How to manage lupus nephritis with menstrual irregularities?

Question

Hello Doctor,

I am 28 years old and was diagnosed with systemic lupus erythematosus last year. My recent kidney biopsy revealed class III lupus nephritis. I have started on Mycophenolate mofetil (an immunosuppressive agent) and low-dose glucocorticoids (steroids). My serum creatinine level is 1.3 milligrams per deciliter, and my 24-hour urine protein excretion is 1.4 grams per day.

Since beginning treatment, my menstrual cycles have become irregular. Could this be a known side effect of Mycophenolate mofetil or glucocorticoids, or is it more likely associated with systemic lupus erythematosus itself? Additionally, what aspects should I ask my rheumatologist to monitor more closely regarding kidney function and the potential effects on fertility while I am on these medications?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your concerns are valid. However, as mentioned earlier, you must consult a rheumatologist. Although you are currently under urological care, the management of systemic lupus erythematosus and lupus nephritis primarily falls within the expertise of rheumatology and sometimes nephrology, not urology. That said, I can still help clarify some aspects to discuss with your rheumatologist. Irregular menstrual cycles can have several potential causes.

Glucocorticoids, such as Prednisone, are known to affect hormonal balance and may contribute to irregular periods., Systemic lupus erythematosus itself can disrupt the hypothalamic-pituitary-ovarian axis, impacting menstrual regularity. While Mycophenolate mofetil is not commonly linked to menstrual changes, rare indirect effects may occur. In your case, the irregularity is more likely due to the underlying disease or the use of steroids rather than Mycophenolate mofetil.

Your rheumatologist will monitor kidney function through serum creatinine, estimated glomerular filtration rate, proteinuria (24-hour collection or spot protein-to-creatinine ratio), urinalysis for blood, casts, and dysmorphic red blood cells, along with autoimmune markers such as anti-double-stranded DNA antibodies and complement levels (C3, C4), and ensure proper blood pressure control.

Regarding reproductive health, you may want to assess ovarian reserve through anti-Müllerian hormone (AMH) levels and consider checking other hormones such as follicle-stimulating hormone, luteinizing hormone, estradiol, and prolactin, especially if fertility is a concern. Keeping track of menstrual cycles and seeking a gynecologist or endocrinologist referral may also be helpful.

It is crucial to note that Mycophenolate mofetil is teratogenic and not safe during pregnancy, so reliable contraception is necessary. If pregnancy is a future goal, transitioning to a safer alternative like Azathioprine may be discussed. You may wish to ask your rheumatologist about the frequency of kidney monitoring, evaluation of ovarian reserve, plans for tapering steroids, and when to consider changing medications for pregnancy planning. Lastly, I want to emphasize that these concerns lie outside the scope of urology, so you must follow up in person with a rheumatologist for appropriate management.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.