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Author Notes:

Email: jhknigh@emory.edu

All contributors meet the criteria for authorship and approved the submitted version of the manuscript.

The authors thank the patients who participated in the study.

Competing interests: None declared.


Research Funding:

The Georgia Lupus Registry was supported in part by the CDC and by cooperative agreement CDC-RFA-DP08-806 and earlier by cooperative agreement PA03022 from the CDC.

The Georgians Organized Against Lupus Cohort was supported in part by an investigator-initiated grant from GlaxoSmithKline.

SSL is supported in part by the NIH (R01AR065493) and the CDC (U01DP005119).

JHK was supported during this research by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Reproductive, Perinatal, & Pediatric Training Grant (T32HD052460).


  • Cyclophosphamide
  • Outcomes research
  • Systemic Lupus Erythematosus

Characteristics related to early secondary amenorrhoea and pregnancy among women diagnosed with systemic lupus erythematosus: an analysis using the GOAL study.


Journal Title:

Lupus Science & Medicine


Volume 3, Number 1


, Pages e000139-e000139

Type of Work:

Article | Final Publisher PDF


OBJECTIVE: Systemic lupus erythematosus (SLE) disproportionately affects women and often develops during their reproductive years. Research suggests that some women who receive cyclophosphamide as treatment for SLE experience earlier decline in menstrual function, but reproductive health among women with SLE who have not taken this drug is less well understood. This study aims to better understand the relation between SLE and reproduction by assessing early secondary amenorrhoea and pregnancy in women treated with and without cyclophosphamide from a population-based cohort with large numbers of African-Americans. METHODS: Female patients with SLE, ages 20-40 at time of diagnosis, who were 40 years or older at the time of the survey were included in this analysis (N=147). Participants in the Georgians Organized Against Lupus (GOAL) study were asked about their reproductive histories including early secondary amenorrhoea, defined as loss of menstruation before age 40. RESULTS: Women who were cyclophosphamide naïve had an increased prevalence of early secondary amenorrhoea compared with population estimates, 13-17% compared with 1-5%. Factors associated with early secondary amenorrhoea in women not treated with cyclophosphamide were marital status and receipt of a kidney transplant. Treatment with cyclophosphamide doubled the prevalence after adjustment for patient characteristics. Over 88% of women reported being pregnant at least once, and about 83% of these had a child, but the majority of pregnancies occurred before diagnosis. CONCLUSIONS: SLE diagnosed in early adulthood may affect women's reproductive health even if they are not treated with cyclophosphamide. Better understanding of other factors related to reproductive health in this population will improve clinicians' and patients' abilities to make treatment and family planning decisions.

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Published by the BMJ Publishing Group Limited.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/).

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