Menstrual disorders in systemic lupus erythematosus patients; A cross-sectional pilot study

Background: Persistent menstrual disorders are relatively common in patients with systemic lupus erythematosus (SLE). The purpose was to shed light on the causes and associations of menstrual disorders, particularly focusing on the potential influence of immunosuppressive medications. Patients and methods: This cross-sectional pilot study was performed on all the patients with SLE referred to our medical department who were eligible for participation. Venous blood samples were taken for FSH, LH, and anti-mullerian hormone measurement. Results: This study examined menstrual disorders and their association with disease activity on 50 patients with SLE. Patients were divided into 16-35 years (n = 23) and 36-51 years (n = 27) groups. Medications included hydroxychloroquine (82%), prednisolone (80%), azathioprine (20%) and methotrexate (6%). Dysmenorrhea was more common in the older group but not significantly. A remarkably higher proportion of prednisolone users reported dysmenorrhea compared with non-users (94.7% vs 5.3%, p < 0.05) in this pilot sample. No significant association was seen between polymenorrhea/menorrhagia and hydroxychloroquine, azathioprine or no medications. FSH, LH and anti-mullerian hormone levels were comparable across SLEDAI-2K groups. Although prednisolone usage was associated with dysmenorrhea, it is important to emphasize that this study is cross-sectional and therefore cannot establish a causal relationship. The observed association should not be interpreted as a definitive cause-and-effect link, and further prospective studies are needed to test such mechanisms. Conclusion: The significant association between prednisolone usage and dysmenorrhea in our study suggests that medications may contribute to menstrual disorders in SLE, possibly alongside disease activity. This important finding underscores the need for healthcare providers to be aware of the potential side effects of medications commonly used in treatment of SLE.