Disease activity during the premenopausal and postmenopausal periods in women with systemic lupus erythematosus

Purpose Cyclophosphamide-induced ovarian failure has been reported to be protective against flares of systemic lupus erythematosus (SLE). We studied whether patients with SLE experience a decrease in disease activity after natural menopause. Subjects and methods We studied 30 SLE patients with natural menopause who had been observed at least 2 years before and after menopause and who did not receive hormone replacement therapy or danazol. Menopause was defined as the date of the last self-reported menstrual period. Disease activity was assessed retrospectively by medical chart review using standard measures (the SLE disease activity index) during the immediate premenopausal and postmenopausal periods, and 2 (n = 30 patients), 3 (n = 19), and 4 (n = 13) years before and after menopause. We also compared the use of health services and medications. Results Patients were studied for a mean (± SD) of 6.4 ± 1.7 years (premenopausal, 3.3 ± 0.9 years; postmenopausal, 3.2 ± 0.9 years). During the premenopausal periods, the mean disease activity score was 2.3 ± 2.3 (range, 0 to 9 on a 0 to 105 scale), compared with 2.3 ± 2.9 (range, 0 to 12; P = 0.37) after menopause. The maximum disease activity score was somewhat greater in the premenopausal period (7.9 ± 6.0 [range, 0 to 22] vs. 5.8 ± 5.1 [range, 0 to 22]; P = 0.04). The incidence rates of flares (0.56 per year vs. 0.43 per year, P = 0.20) and severe flares (0.17 per year vs. 0.12 per year, P = 0.33) were similar in the premenopausal and postmenopausal periods. Differences in disease activity scores (mean and maximum) and the number of visits to a rheumatologist’s office were only significant when the fourth year before menopause was compared with the fourth year after menopause. Conclusion Disease activity is mild during the premenopausal and postmenopausal periods in women with SLE. A modest decrease, especially in the maximum disease activity, is seen after natural menopause.