Endocrine Abstracts

Background: Premature ovarian failure (POF) due to cyclophosphamide (Cyc) therapy is well documented in systemic lupus erythematosus (SLE) patients. Studies show that the use of gonadotropin releasing hormone (GnRH) analogues appears to protect women from POF. We present our experience in SLE patients treated with triptorelin.

Methods: Observational study of 15 women diagnosed of SLE who have received concomitant treatment with Cyc and GnRH analogues (triptorelin). Cyc was administered as 6–12 intravenous pulses at a dose of 0.5–1 g/m² (adjusted for leucopenia and renal function) every 3–4 weeks, and triptorelin by intramuscular injection at a dose of 0.06 mg/kg every four weeks from the first through the last pulse. All patients were asked about menstrual status (formula, disturbances), gestational formule, reproductive desire. Gonadotropin and estradiol serum levels were determined. We also evaluated the SLICC scale for cumulative SLE damage. The median age at menarchia was 13 years (p25 12, p75 14), SLE duration 7 years (range 2–19). All patients received Cyc due to renal disease and had received corticosteroids (median accumulated dose of 15.4 g). Median SLICC was 1 (range 0–4). They received GnRH analogues (median dose 0.063 mg/kg per m) concomitantly with Cyc (median total dose 16 g; range 7.5–27.7). Median age 24 years (range: 15–35) when beginning Cyc treatment. Median time of follow-up after therapy: 22 months.

Results: All patients had adequate gonadal suppression and 14/15 also had hot flushes as a symptom of hypoestrogenism. Fourteen recuperated menstruation a median of 3 months (range 1–10) after withdrawing GnRH analogues. Although menstrual disturbances increased after therapy, mainly dysmenorrhea, only one patient presents POF, with amenorrhea after 11 months of follow-up, and three patients altered ovarian reserve. There have been no pregnancies after Cyc therapy.

Conclusion: Our data show a low prevalence of amenorrhea and POF, supporting the treatment with triptorelina in these patients.