Unexplained amenorrhea in a patient taking methotrexate for the treatment of rheumatoid arthritis

Abstract

Background. The cause of secondary amenorrhea in the following case cannot be explained by traditional etiologies. We therefore questioned whether long-term methotrexate treatment played a role as an endometrial inhibitor.

Case. A 44-year-old G4P2, with a 5-year history of rheumatoid arthritis, presented with a 2-year history of secondary amenorrhea. The patient took methotrexate since diagnosis. Her FSH, estrogen, prolactin, TSH and T4 levels were normal, her B-HCG was negative, her BMI was 22 and she had no history of Asherman's syndrome.

Conclusion. There is no information, based on our search, on whether long-term methotrexate treatment has an effect on the menstrual cycle. This case highlights the need for the elucidation of the effects of long-term methotrexate treatment on the menstrual cycle in patients with rheumatoid arthritis.

Keywords:

• Amenorrhea
• methotrexate
• endometrium
• unexplained
• rheumatoid arthritis

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article