Função ovariana em mulheres lúpicas submetidas ao uso de ciclofosfamida em dois grandes centros de atendimento reumatológico de Curitiba, Estado do Paraná

Abstract

PURPOSE: To evaluate the ovarian response after cyclophosphamide use (CPM) in patients with systemic lupus erythematosus (SLE) and to correlate the age and cumulative dose findings with changes in menstrual cycle and/or progression to ovarian failure (OF). METHODS: This was a cross-sectional, retrospective study of 50 patients with a diagnosis of SLE who used CFM with a clinical follow-up of at least 1 year. Included were patients aged 12–40 years, who had undergone chemotherapy for SLE control and who had regular menstrual cycles before the beginning of CPM treatment. Patients who discontinued follow-up, who were followed up for less than one year or who had irregular/absent menses before the beginning of CPM treatment were excluded. All women studied were submitted to an interview and a questionnaire containing questions about the pattern of the menstrual cycle before and after therapy, and about the gestational periods and contraception. We asked if the patients had been instructed about the side effects and consequences of CFM. Statistical analysis was performed using the Student t-test and the Mann Whitney, χ 2 and nonparametric Kolmogorov-Smirnov tests. RESULTS: The mean age of the patients included in the study was 30.8 years and the mean age at the time of use of CPM was 25.3 years. After CFM, 24% of patients stopped menstruating, 28% returned to regular cycles and 48% continued to have irregular cycles. It was found that the patients who developed OF had longer disease duration (12.3 years) than those who did not develop it (8.9 years). Thirteen patients became spontaneously pregnant after CFM; however, 66% progressed to abortion. The mean age of the patients who used CFM and developed OF was 28.1 years. Amenorrhea occurred in 50% of those aged 31–40 years, in 22.2% of those aged 21–30 years and in 7.7% of those aged 12–20 years. Our study showed no statistical correlation between cumulative dose and OF, although cumulative doses greater than 11grams tended to promote some type of menstrual irregularity. CONCLUSION: SLE disease duration, age at the time of treatment and the highest cumulative doses are important predictors of OF after therapy with CFM. Pregnancy in lupus patients is more likely to evolve with abortion after the use of chemotherapy. It was seen that a small proportion of patients were aware of all the implications of the drug. Therefore, additional studies should be conducted for further knowledge and awareness of the importance of contraception and the preservation of ovarian tissue on the part of the medical community.