When a woman of child bearing age is diagnosed with cancer one of the first concerns is of fertility and it is suggested the she receive fertility preservation counseling. However cancer and its treatment are not the only circumstances that can impact a woman’s fertility or ovarian function. Janet F. McLaren, MD, a reproductive endocrinologist at the University of Alabama at Birmingham, recently presented research conducted with her colleagues at the University of Pennsylvania on “Early Menopause in Women with Chronic Inflammatory Disease: A Population-Based Cohort Study” at the American Society of Reproductive Medicine 67th Annual Meeting.
The objective of Dr. McLaren’s research was to determine if women with specific autoimmune disorders are at a higher risk for premature ovarian failure (menopause at <40 yrs) and early menopause (menopause at <45 yrs). In her research she looked at 4 common chronic inflammatory diseases (CID) in women: Rheumatoid Arthritis, Inflammatory Bowel Disease, Psoriasis, and Systemic Lupus. The study involved over 1.7 million women of reproductive age (>15yo - <45yo) who had been identified with either of these CID’s, and who’s outcome was early menopause or premature ovarian failure (POF).
Current knowledge is limited as to how chronic inflammatory disease or the medications used to treat these conditions affect ovarian function. There is limited research suggesting an earlier age of menopause in women with RA, and POF in women who have SLE who have and have not been treated with gonadotoxic agent cyclophosphamide. “The effect of disease-modifying antirheumatic agents (DMARDs) on the ovary is not well-understood. Women with serious cases of inflammatory disease are treated more aggressively. Some of the more aggressive drugs used to treat advanced cases of RA and SL are known to cause issues with egg and sperm production.” states Dr. McLaren.
Her research demonstrates a 2 to 5 fold increase for both early menopause and POF for women with CID. More specifically her study shows a 2 fold increase of POF in women who have RA, psoriasis and IBD and a 6 fold increase for those with systemic lupus. Early Menopause was shown with a 2 fold increase for women who have Psoriasis and IBD, and a 4 fold increase for those with RA and SLE.
According to Dr. McLaren, “While the primary concern may be of fertility and pregnancy, early menopause brings on important health changes, too. Early menopause can affect bone and cardiovascular health, and these changes may increase a woman’s health risks.”
Dr. McLaren’s research indicates that women with chronic inflammatory diseases may be at increased risk for early menopause and POF but how much of this is caused by the disease or the treatments are unknown. Further investigation must be done to determine whether the cause is due to the treatment or the disease.