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Menstruation may not act as a uniform trigger for familial Mediterranean fever flares in adolescents, as many self-reported attacks likely reflect premenstrual syndrome or primary dysmenorrhea rather than true systemic inflammation.
When an adolescent with familial Mediterranean fever (FMF) experiences pain during menstruation, an important clinical question arises: Is it a genuine autoinflammatory flare or menstrual discomfort?
A prospective cross-sectional study issued in "Rheumatology" scrutinized this overlap, examining whether menstruation triggers FMF attacks or whether primary dysmenorrhoea and premenstrual symptoms contribute to the reported episodes. The study, led by Feray Kaya et al., recruited 42 FMF-affected adolescents. Researchers classified attacks via the Eurofever/Pediatric Rheumatology International Trials Organization (PRINTO) criteria and assessed C-reactive protein (CRP) levels during attacks and menstruation.
Premenstrual symptoms were evaluated via the Premenstrual Symptoms Screening Tool. The key outcomes were as follows:
These insights emphasize that menstruation does not consistently provoke autoinflammatory attacks in adolescent FMF patients. Instead, overlapping symptoms like pelvic pain, fatigue, and mood fluctuations during menses may often stem from primary dysmenorrhea or PMDD/PMS rather than true systemic inflammation. Clinicians are encouraged to examine inflammatory biomarkers like CRP during suspected menstrual flares to avoid unnecessary treatment escalation and to properly handle the underlying gynecological and premenstrual health symptoms.
Rheumatology (Oxford)
Menstruation in adolescents with familial Mediterranean fever: attack trigger or dysmenorrhoea? A prospective cross-sectional study
Feray Kaya et al.
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