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Systemic lupus erythematosus and menopause

Gompel A1.

Climacteric. 2019 Oct 28:1-7. doi: 10.1080/13697137.2019.1679113. [Epub ahead of print]

 

Abstract

Estrogen has been known for a long time to be a trigger on auto-immunity and may influence the course of lupus. Women experiencing systemic lupus are at high risk for premature ovarian insufficiency if using cyclophosphamide, of osteoporosis, arterial ischemic diseases and venous thrombosis at young age. In about 30% of them, an antiphospholipid/anticoagulant antibody can occur which is associated with very high risk of thrombosis. However, the severity of the disease may vary and some women with lupus could benefit from a menopausal hormone therapy (MHT). As a consequence, management of menopause symptoms needs to evaluate carefully the condition of the patient, her lupus history and cardiovascular risk. We will describe the effect of lupus on menopause, of menopause on lupus and report in detail the literature available on MHT and the risk of lupus or the risk of flares in women with lupus. Some other options than MHT for the management of climacteric symptoms will be discussed.

Conclusions Despite the fact that women with SLE are at higher risk of POI, c-v events and osteoporosis at young age, those women are not always good candidates for MHT. Thirty percent of them may carry an APLs which can be extremely deleterious with the risk of arterial and VTE. A careful evaluation of the condition of the woman in conjunction with the expert involved in its follow-up will help to discriminate which one can benefit from MHT. If indicated, transdermal E2 at low dose combined with P or dydrogesterone can be used. Close monitoring of lupus activity is then recommended. P can alleviate climacteric symptoms and sleep disorders and can be combined with topical estrogens which are not contraindicated even in women with APLs. Non-hormonal alternatives can always be used.