Reproductive Life Stages Drive Meaningful Changes in Uveitis Activity, Study Finds

Noninfectious uveitis activity in female patients shifts meaningfully across reproductive life stages, with early puberty and perimenopause standing out as key periods of increased relapse risk, according to new data published in the American Journal of Ophthalmology. In this retrospective, cross-sectional analysis, investigators evaluated whether uveitis behavior changes across reproductive life stages and whether these patterns differ by sex. The registry sample included 425 female patients with noninfectious uveitis and 275 male controls enrolled in the AIDA Network Uveitis Registry between 2020 and 2025. Researchers analyzed uveitis patterns across the lifespan, revealing how reproductive life stages influence disease activity. This chart from the study shows the proportions of subjects with disease duration greater than 12 months who received systemic or regional therapies stratified by reproductive life stages. (bDMARDs: biologic disease-modifying anti-rheumatic drugs, cDMARDs: conventional disease-modifying anti-rheumatic drugs, tsDMARDs: targeted synthetic disease-modifying anti-rheumatic drugs). Photo: Gaggiano C, et al. Am J Ophthalmol. November 14, 2025. Click image to enlarge. Reproductive life stages were assigned using epidemiologically derived age intervals: pre-pubertal, early puberty, late puberty, reproductive, perimenopausal and post-menopausal. Researchers evaluated several outcomes, including flare frequency, anterior chamber cells and flare, vitreous haze, new posterior segment inflammatory signs and immunosuppressive treatment exposure.Data showed that relapse rates varied by life stage, with a notable interaction between sex and reproductive life stage. Women demonstrated a distinct perimenopausal peak in activity that was not mirrored in men. Median 12-month relapse counts were highest in early puberty and perimenopause, while late puberty and post-menopause had comparatively lower activity.Among patients with active anterior involvement, anterior chamber cell grades were significantly higher in pre-pubertal and early pubertal groups. Additionally, immunosuppressive treatment exposure was significantly higher in pre-puberty and puberty than in other life stages.The researchers emphasized that these findings have important implications for everyday practice. The early pubertal peak, combined with higher immunosuppressive treatment exposure in this age group, highlights the need for tighter surveillance and thoughtful therapeutic planning in adolescent patients. According to the researchers, clinicians must consider the rapidly changing hormonal environment, growth dynamics and the potential for inconsistent adherence when balancing efficacy with long-term safety. The sex-specific activity increase in perimenopause suggests that midlife women represent another vulnerable population, they added, while highlighting the importance of proactive monitoring, patient education and timely therapeutic adjustments when needed. “Taken together, these insights support a model in which reproductive life stages function as a clinically relevant modifier of uveitis activity, which should be explicitly integrated into patient education, risk stratification, and individualized treatment planning,” the study authors concluded in their American Journal of Ophthalmology paper. Click here for the journal source. Gaggiano C, De-la-Torre A, Guerriero S, et al. Reproductive life stages and female sex-specific patterns in uveitis activity: data from the AIDA Network Uveitis registry. Am J Ophthalmol. November 14, 2025 [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.