Menopause And HIV

Many years back, researchers investigated the menopausal phase in women who were HIV positive. This study was conducted at the Albert Einstein College. In HIV negative and otherwise healthy women, menopausal phase begins after they reach 50’s. however, in HIV positive women, the occurrence of menopausal symptoms depends on the following factors:

• Having a low paying job
• Tobacco smoking
• Using street drugs/drug abuse
• Reduced physical activity
• Reduced counts of CD4+ cells

Few studies suggest that menopause is likely to occur earlier in black women as compared to white women.

Symptoms Associated With Menopause

A menopausal woman may experience symptoms such as:

• Tenderness of breasts
• Sexual dysfunction
• Dryness of vagina and surrounding area
• Mood swings
• Headache
• Forgetfulness
• Difficulty in concentrating
• Disturbed sleeping pattern
• Night sweats and hot flashes

According to some studies, HIV positive females are much more likely to experience severe symptoms than HIV- negative females. The reason behind this observation remains unknown. Another study found that many HIV positive women do not tend to report their symptoms to the doctor because they are not sure whether the symptoms are associated with the menopause or to another health condition.

Effect On The Hormones

With menopause comes hormonal changes such as increased levels of follicle stimulating hormone (FSH) and luteinizing hormone levels (LH) in the serum; whereas estrogen levels go down. A study based on a small sample of 15 HIV negative females and 82 HIV positive females revealed that this virus was not found to produce any significant effect on the following hormones:

• TSH (thyroid stimulating hormone)
• Prolactin
• Estrogen

A different study also claimed that prolactin and estrogen remain unaffected by the antiretroviral therapy as well.

Effect On The Bone Health

Studies have revealed that HIV negative women are less prone to bone thinning as compared to HIV positive women. Studies also suggested that HIV positive women have increased likelihood of developing Vitamin D deficiency.

It has been found that ART (anti-HIV treatment) causes no effect on the bones and do not promote loss of bones in the long run.

Effect On The Cardiovascular Health

Researchers speculate that there is a positive association between HIV status and potential risk of developing CVD (cardiovascular disease). The infection exacerbates the persistent inflammation which may explain the high CVD risk. Estrogen tends to exhibit anti-inflammatory effect and since the estrogen levels go down in menopausal women, they become more prone to inflammatory effects. Other factors that also increase the susceptibility, can at times be taken care of by adopting healthy lifestyle changes. Some poor lifestyle choices that may worsen the CVD risk are:

• Smoking tobacco
• Substance use
• Reduced physical activity
• Obesity
• High blood pressure
• Type 2 diabetes
• High serum triglycerides and cholesterol levels

Effect On The Brain

Menopause has been linked with neuro-cognitive changes like forgetfulness and inability to concentrate or think clearly. It is speculated that difficulty in sleeping may promote memory associated problems. Mood swings are also very common in menopausal women.

Approaches To Healthy Life

Simple life style changes can help improve the overall health conditions. These include:

• Minimal consumption of alcohol
• Reduced substance use
• Following a healthy diet rich in nutrition
• Getting treatment for the co-morbidities
• Socializing and building strong social circles
• Increased physical activities
• Practicing de-stressing activities like yoga, meditation
• Indulging in activities that triggers the thinking process and require concentration

References

• Chirwa, M., Ma, R., Guallar, C., & Tariq, S. (2017). Managing menopause in women living with Human Immunodeficiency Virus: A survey of primary care practitioners. Post Reproductive Health, 2053369117712181.
• Calvet, G. A., Grinsztejn, B. G. J., Quintana, M. D. S. B., Derrico, M., Jalil, E. M., Cytryn, A., ... & Friedman, R. K. (2015). Predictors of early menopause in HIV-infected women: a prospective cohort study. American journal of obstetrics and gynecology, 212(6), 765-e1.