Primary Sjogren’s syndrome (pSS) is a systemic autoimmune disease that mainly affects the exocrine gland, especially in women. Currently, the results of studies on the menstruation or fertility of pSS patients remain controversial. This study aimed to examine the menstrual and reproductive characteristics of pSS patients.
Clinical data of 449 pSS patients who were admitted to Tongji Hospital in Hubei, China, from January 2015 to November 2021 were obtained and their menstrual and reproductive information analyzed. In addition, the clinical features of pSS patients with premenopausal or postmenopausal onset were compared.
The spontaneous abortion rate of pSS patients was not higher than the reported rate of the general population and that the age of menarche, menstrual cycle, and menstrual period of pSS patients did not significantly differ from those reported in the general population; however, early menopause seemed to be more common in pSS patients. Skin involvement (27.96% vs. 15.00%, P=0.005) and hyperglobulinemia (10.64% vs. 4.16%, P=0.033) were more common in patients with premenopausal pSS onset, but patients with postmenopausal onset had a significantly greater incidence of interstitial lung disease (32.50% vs. 17.02%, P=0.0004). Also, erythropenia (47.00% vs. 31.25%, P=0.002), hypoalbuminemia (19.49% vs. 8.22%, P=0.0009), and prevalence of high hypersensitive C-reactive protein levels (21.67% vs. 10.94%, P=0.005) were more common in pSS patients with postmenopausal onset. Notably, the rate of abnormal pregnancy was significantly greater in patients with premenopausal onset (9.72% vs. 2.50%, P=0.011).
Patients with pSS onset before or after menopause may have different risks in pulmonary involvement and laboratory manifestations.
Shiboski CH, Shiboski SC, Seror R, et al. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjogren’s Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Arthritis Rheumatol, 2017,69(1):35–45
Brito-Zerón P, Baldini C, Bootsma H, et al. Sjögren syndrome. Nat Rev Dis Primers, 2016,2:16047
Fox RI. Sjögren’s syndrome. Lancet, 2005,366(9482): 321–331
De Carolis S, Salvi S, Botta A, et al. The impact of primary Sjogren’s syndrome on pregnancy outcome: our series and review of the literature. Autoimmun Rev, 2014,13(2):103–107
Ballester C, Grobost V, Roblot P, et al. Pregnancy and primary Sjögren’s syndrome: management and outcomes in a multicentre retrospective study of 54 pregnancies. Scand J Rheumatol, 2017,46(1):56–63
Hussein SZ, Jacobsson LT, Lindquist PG, et al. Pregnancy and fetal outcome in women with primary Sjogren’s syndrome compared with women in the general population: a nested case-control study. Rheumatology (Oxford), 2011,50(9):1612–1617
Elliott B, Spence AR, Czuzoj-Shulman N, et al. Effect of Sjögren’s syndrome on maternal and neonatal outcomes of pregnancy. J Perinat Med, 2019,47(6):637–642
McCoy SS, Sampene E, Baer AN. Association of Sjögren’s Syndrome With Reduced Lifetime Sex Hormone Exposure: A Case-Control Study. Arthritis Care Res (Hoboken), 2020,72(9):1315–1322
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, 2016,36(1):155–160
Upala S, Yong WC, Sanguankeo A. Association between primary Sjögren’s syndrome and pregnancy complications: a systematic review and meta-analysis. Clin Rheumatol, 2016,35(8):1949–1955
Haga HJ, Gjesdal CG, Irgens LM, et al. Reproduction and gynaecological manifestations in women with primary Sjögren’s syndrome: a case-control study. Scand J Rheumatol, 2005,34(1):45–48
Pasoto SG, Augusto KL, Alvarenga JC, et al. Cortical bone density and thickness alterations by high-resolution peripheral quantitative computed tomography: association with vertebral fractures in primary Sjögren’s syndrome. Rheumatology (Oxford), 2016,55(12):2200–2211
Balarini GM, Zandonade E, Tanure L, et al. Serum calprotectin is a biomarker of carotid atherosclerosis in patients with primary Sjögren’s syndrome. Clin Exp Rheumatol, 2016,34(6):1006–1012
Zheng D, Li C, Wu T, et al. Factors associated with spontaneous abortion: a cross-sectional study of Chinese populations. Reprod Health, 2017,14(1):33
Hu CY, Yang XJ, Hua XG, et al. Risk factors for spontaneous abortion from a prevention perspective in rural China: a population-based follow-up study. J Matern Fetal Neonatal Med, 2021,34(16):2583–2591
Zeng LX, Yan H, Chen ZJ. Study on the current status and risk factors of spontaneous abortion of women at reproductive age in rural areas of Xianyang district, Shaanxi province. Zhonghua Liu Xing Bing Xue Za Zhi (Chinese), 2007,28(1):19–23
Su Y, Xie X, Zhou Y, et al. Association of induced abortion with hypertensive disorders of pregnancy risk among nulliparous women in China: a prospective cohort study. Sci Rep, 2020,10(1):5128
Wang C. Induced abortion patterns and determinants among married women in China: 1979 to 2010. Reprod Health Matters, 2014,22(43):159–168
Tang L, Wu S, Liu D, et al. Repeat Induced Abortion among Chinese Women Seeking Abortion: Two Cross Sectional Studies. Int J Environ Res Public Health, 2021,18(9):4446
Wang X, Wu J, Li Y, et al. Changes in the Prevalence of Induced Abortion in the Floating Population in Major Cities of China 2007–2014. Int J Environ Res Public Health, 2019,16(18):3305
Zhou Z, Zheng D, Wu H, et al. Epidemiology of infertility in China: a population-based study. Bjog, 2018,125(4):432–441
He Y, Zheng D, Shang W, et al. Prevalence of oligomenorrhea among women of childbearing age in China: A large community-based study. Womens Health (Lond), 2020,16:1745506520928617
Liang S, Chen Y, Wang Q, et al. Prevalence and associated factors of infertility among 20–49 year old women in Henan Province, China. Reprod Health, 2021,18(1):254
Honigberg MC, Zekavat SM, Aragam K, et al. Association of Premature Natural and Surgical Menopause With Incident Cardiovascular Disease. Jama, 2019,322(24):2411–2421
Honigberg MC, Patel AP, Lahm T, et al. Association of premature menopause with incident pulmonary hypertension: A cohort study. PloS One, 2021,16(3):e0247398
Shifren JL, Gass ML. The North American Menopause Society recommendations for clinical care of midlife women. Menopause, 2014,21(10):1038–1062
Shiboski CH, Shiboski SC, Seror R, et al. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren’s syndrome: A consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis, 2017,76(1):9–16
Harbuz MS, Chover-Gonzalez AJ, Jessop DS. Hypothalamo-pituitary-adrenal axis and chronic immune activation. Ann N Y Acad Sci, 2003,992:99–106
LaBarbera AR, Miller MM, Ober C, et al. Autoimmune etiology in premature ovarian failure. Am J Reprod Immunol Microbiol, 1988,16(3):115–122
Madhusudan D, Raju A, Vijaya N. Correlation of Maternal Autoantibodies with Fetal Congenital Heart Block. J Obstet Gynaecol India, 2016,66(Suppl 1):112–116
Anami A, Fukushima K, Takasaki Y, et al. The predictive value of anti-SS-A antibodies titration in pregnant women with fetal congenital heart block. Mod Rheumatol, 2013,23(4):653–658
Augusto KL, Bonfa E, Pereira RM, et al. Metabolic syndrome in Sjögren’s syndrome patients: a relevant concern for clinical monitoring. Clin Rheumatol, 2016,35(3):639–647
Kirshenbaum M, Orvieto R. Premature ovarian insufficiency (POI) and autoimmunity-an update appraisal. J Assist Reprod Genet, 2019,36(11):2207–2215
Straub RH. The complex role of estrogens in inflammation. Endocr Rev, 2007,28(5):521–574
Al-Lami RA, Urban RJ, Volpi E, et al. Sex Hormones and Novel Corona Virus Infectious Disease (COVID-19). Mayo Clin Proc, 2020,95(8):1710–1714
Honma N, Hosoi T, Arai T, et al. Estrogen and cancers of the colorectum, breast, and lung in postmenopausal women. Pathol Int, 2015,65(9):451–459
Hsu LH, Chu NM, Kao SH. Estrogen, Estrogen Receptor and Lung Cancer. Int J Mol Sci, 2017,18(8)
Spratt DI, Buchsbaum RJ. COVID-19 and Hypercoagulability: Potential Impact on Management with Oral Contraceptives, Estrogen Therapy and Pregnancy. Endocrinology, 2020,161(12): bqaa121
We are very grateful to all the staff working in the Department of Medical Records of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, for their help in this study.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Author Ling-li DONG is a member of the Editorial Board for [Current Medical Science]. The paper was handled by other editors and has undergone rigorous peer review process. Author Ling-li DONG was not involved in the journal’s review of, or decisions related to, this manuscript.
Rights and permissions
About this article
Cite this article
Zhu, Yz., Zhong, Jx. & Dong, Ll. Menstrual and Reproductive Characteristics of Patients with Primary Sjogren’s Syndrome: A 7-year Single-center Retrospective Study. CURR MED SCI 43, 139–145 (2023). https://doi.org/10.1007/s11596-022-2675-4
- primary Sjogren’s syndrome
- clinical features