Impact of cyclophosphamide on gonadotropins in menopausal systemic lupus erythematosus patients: Relation to disease activity and damage

Background: Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease that affects females at reproductive age, where lupus patients experience menopause at younger age. It is debated whether early menopause in lupus patients results from gonadotoxic effect of cyclophosphamide treat- ment or an autoimmune mediated ovarian injury. Aim of the work: To identify menopausal symptoms and characteristics in an Egyptian cohort of SLE females and its relation to disease activity, disease damage, lupus nephritis and treatment. Patients and methods: 120 consecutive SLE female patients above the age of 35 were studied. Disease activity was assessed by SLE Disease Activity Index (SLEDAI), and accumulated damage by Systemic Lupus International Collaborative Clinics -Damage Index (SLICC-DI). Laboratory assessment was done including follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels. Results: The mean age of the patients was 45.1 +/- 8.2 years (35-63 years) and the age at menopause was 45.2 +/- 7.3 years (26-54 years). Their mean disease duration was 5.1 +/- 5.7 years (1 month to 21 years). The mean SLEDAI was 4.7 +/- 3.5 and SLICC-DI was 0.63 +/- 0.82. 24 (20%) of patients had premature menopause, 29.2% had natural menopause and 50.8% were menstruating. There was a significant negative correlation between LH and SLEDAI. There was a significant correlation of FSH and LH with the cumulative cyclophosphamide dose. Conclusion: SLE patients have early mean age of menopause at 45 years. High LH is associated with lower disease activity. High cumulative cyclophosphamide dose is associated with high FSH and LH. cyclophos- phamide is potentially associated with premature menopause. (c) 2020 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).