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Early Menopause Is More Frequent in Sjögren’s, Miscarriage Is Not


Women with Sjögren’s syndrome had early menopause more often, but didn’t have a higher rate of miscarriage compared with the general population, a study in a Chinese population shows.

The study, “Menstrual and reproductive characteristics of patients with primary sjogren’s syndrome: a 7-year single-center retrospective study,” was published in Current Medical Science.

Sjögren’s syndrome is a chronic autoimmune disease that mainly affects the glands producing tears and saliva. It can arise at any age, but tends to appear more often in women over 40.

Previous studies reported that Sjögren’s is linked to an increased risk of miscarriage and other side effects during pregnancy. Some also showed it may impact menopause, fertility, and menstruation.

This relationship can be explained by two mechanisms. One relies on the effects of chronic inflammation on the brain’s network that controls the ovaries — hormone-producing glands that play a key role in menstruation and fertility. The other is the production of anti-ovarian antibodies that damage ovarian tissue and lower the ovaries’ ability to produce viable egg cells.

The association between Sjögren’s and fertility, menstruation, or miscarriage wasn’t observed in other studies, however, making it controversial. More analyses of fertility and menstruation in people with Sjögren’s are needed to provide a deeper knowledge on the relationship.

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Menstruation, fertility data in women in China with Sjögren’s

There is also little information about menstruation and fertility in people with Sjögren’s in China, making research there “on the menstrual and reproductive characteristics of pSS [primary Sjögren’s syndrome] patients with a relatively large sample size” of much significance, the researchers wrote.

The researchers from Tongji Hospital in Hubei, China analyzed menstrual and reproductive data from 449 women (mean age, 46.18) with Sjögren’s. The study also compared patients’ outcomes before and after menopause.

Data collected included age at the first menstrual cycle (menarche), menstruation, and spontaneous abortion rate. The study also assessed disease manifestations, such as skin symptoms, lung involvement, and blood levels of immunoglobulins (antibodies), red blood cells, albumin (a measure of liver and kidney function), and C-reactive protein (CRP, an inflammation marker).

Most patients had active disease, with a greater involvement of lung and blood system compared with the liver and kidney.

The study found no significant differences in age of menarche, or in menstruation and spontaneous abortion rate between Sjögren’s patients and the general population.

But early menopause — defined as taking place between ages 40–45 — was more frequent with Sjögren’s than the general population (8.89% vs. 5%), confirming “that the ovarian function of pSS patients may be affected by autoimmune disease,” the researchers wrote.

Infertility among Sjögren’s patients (0.89%) was lower than in Chinese women of childbearing age, which ranged between 9% and 25%. Researchers said a larger sample size was needed to confirm the findings.

Compared with women who developed Sjögren’s after menopause, those who had menopause before the onset of the disease had higher skin involvement (15% vs. 27.96%) and increased blood levels of immunoglobulins (4.16% vs. 10.64%).

However, women with postmenopausal Sjögren’s had a significantly higher incidence of interstitial lung disease (32.5% vs. 17.02%), the most common complication. This may be because of the menopause-induced reduction in sex hormone levels, which are known to have a protective effect against lung inflammation.

Women in the postmenopausal onset group also had a greater decrease in red blood cells (47% vs. 31.25%) and albumin (19.49% vs. 8.22%), and greater levels of CRP (21.67% vs. 10.94%).

Women in the premenopausal onset group had a significantly higher rate of abnormal pregnancy (9.72% vs. 2.5%) compared with those who developed Sjögren’s after menopause.

The results showed “the relationship between the onset of pSS and the timing of menopause may affect the clinical characteristics of patients,” the researchers wrote, noting the study provided valuable information about menstruation and reproduction in women in China with Sjögren’s.



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