Teprotumumab associated menstrual changes

PURPOSE: To evaluate the incidence and characteristics of menstrual changes associated with teprotumumab treatment for thyroid eye disease (TED). METHODS: A retrospective chart review of female patients receiving teprotumumab treatment was performed across three institutions between 1/2020 and 12/2023. Data collection included age, thyroid status, hormonal contraception use, pre- and post-treatment clinical activity score, adverse events, and type of menstrual changes. If menstrual changes occurred, further data collection included onset and duration of menstrual changes. RESULTS: Fifty-one patients were included with a mean age of 37 years (range 18-51). Changes in menstruation occurred in 28 patients (55%). Among these patients, 21 (75%) had amenorrhea, 6 (21%) had oligomenorrhea, and 1 (4%) had dysmenorrhea. The average number of days between first infusion and first change in menstruation was 58 days (range 7-150), and between last infusion and return to normal menstruation was 155 days (range 6-405). Four patients (14%) did not have a return to normal menstruation at time of last follow-up (mean 9 months, range 6-11 months). Overall mean follow-up was 16 months after last infusion. CONCLUSIONS: Menstrual changes occurred in 55% of menstruating females receiving teprotumumab therapy. The most common changes were amenorrhea and oligomenorrhea. The majority of patients regained normal menstruation after cessation of therapy. It is important for providers to be aware of this potential adverse event when treating menstruating women with TED.