MENSTRUATION-RELATED DISORDERS IN WOMAN WITH RHEUMATIC DISEASE (RDS): BLEEDING AND PAIN

Introduction. Gynaecological and reproductive \nhealth is an integral part of well-being in women \nfrom menarche to menopause and monthly menstruation characterizes women’s life. In rheumatic \ndiseases (RDs), gynecological problems are often \nneglected even if they may therefore have a negative impact on quality of life. \nAim: The aim of this study was to describe gynecological symptoms in premenopausal women with \nRDs and evaluate their impact on quality of life. \nPatients and Methods. A monocentric, cross-sectional observational study was conducted in the \nRheumatology Department of Careggi Hospital in Florence. Inclusion criteria were diagnosis \nof RDs, female gender, and premenopausal age. \nGynecological anamnesis was obtained, symptoms were investigated, and all patients filled up \na self-administered validated questionnaire. RDs \ngroup were also compared to a control group (HC) \nof 305 age matched health female. \nResults. From September 1st, 2020 to February 21 st, 2021, 200 patients were enrolled (mean \nage 39.1±8.7 years (M±SD)): 58% arthritis, 40% \nconnective tissue disease and 1.5% systemic \nvasculitides. In family history, heavy menstrual \nbleeding (HMB), dysmenorrhea, or chronic pelvic \npain were reported in 59%, 55 and 7% of patients, \nrespectively. Mostly woman reported menstrual \ndisorders during adolescence (56% experienced \ndysmenorrhea and 52% HMB). Menstrual disorders and abnormal bleeding were frequently \nreported also in adulthood: 71% had dysmenorrhea and 47% reported HMB. Moreover, 26% of \npatients referred non- menstrual pelvic pain, 19% \nurinary pain and 18% pain during defecation. Vaginal symptoms were frequent: 36% of patients \nreferred vaginal dryness, 29% burning, 19% recurrent vaginal infections and 39% dyspareunia. \nUterine fibroma was present in 23% and endometriosis in 10% of patients. Comparing RDs to HC, \nmenstrual disorders were significantly different in \nthe two groups. HMB was more frequent in the RDs group respect to the HC both during adolescence (55.6% and 25.4%, respectively; p=0.0001) and adult age (37.7% and 25.9%, respectively; p=0.0065). In adulthood, also dysmenorrhea was higher in Rs group respect to HC (51.7% and 45.4%, respectively; p=0.1971). RDs patients reported also dyspareunia with higher frequency than HC (17.9% and 8.1%; p=0.0022). Quality of life in RDs patients was lower than in HC women, in both physical and mental domains of SF-12: SF-physical was 41.5±12.4 and 51.2±6.0, respectively, p=0.0001; SF-mental was 44.7±11.2 and \n47.6±9.0, respectively, p=0.0014. \nConclusions. Young premenopausal women with RDs frequently reported menstrual disorders \n(dysmenorrhea and HMB) that were significantly greater in RDs patients than in HC population \nin both adolescence and adulthood and they may therefore have a negative impact on quality of life. \nFor this reason, RDs patient should be always referred for an accurate evaluation of the gynaecological aspects (menstruation, fertility, maternity,bsexuality).