title: Unexplained amenorrhea in a patient taking methotrexate for the treatment of rheumatoid arthritis.
abstract: BACKGROUND
  The cause of secondary amenorrhea in the following case cannot be explained by traditional etiologies. We therefore questioned whether long-term methotrexate treatment played a role as an endometrial inhibitor.
  
  
  METHODS
  A 44-year-old G4P2, with a 5-year history of rheumatoid arthritis, presented with a 2-year history of secondary amenorrhea. The patient took methotrexate since diagnosis. Her FSH, estrogen, prolactin, TSH and T4 levels were normal, her B-HCG was negative, her BMI was 22 and she had no history of Asherman's syndrome.
  
  
  CONCLUSIONS
  There is no information, based on our search, on whether long-term methotrexate treatment has an effect on the menstrual cycle. This case highlights the need for the elucidation of the effects of long-term methotrexate treatment on the menstrual cycle in patients with rheumatoid arthritis.
authors.affiliation: Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Toronto, Ontario, Canada. jamie.kroft@utoronto.ca
authors.forename: Jamie
authors.initials: J
authors.lastname: Kroft
authors.forename: Sally
authors.initials: S
authors.lastname: Sabra
authors.forename: Rebecca
authors.initials: R
authors.lastname: Arthur
authors.forename: Wendy
authors.initials: W
authors.lastname: Wolfman
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000139:chemically induced*; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate