Menorrhagia and severe menstrual pain related to the use of adalimumab in a psoriatic

The case is reported of a 32-year-old morbidly obese white woman who used adalimumab 40 mg every other week for 4 months for psoriatic arthritis, psoriasis vulgaris and inverse psoriasis with total clearance of her psoriasis who developed menorrhagia (at least twice the number of pads used daily for 4-6 days as opposed to 3-5 days previously) and severe menstrual pain. Treatment with Aviane (R) (ethinyl estradiol and levonorgestrel) abated some of these menstrual symptoms. The symptoms resolved altogether when the adalimumab was discontinued. Menstrual disorders are listed as possible side effects from the use of infliximab and adalimumab in their respective package inserts and also for adalimumab and etanercept in the United Kingdom's Medicines and Healthcare products Regulatory Agency's drug side-effect database, but few case reports of menstrual side effects exist from including tumor necrosis alpha (TNF alpha) blockers. Physicians should be aware of the menstrual side effects of adalimumab and the role of oral contraceptive pills in treating such menstrual side effects.