title: Menstrual and hormonal alterations in juvenile dermatomyositis.
abstract: OBJECTIVE
  To evaluate age at menarche, menstrual cycles and hormone profile in juvenile dermatomyositis (JDM) patients and controls.
  
  
  METHODS
  Twelve consecutive JDM patients were compared to 24 age-matched healthy subjects. Age at menarche and age of maternal menarche were recorded. Menstrual cycle was evaluated prospectively for 6 consecutive months and the mean cycle length and flow were calculated. The hormone profile was collected on the last menstrual cycle. Demographic data, clinical features, muscle enzymes, JDM scores and treatment were analysed.
  
  
  RESULTS
  The median of current age of JDM patients and controls was similar (18 vs. 17 years, p=0.99). The median age at menarche of the JDM patients was higher than in the control group (13 vs. 11 years, p=0.02) whereas the median age of maternal menarche was alike in both groups (12 vs. 13 years, p=0.67). Menstrual disturbances were not observed, except for one patient who had longer length of menstrual cycle. The median of follicle stimulating hormone (FSH) was significantly higher in JDM patients compared to controls (4.5 vs. 3.0 IU/L, p=0.02) and none of them had premature ovarian failure (POF). The median of progesterone was significantly lower in JDM patients (0.3 vs. 0.7 ng/mL, p=0.01) with a higher frequency of decreased progesterone compared to controls (75% vs. 29%, p=0.01).
  
  
  CONCLUSIONS
  Our study identifies in JDM patients delayed menarche with normal cycles and low follicular reserve. The decreased progesterone levels may suggest an underlying subclinical corpus luteum dysfunction in this disease.
authors.affiliation: Paediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. nadia.aikawa@gmail.com
authors.forename: N E
authors.initials: NE
authors.lastname: Aikawa
authors.forename: A M E
authors.initials: AM
authors.lastname: Sallum
authors.forename: M M
authors.initials: MM
authors.lastname: Leal
authors.forename: E
authors.initials: E
authors.lastname: Bonfá
authors.forename: R M R
authors.initials: RM
authors.lastname: Pereira
authors.forename: C A A
authors.initials: CA
authors.lastname: Silva
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D003338:Corpus Luteum / Q000503:physiopathology; D003882:Dermatomyositis / Q000097:blood* / Q000503:physiopathology*; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008572:Menarche / Q000502:physiology; D008597:Menstrual Cycle / Q000502:physiology*; D018482:Muscle, Skeletal / Q000201:enzymology; D006080:Ovarian Follicle / Q000503:physiopathology; D011374:Progesterone / Q000097:blood*; D013739:Testosterone / Q000097:blood; D055815:Young Adult
chemical_list: D013739:Testosterone; D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone