Regular menstrual cycles do not rule out ovarian damage in adult women with systemic lupus erythematosus

Abstract

The aim of this study was to evaluate ovarian reserve markers in women with systemic lupus erythematosus (SLE) and regular menstrual cycles, and explore the relationship of such markers with clinical and treatment features. This was a case–control study including 27 women with SLE and 27 controls. All participants were aged 18–40 years, were eumenorrheic and had not used hormone therapy or hormone contraceptives in the past six months. Clinical manifestations of SLE, past and current use of immunosuppressive therapy and organ damage index were assessed at a regular follow-up visit, while antral follicle count (AFC), serum anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) were assessed at early follicular phase of menstrual cycle. AFC was significantly reduced in SLE women [median (interquartile interval) 7 (5–11) versus 11 (7–12), p = 0.029]. AMH levels were more heterogeneous in SLE patients compared to the control group [1.23 (0.24–4.63) ng/ml versus 1.52 (1.33–1.88) ng/ml]. The SLE and control groups had similar serum FSH levels [6.44 (4.19–7.69) versus 7.5 (6.03–8.09) IU/L, p = 0.135]. AFC was inversely correlated with organ damage index (p = 0.046) and cumulative dose of cyclophosphamide (p = 0.028), while AMH levels were negatively correlated with the maximal dose of corticosteroid ever used (p = 0.003). These findings suggest that ovarian reserve may be decreased in women with SLE despite regular menstrual cycles.

Chinese abstract

本研究的目的为评估患有系统性红斑狼疮（SLE）女性卵巢储备标志物和探究这些标志物与临床及治疗特征之间的相互联系。 研究为包括27名患SLE女性和27名对照的病例对照研究。所有受试者均为18-40岁，月经正常，且在过去的六个月中未受过激素治疗或未使用过口服避孕药。 SLE临床表现，过去和目前所使用的免疫抑制疗法及器官损伤指数均会在规律的随访中评估，而窦卵泡数（AFC），血清抗苗勒氏管激素和卵泡刺激素水平在月经周期中的早期卵泡期进行评估。 SLE妇女AFC水平显著降低[中位 (四分位间隔)7 (5–11) 与 11 (7–12), p=0.029]。SLE患者AMH水平与对照组相比更为异常[1.23 (0.24–4.63) ng/ml 与 1.52 (1.33–1.88) ng/ml]。SLE组和对照组FSH水平相类似[6.44 (4.19–7.69) 与 7.5 (6.03–8.09) IU/L, p=0.135]。 AFC与器官损伤指数(p=0.046) 和环磷酰胺累积剂量呈反相关(p=0.028), 而AMH水平与曾用过最大剂量皮质类固醇呈负相关(p=0.003)。这些发现说明即使月经周期规律的SLE患者卵巢储备也有可能降低。

• Anti-Mullerian hormone
• antral follicle count
• follicle-stimulating hormone
• ovarian reserve
• systemic lupus erythematosus

Acknowledgements

We thank Professors C. Lanna and M. Carneiro for helpful comments and suggestions.