ArticleInternal and emergency medicine2026
Menstrual characteristics among rheumatoid arthritis patients receiving Janus kinase inhibitor, biologics, or methotrexate.
Article in Internal and emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Rheumatoid arthritis (RA) affects women during reproductive years, yet menstrual outcomes under disease-modifying antirheumatic drugs remain poorly investigated. Because the JAK-STAT pathway regulates both immunity and ovarian function, Janus kinase inhibitors (JAKi) might influence menstrual health. We performed a cross-sectional, retrospective study of reproductive-aged women with RA attending rheumatology and gynecology clinics. Eligible participants had been receiving stable therapy for at least three months. Treatment categories included JAKi, Tumor necrosis factor inhibitors (anti-TNF) agents, non-anti-TNF biologics, and methotrexate. A structured questionnaire retrospectively assessed menstrual characteristics prior to therapy and during treatment. Outcomes included amenorrhea, cycle frequency, flow, menorrhagia, and metrorrhagia. Standardized definitions were applied, and analyses included chi-square tests, McNemar's test, and logistic regression adjusting for disease activity. The cohort included 100 women with RA. Amenorrhea occurred in 10%, metrorrhagia in 18%, menorrhagia in 10%, and altered cycle frequency in 41%. A significant within-patient increase in amenorrhea was observed during therapy (p = 0.04), but no between-group differences were detected. Multivariable regression adjusting for BMI and disease activity confirmed that JAKi were not independently associated with amenorrhea compared with other treatments (adjusted OR 1.82, 95% CI 0.46-7.29). Menstrual disturbances affected a minority of patients across all treatment groups. These findings suggest that JAKi do not negatively impact menstrual health.
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