Menstrual and hormonal alterations in juvenile systemic lupus erythematosus

Abstract

Menstrual cycles of 30 patients with juvenile systemic lupus erythematosus (JSLE) were compared with 30 age-matched controls. The mean age of patients with JSLE and controls was similar (17.4 +/- 3.2 vs 17.06 +/- 2.08 years, P = 0.66). The mean menarche age was higher in JSLE than controls (13.13 +/- 1.4 vs 11.56 +/- 1.5 years, P = 0.0008). On the contrary, the mean maternal menarche age was similar in both groups (P = 0.62). Menstrual abnormalities and longer length cycles were more frequently observed in JSLE than controls (63% vs 10%, P = 0.0001; 23% vs 0%, P = 0.0105, respectively). The median of follicle stimulating hormone was significantly higher in patients with JSLE compared with controls (4.6 vs 3.4 IU/L, P = 0.0207), and the median of progesterone was lower (32.5 vs 70 ng/mL, P = 0.0033). The median of luteinizing hormone was lower in patients with JSLE with menstrual abnormalities versus normal cycles (2.9 vs 5.5 IU/L, P = 0.019) and both had a high percentage of decreased progesterone levels (63% vs 73%, P = 0.70). Our findings support the notion that menstrual disturbances are frequent and may be associated with pituitary dysfunction leading to a decreased progesterone production. We also reported that in spite of premature ovarian failure being a rare event in JSLE the follicular reserve seems to be low regardless of intravenous cyclophosphamide treatment.

Hormone profile in juvenile systemic lupus erythematosus with previous or current amenorrhea

“…This menstrual alteration in the Wrst years post menarche may be a consequence of physiologic anovulation due to hypothalamic-pituitary-ovarian axis dysfunction [7]. Other possible risk factors for amenorrhea in lupus are disease activity [2,4,8], high cumulative organ damage [4], drugs [3][4][5][6] and hormone alterations [4,6], such as hyperprolactinemia [8,9].…”

“…Menstrual disturbances are common in juvenile SLE (JSLE) patients ranging from shorter or longer cycles, decreased or increased Xow, amenorrhea [2][3][4][5] and premature ovarian failure (POF) [3][4][5][6].…”

Ovarian Function and Reproductive Outcomes of the Female Patients with Systemic Lupus Erythematosus and the Strategies to Preserve their Fertility

“…• Chronic inflammatory state may prevent the proper functioning of the hypothalamic-pituitary-ovarian axis (HPO) [15] • Autoimmune ovarian injury most commonly in the form of autoimmune oophoritis may hamper ovarian function [16] • Lupus flares are associated with hyperprolactinemia, which may interfere with ovulation process and affect immune activity [17] • Thrombocytopenia, antiphospholipid antibodies, and the use of glucocorticoids and/or nonsteroidal anti-inflammatory drugs can contribute to menorrhagia [14] • Temporary or even permanent early (or premature) amenorrhea may result from autoimmune ovarian injury or from the administration of cytotoxic agents such as cyclophosphamide [18] Figure 1: Contributory factors causing menstrual irregularity, ovarian failure and infertility in women with systemic lupus erythematosus. SLE involves many organ systems.…”

“…Sex steroid hormones, namely estradiol, testosterone, progesterone, dehydroepiandrosterone (DHEA), and pituitary hormones, including prolactin, have immunoregulatory roles; therefore can modulate the incidence and severity of SLE [1,5,13]. The use of estrogen-containing contraceptive agents is associated with a 50 percent increase in risk of developing SLE; while either early onset of menarche (age ≤ 10 years) or administration of estrogen to postmenopausal women doubles their risk [14]. In this review article we aimed to provide an update on the impact of systemic lupus erythematosus and therapies on reproductive function and current fertility preservation strategies in women suffering from this disease.…”

Redução da reserva ovariana em pacientes adultas com dermatomiosite

“…1 Assim sendo, conforme estudo prévio do nosso grupo, pacientes com lúpus eritematoso sistêmico (LES) juvenil apresentam maior incidência de disfunção sexual, menarca atrasada e frequência maior de anormalidades menstruais em relação aos controles saudáveis pareados por idade e raça. [3][4][5][6] Além disto, a amenorreia é evidenciada em aproximadamente 12% das pacientes com LES juvenil. 7 Com relação às miopatias inflamatórias idiopáticas, foi observado em trabalho recente que pacientes com DM juvenil apresentam também atraso da menarca e baixa reserva folicular.…”