Impact of Phases of Menstrual Cycle on Patient‐Reported Outcomes in Females With Lupus: A Narrative Review

The objective of this narrative review is to synthesize existing evidence on menstrual‐cycle‐associated variation in patient‐reported outcomes (PROs) in reproductive‐aged women with systemic lupus erythematosus (SLE), integrate comparative findings from disease controls and nondisease controls, identify clinical implications, and indicate directions for future studies. A review of the literature was conducted using PubMed, Medline (Clarivate), JISC Library Hub, PsychINFO, and Web of Science. Inclusion criteria included articles referencing women with SLE, PROs, and menstrual cycle phases. Database research conducted yielded 74 articles with 34 meeting inclusion criteria. Key findings from the review include: (1) biologic plausibility for phase‐linked activity: estrogen signaling via type‐I IFN pathways amplifies proinflammatory cytokine production whereas progesterone decreases this effect. Premenstrual decline may remove this protection. Furthermore, gene expression and peripheral immune cell phenotypes vary with phases of menstrual cycle. (2) Pattern of symptom fluctuation: across studies, premenstrual and menstrual phases are associated with increased pain, fatigue, and mood disturbances. Several observational cohorts report significant worsening of visual analog score pain or fatigue and disease activity scores during menses compared with postovulatory phases. Rheumatoid arthritis and fibromyalgia (FM) cohorts suggest similar findings; FM shows the largest increase in widespread pain with changes in menstrual cycle. Female athlete studies corroborate cycle‐related fluctuations in energy, mood, and pain sensitivity. Menstrual cycle phase is a clinically relevant modulator of impairment to quality of life in reproductive‐aged women with SLE. Recognition of cyclical patterns can improve the interpretation of patient‐reported outcome measure score, reduce misclassification of flares, and support personalized management strategies. Integration of menstrual phase data into routine clinical assessment and trial design is warranted.