Chronic Inflammation May Mean Early Menopause

From Medscape Medical News Megan Brooks October 21, 2011 (Orlando, Florida) — Women with psoriasis, rheumatoid arthritis, inflammatory bowel disease, or systemic lupus erythematosus have an increased risk for both early menopause (before 45 years of age) and premature ovarian failure, new research confirms. "Our findings support and add to existing studies," Janet F. McLaren, MD, from the division of reproductive endocrinology and infertility, University of Alabama, Birmingham, told Medscape Medical News. She presented the research here at the American Society for Reproductive Medicine 67th Annual Meeting. Dr. McLaren and colleagues from the University of Pennsylvania School of Medicine in Philadelphia reviewed the records of more than 1.7 million women of reproductive age (15 to 45 years). They accomplished this using The Health Improvement Network, an electronic medical records database. The researchers looked for diagnostic codes for psoriasis, rheumatoid arthritis, inflammatory bowel disease, and systemic lupus erythematosus. "These are the 4 most prevalent conditions in women of reproductive age," Dr. McLaren noted. Women without these conditions comprised the comparator group. Results of unadjusted analyses point to a 2- to 5-fold increased risk for both early menopause and premature ovarian failure in women with these common chronic inflammatory diseases, Dr. McLaren reported. IBD Finding Novel? "It's known that women with lupus have antiovarian antibodies and that they have premature ovarian failure," Dr. McLaren said. "Some studies have suggested that there is an earlier age at menopause in women with rheumatoid arthritis, and there are some older publications that show that the number of children they have is slightly lower than other women," she added. However, she said she has not been able to find any studies showing an increased risk for menopause in women with inflammatory bowel disease. The researchers controlled for smoking, body mass index, previous pelvic surgery, socioeconomic status, and drug therapy. After adjustment for these factors, psoriasis, rheumatoid arthritis, and inflammatory bowel disease were no longer associated with premature ovarian failure; lupus, however, remained associated, with an odds ratio of 2.5. "It is still likely," Dr. McLaren said, "that all of these diseases are associated with premature ovarian failure. It's just when you control for the medications, you control for the severity of the disease; so it's 'confounding by indication' — the more severe patients are getting the more aggressive medications." "Further research is needed to [determine] if the effect is due to the underlying illness or treatment," the study team notes in a meeting abstract. Dr. McLaren said adjusted analyses for early menopause have not been completed yet. "The next step of the project is to look more specifically at the different disease exposures and see which of these exposures are highly associated with early menopause," Dr. McLaren said. The study was supported by grants from the National Institutes of Health. The authors have disclosed no relevant financial relationships. American Society for Reproductive Medicine (ASRM) 67th Annual Meeting: Abstract 10. Presented October 17, 2011.