Abstract
Primary Sjögren’s syndrome (pSS) is a progressive systemic autoimmune disorder with a strong female predominance. Hormonal influences are thought to play a role in the development of pSS. However, no studies have specifically evaluated the association between irregular menstrual cycles and pSS. Therefore, using a health claims database, this study investigated the risk of pSS in women with irregular menstrual cycles. We conducted a case–control study using the Taiwan’s National Health Insurance Research Database. A total of 360 patients diagnosed with pSS (International Classification of Diseases, ninth revision, clinical modification, ICD-9-CM code 710.2) between 2001 and 2012 were identified. Controls were frequency-matched at a rate of 5:1 to the cases by five-year age interval and index year. Both cases and controls were retrospectively traced back until 2001 for the diagnosis of irregular menstrual cycles (ICD-9-CM code 626.4). The risk of pSS was assessed using multivariate logistic regression analyses. Irregular menstrual cycles were significantly associated with pSS [adjusted odds ratio, (AOR) = 1.38, p = 0.027], after adjusted for insured amount, urbanization level, and thyroid disorder. In addition, when the data were stratified by three age categories, only the patients in the age category of 45–55 years showed significant association between irregular menstrual cycles and pSS (AOR = 1.74, p = 0.005). In this nationwide, population-based case–control study, we found a significant increased risk of pSS in female patients with irregular menstrual cycles, particularly those in their mid-forties to mid-fifties.
References
Rosenfield RL (2013) Clinical review: adolescent anovulation: maturational mechanisms and implications. J Clin Endocrinol Metab 98(9):3572–3583
Hull MG (1987) Epidemiology of infertility and polycystic ovarian disease: endocrinological and demographic studies. Gynecol Endocrinol 1(3):235–245
Franks S, Adams J, Mason H, Polson D (1985) Ovulatory disorders in women with polycystic ovary syndrome. Clin Obstet Gynaecol 12(3):605–632
Solomon CG, Hu FB, Dunaif A, Rich-Edwards J, Willett WC, Hunter DJ, Colditz GA, Speizer FE, Manson JE (2001) Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus. JAMA 286(19):2421–2426
Solomon CG, Hu FB, Dunaif A, Rich-Edwards JE, Stampfer MJ, Willett WC, Speizer FE, Manson JE (2002) Menstrual cycle irregularity and risk for future cardiovascular disease. J Clin Endocrinol Metab 87(5):2013–2017
Wang ET, Cirillo PM, Vittinghoff E, Bibbins-Domingo K, Cohn BA, Cedars MI (2011) Menstrual irregularity and cardiovascular mortality. J Clin Endocrinol Metab 96(1):E114–E118
Minami Y, Sasaki T, Komatsu S, Nishikori M, Fukao A, Yoshinaga K, Hisamichi S (1993) Female systemic lupus erythematosus in Miyagi Prefecture, Japan: a case-control study of dietary and reproductive factors. Tohoku J Exp Med 169(3):245–252
Costenbader KH, Feskanich D, Stampfer MJ, Karlson EW (2007) Reproductive and menopausal factors and risk of systemic lupus erythematosus in women. Arthritis Rheum 56(4):1251–1262
Reksten TR, Jonsson MV (2014) Sjögren’s syndrome: an update on epidemiology and current insights on pathophysiology. Oral Maxillofac Surg Clin North Am 26:1–12
Weng MY, Huang YT, Liu MF, Lu TH (2011) Incidence and mortality of treated primary Sjogren’s syndrome in Taiwan: a population-based study. J Rheumatol 38:706–708
Skopouli FN, Papanikolaou S, Malamou-Mitsi V, Papanikolaou N, Moutsopoulos HM (1994) Obstetric and gynaecological profile in patients with primary Sjögren’s syndrome. Ann Rheum Dis 53:569–573
Marchesoni D, Mozzanega B, De Sandre P, Romagnolo C, Gambari P, Maggino T (1995) Gynaecological aspects of primary Sjogren’s syndrome. Eur J Obstet Gynecol Reprod Biol 63(1):49–53
Mulherin DM, Sheeran TP, Kumararatne DS, Speculand B, Luesley D, Situnayake RD (1997) Sjögren’s syndrome in women presenting with chronic dyspareunia. Br J Obstet Gynaecol 104(9):1019–1023
Haga HJ, Gjesdal CG, Irgens LM, Ostensen M (2005) Reproduction and gynaecological manifestations in women with primary Sjögren’s syndrome: a case-control study. Scand J Rheumatol 34(1):45–48
National Health Insurance Administration (2014) 2014–2015 National Health Insurance Annual Report. http://www.nhi.gov.tw/Resource/webdata/13767_1_NHI2014-2015%20Annual%20Report%20%28bilingual%29_141230.pdf
National Health Insurance Research Database, Taiwan. http://nhird.nhri.org.tw/en/
Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, Daniels TE, Fox PC, Fox RI, Kassan SS, Pillemer SR, Talal N, Weisman MH, European Study Group on Classification Criteria for Sjögren’s Syndrome (2002) Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American–European Consensus Group. Ann Rheum Dis 61(6):554–558
Lu MC, Yin WY, Tsai TY, Koo M, Lai NS (2013) Increased risk of primary Sjögren’s syndrome in female patients with thyroid disorders: a longitudinal population-based study in Taiwan. PLoS ONE 8(10):e77210
Liu CY, Hung YT, Chuang YL, Chen YJ, Weng WS, Liu JS, Liang KY (2006) Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manage 4:1–22 (in Chinese)
Pasoto SG, Mendonça BB, Bonfá E (2002) Menstrual disturbances in patients with systemic lupus erythematosus without alkylating therapy: clinical, hormonal and therapeutic associations. Lupus 11(3):175–180
Shabanova SS, Ananieva LP, Alekberova ZS, Guzov II (2008) Ovarian function and disease activity in patients with systemic lupus erythematosus. Clin Exp Rheumatol 26(3):436–441
Costenbader KH, Feskanich D, Stampfer MJ, Karlson EW (2007) Reproductive and menopausal factors and risk of systemic lupus erythematosus in women. Arthritis Rheum 56(4):1251–1262
Shen SY, Huang SY, Hsieh CH, Hsu MI, Cheng CY, Hsu CS (2014) Clinical and biochemical characteristics of women with menstrual disturbance. Taiwan J Obstet Gynecol 53(2):178–182
Oertelt-Prigione S (2012) The influence of sex and gender on the immune response. Autoimmun Rev 11(6–7):A479–A485
Ngo ST, Steyn FJ, McCombe PA (2014) Gender differences in autoimmune disease. Front Neuroendocrinol 35(3):347–369
Porola P, Laine M, Virkki L, Poduval P, Konttinen YT (2007) The influence of sex steroids on Sjögren’s syndrome. Ann N Y Acad Sci 1108:426–432
Konttinen YT, Fuellen G, Bing Y, Porola P, Stegaev V, Trokovic N, Falk SS, Liu Y, Szodoray P, Takakubo Y (2012) Sex steroids in Sjögren’s syndrome. J Autoimmun 39(1–2):49–56
Acknowledgments
The study is based in part on data from the National Health Insurance Research Database provided by the National Health Insurance Administration, Ministry of Health and Welfare, and managed by the National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of the National Health Insurance Administration, Ministry of Health and Welfare, or the National Health Research Institutes.
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to declare.
Additional information
Ming-Chi Lu and Min-Chih Hsieh contributed equally to this work.
Rights and permissions
About this article
Cite this article
Lu, MC., Hsieh, MC., Koo, M. et al. Risk of Sjögren’s syndrome in Taiwanese female adults with irregular menstrual cycles: a population-based case–control study. Rheumatol Int 36, 155–160 (2016). https://doi.org/10.1007/s00296-015-3324-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-015-3324-z