immunology

1. MENSTRUAL DISTURBANCES IN SYSTEMIC
LUPUS ERYTHEMATOSUS PATIENTS USING
IMMUNOSSUPPRESSANTS

2. PRESENTED TO: Dr. Humaira kusar
PRESENTED BY: Bakhtawar Attique
MAJOR: Biotechnology
COURSE TITLE: Immunology

3. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
• Meaning: Systemic means affects multiple organs, lupus means wolf in Latin it
usually refers to variety of diseases that affect the skin and these diseases
resembles to wolf bite, and Erythematosus means skin redness.

4. HOW LUPUS AFFECT ALL THE ORGANS?
• The immune system protects the body’s tissue from invaders, but lupus is auto-
immune disease, which means that immune cells start attacking the body
tissues unless to protect them. A person suffering from this disease any tissue
or organ of the body are targeted by the immune system.
• Factors responsible for causing autoimmune disease.
Genetics Hormones Medication Bacteria
Cigarette
smoking
viruses Environmental
factors

5. AUTOIMMUNE ACTIVATION PROCESS

6. AUTOIMMUNE ACTIVATION PROCESS
Antinuclear
antibodies

7. MENSTRUAL CYCLE DISTURBANCE
• In this article the main focus is on the disturbance of menstrual cycle in women due to some
medication such as immunessuppressants agents which are mainly used for SLE treatment
and result in amenorrhea (Is the absence of menstruation one or more missed menstrual
periods. Women who have missed at least three menstrual periods in a row have amenorrhea,
as do girls who haven't begun menstruation by age 15. The most common cause of
amenorrhea is pregnancy) and premature ovarian failure (Premature ovarian failure (POF) is
when a woman's ovaries stop working before she is 40).
• Ovaries are sensitive to toxic substances, and the sensitivity depend upon the age,
medication, dose and evolution of ovarian follicle stage (larger follicles, antral and pre-
ovulatory follicles) and these stages are more sensitive as compared to other factors when
treatment is depend upon the ionizing radiation and alkylating agents (cyclophosphamide

8. MENSTRUALALTERATIONS:
1. Increased bleeding (iron-deficiency anemia).
2. Loss of fertility.
3. Premature menopause leads to chronic degenerative diseases such as
gynecological cancer and early mortality.
AIM
Evaluate effects of immunosuppressive drugs on the ovarian function used in
the treatment of SLE by clinical expressions on menstrual irregularities.

9. METHOD
Immunosuppressive agents (ISA) and dose of consumption:
Prednisone (1 mg/Kg/day with a maintenance dose of 5-10 mg/day via oral
route).
Cyclophosphamide (0.75 g/m2 up to 1 g/m2 via IV route, monthly).
Azathioprine (2-3 mg/Kg/day via oral route).
Methotrexate (10-25 mg via oral, intramuscular or IV route, weekly).

10. DIAGNOSIS
Normality: eumenorrhea, bleeding between 21 and 35 days (amount between 20 and 80 mL), for 3 to 7 days.
The alterations referred as either by extreme or lessened menstrual flow, increased time break or reduced
period of bleeding. Altered uterine bleeding:
Hypermenorrhea: with menstrual bleeding for more than seven days;
Menorrhagia: with a volume of bleeding > 80 mL during the menstrual period;
Polymenorrhea: in case of bleeding within an interval < 18 days;
Hypomenorrhea: when the menstrual period lasts < 3 days;
Oligomenorrhea: when there is an interval > 45 days between menstrual periods;
Secondary amenorrhea: when there is an interval > 90 days between the bleeding episodes after the
occurrence of menarche.

11. RESULTS
SLE treated with immunosuppressive agent
Treatment with immunosuppressive agents at the
time of research.

12. DISCUSSION
• Disease concentrates on the fertile period of the women, with a mean age of 28.01 ±
5.81 years, which supports the concerns of the clinicians regarding ovarian function.
• Menstrual alterations were observed in 37.9% of the patients that used medications.
• Menstrual alterations were observed in 49% of 61 patients with SLE.
• 90% used cyclophosphamide, 5% azathioprine and 5% used cyclosporine. Most of
the patients with menstrual alterations were between 31 and 50 years.
• Menstrual irregularity was a dependent variable and the patient age,
immunosuppressive therapy and cyclophosphamide were considered predictive for
this adverse effect.