Thalidomide-Induced Primary Amenorrhea in a Patient With HbE/Beta-Thalassemia

Area of Science:

• Reproductive Endocrinology
• Hematology

Background:

• A case study of an 18-year-old female with hemoglobin E (HbE)/beta-thalassemia presenting with primary amenorrhea.
• The patient required monthly blood transfusions for her condition and was treated with thalidomide at age 12 to reduce transfusion needs.

Observation:

• Thalidomide treatment rendered the patient transfusion-independent within 6 months.
• Despite normal physical maturation, the patient failed to achieve menarche, exhibiting elevated gonadotropins and primary ovarian dysfunction, characterized by absent ovarian follicles on ultrasound.
• The patient's karyotype was 46,XX, with no urogenital abnormalities.

Findings:

• Upon cessation of thalidomide, the patient experienced spontaneous menarche within 3 months, followed by regular menstrual cycles.
• Follow-up ultrasounds revealed the reappearance of ovarian follicles and increased ovarian volume, suggesting recovery of ovarian function.

Implications:

• This case highlights a potential adverse effect of thalidomide on ovarian function, leading to reversible primary ovarian dysfunction and amenorrhea.
• Further research is needed to elucidate the mechanistic links between thalidomide and ovarian dysfunction, possibly involving impaired folliculogenesis or vascular compromise.