Recent advances in HIV treatment have allowed more HIV-infected women to live through and past menopause. But not much is known about the effects of HIV on menopause.
A recent review looked at current data on HIV and menopause. Evidence suggests that HIV-infected women experience menopause earlier, with more intense and frequent symptoms.
The review showed that postmenopausal women with HIV were more at risk for heart attack, heart disease and fractures due to low bone density than women without HIV. Continual use of some antiretroviral therapy (ART) — which is used to treat HIV — has been found to increase the risk of these conditions.
The authors of this review recommended that doctors offer individual counseling that considers the unique health needs of this population. The authors also suggested that more research is needed to better understand the effects of ART on menopause symptoms in women with HIV.
The lead author of this review was Rupa Kanapathipillai, MBBS, FRACP (Fellow of the Royal Australasian College of Physicians), from the Infectious Diseases Unit of the Alfred Hospital in Prahran, Victoria, Australia.
Some evidence has suggested that HIV-infected women go through menopause earlier, but Kanapathipillai and colleagues explained that information on HIV and menopause is limited because previous studies have varied in their methods and study populations.
The authors stated that a major issue in confirming the association between HIV and menopause is the lack of consistent definitions of menopause.
Menopause is when a woman's periods stop and the female hormone production in her ovaries greatly decreases. Sometimes this is followed by irregular bleeding.
HIV-infected women experience more irregular bleeding in general. As such, the standard definitions of menopause may not apply to HIV-infected women.
Previous research has also suggested that HIV-infected women have more intense and frequent symptoms of menopause — particularly depression, hot flashes and night sweats.
The review authors explained that many HIV-infected people also have an increased risk of high cholesterol levels, diabetes and high levels of triglycerides (a type of fat that circulates in the blood), and therefore are more at risk for heart attacks and heart disease.
The review also revealed that the continual use of ART has been reported previously to increase these factors associated with heart attacks and heart disease.
Fractures and weak bones due to lower bone density also have been connected previously to menopause. The authors pointed to a previous analysis of multiple studies which reported that HIV-infected people were three times more likely than those without HIV to suffer from bone disease.
The authors of the current review noted that the association between HIV and fractures is limited and conflicting, and therefore needs further research.
Current international guidelines suggest that HIV-infected, postmenopausal women consider the use of hormone therapy for issues such as hot flashes and night sweats.
Kanapathipillai and colleagues recommended individual counseling on the risks and benefits of hormone therapy, as well as psychological therapy to treat hot flashes and night sweats.
They noted that data on the effectiveness, safety and proper dosing of hormone therapy and psychological medication is lacking, especially regarding potential medication interactions.
Some studies have suggested the use of vitamin D, calcium and/or hormone therapy has helped reduce the risk of bone disease in HIV-infected women. The authors of this review suggested that more research is needed on the issue.
Ultimately, this review highlighted the belief that HIV-infected women going through menopause are a very unique population that needs special consideration. The authors advised doctors to consider traditional and HIV-specific management of heart disease, bone disease and issues such as hot flashes and night sweats.
Overall, the authors see an urgent need for further research on the treatment of menopausal symptoms in HIV-infected women.
This review article was published in the September edition of Menopause.