Background/Purpose: Women of childbearing age are more prone to developing autoimmune diseases, suggesting a role for sex hormones, particularly estrogens, in regulating both cellular and humoral immunity. During menopause, estrogen levels decline significantly, which may affect the immune system and, in turn, influence clinical outcomes in systemic lupus erythematosus (SLE). However, the impact of menopause on patients with SLE has not been widely studied. Therefore, we aimed to assess the long-term outcomes of SLE patients after menopause.

Methods: A retrospective cohort study was conducted involving women with SLE, classified according to the 1997 revised American College of Rheumatology criteria, from a university-based center in Puerto Rico who had undergone menopause. The premenopausal and postmenopausal periods were compared in terms of SLE manifestations, disease activity (assessed using the Systemic Lupus Erythematosus Disease Activity Index), damage accrual (measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), incident comorbidities, disease exacerbations, and hospitalizations. Variables were evaluated annually before and after menopause. Paired analyses were used to compare outcomes between the premenopausal and postmenopausal periods.

Results: Out of 309 female patients, 80 were identified as postmenopausal. Thirty-seven were excluded due to hysterectomy prior to menopause, SLE diagnosis at or after menopause, or an unclear date of menopause. A total of 43 patients were included in the analysis. The mean (standard deviation [SD]) ages at SLE diagnosis, menopause, and last visit were 33.6 (9.1), 46.5 (5.6), and 57.2 (9.0) years, respectively. The mean (SD) durations of SLE before and after menopause were 13.7 (10.9) and 12.0 (6.5) years, respectively. Table 1 summarizes the data for the 43 postmenopausal women included in the analysis. Compared to the premenopausal period, the postmenopausal period was associated with significantly lower frequencies of malar rash, photosensitivity, neurologic involvement, anemia, leukopenia, lymphopenia, and thrombocytopenia. These patients also had significantly lower disease activity and reduced exposure to glucocorticoids and hydroxychloroquine compared to the premenopausal period. While the occurrence of arterial hypertension was more frequent in the premenopausal period, new-onset malignancy was more common in post menopause. No significant differences in damage accrual were observed between the two periods.

Conclusion: In this cohort of patients with SLE, the postmenopausal period was associated with a significant decrease in disease activity and clinical manifestations—particularly mucocutaneous, neurologic, and hematologic involvement—as well as reduced exposure to glucocorticoids and hydroxychloroquine. These findings suggest that the hormonal changes accompanying menopause may influence the long-term course of SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-menopause-on-long-term-outcomes-in-patients-with-systemic-lupus-erythematosus/