OVARIAN FAILURE IN ORAL CYCLOPHOSPHAMIDE TREATMENT FOR SYSTEMIC LUPUS-ERYTHEMATOSUS

Ninety-two women with systemic lupus erythematosus treated with oral c yclophosphamide were studied to ascertain the prevalence and the facto rs associated with ovarian dysfunction. Menstrual disturbance during t reatment occurred in 55% of patients: 36% had amenorrhoea and 19% had oligomenorrhoea. Sustained oligomenorrhoea occurred in 12% patients. P ermanent amenorrhoea (> 12 months) after cessation of oral cyclophosph amide occurred in 27% of patients. Hormonal studies in these patients were consistent with ovarian failure. Older age at initiation of treat ment and high cumulative dose of cyclophosphamide were found to be ass ociated with this outcome. There was a trend towards linear relationsh ip between the age of initiation of cyclophosphamide therapy and frequ ency of amenorrhoea. A statistically significant association between a menorrhoea and cumulative dose of cyclophosphamide after adjustment fo r age was found whereas no such association was linked to the duration of treatment. Fourteen of the 23 women who wished to become pregnant after cessation of treatment conceived resulting in 20 live births and two abortions.