiving the shorter pulse CYC regimen.
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