Menstruation-Related Disorders-Dysmenorrhea and Heavy Bleeding-as Significant Epiphenomena in Women With Rheumatic Diseases.

Martina Orlandi, Silvia Vannuccini, Khadija El Aoufy, Maria Ramona Melis, Gemma Lepri, Gianluca Sambataro, Silvia Bellando-Randone, Serena Guiducci, Marco Matucci Cerinic, Felice Petraglia

Journal: Frontiers in pharmacology 2022;13():807880

PMID: 35185567

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Plain Language Summary

Rheumatic diseases (RDs) affect significantly more women than men, and for this reason, gynaecological disorders may have an additional negative impact on women’s health. The aim of this study was to describe gynaecological symptoms among fertile age women with RDs and their impact on quality of life. This study is a monocentric, cross-sectional observational study. Results show that a large number of women with RDs report menstrual disorders. In fact, more than half of the population reported of having dysmenorrhea since adolescence. Similarly, during fertile age, menstrual pain was frequently reported, and in 72% of the cases, the intensity resulted to be moderate/severe. Additionally, heavy menstrual bleeding was found in 38% of the patients during adulthood and in 52% of patients during adolescence. Authors conclude that the management of female patients with RDs is a challenge for clinicians and should include an accurate evaluation of gynaecological aspects (menstruation, fertility, maternity, and sexuality) as well as manage an interdisciplinary teamwork approach (rheumatologist and gynaecologists).

Abstract

In women with rheumatic diseases (RDs) menstruation-related disorders have never been investigated. The aim of this study was to evaluate gynecological symptoms/disorders in fertile age women with RDs. All patients (n = 200) filled up a self-administered questionnaire on their gynecological history, menstrual cycle pattern, menstrual-related symptoms, and quality of life (QoL). The RD group was then compared to a control group of 305 age-matched fertile age women. Among patients with RDs, 58% had arthritis, 40% connective tissue diseases (CTDs), and 1.5% systemic vasculitis. No differences were observed between CTDs and arthritis, except for a family history of HMB which was more common among women with CTDs ( < .01). When compared to controls, women with RDs reported more frequent heavy menstrual bleeding (HMB) during adolescence (51.7 and 25.4%, respectively; = .0001) and adult life (37.7 and 25.9%, respectively; = .0065). Also, dysmenorrhea in adolescence was significantly more common among cases (55.6 and 45.4%, respectively; = .0338). Gynecological pain (dysmenorrhea, non-menstrual pelvic pain, dyspareunia, dysuria, and dyschezia) in patients with RDs was more frequent than in controls ( = .0001, .0001, .0001, .0001, .0002, respectively). Considering women who reported moderate and severe symptoms in RDs, dysmenorrhea and dyspareunia remain significantly more frequent in women with RDs than in controls ( = .0001; = .0022; respectively). QoL scores were significantly reduced in women with RDs, either in physical ( = .0001) and mental domains ( = .0014) of short-form 12. Women affected by RDs frequently presented menstruation-related disorders; thus, female patients with RDs should be questioned about gynecological symptoms and referred to the gynecologist for an accurate evaluation.

Address: Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC and Scleroderma Unit, Florence, Italy.; Obstetrics and Gynecology, Department of Maternity and Infancy, AOU Careggi Florence, Florence, Italy.; Artroreuma S.R.L., Rheumatology Outpatient Clinic Associated with the National Health System, Catania, Italy.; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy.

DOI: 10.3389/fphar.2022.807880