Little Known About Timing of Menopause in Women With HIV
As the life expectancy of people living with HIV increases due to more effective care and treatment, there is an increasing focus on the presentation and management of conditions associated with aging. For all older women, menopause presents a physiological change whose management has undergone dramatic changes over the last few years as a result of studies questioning the safety of hormone replacement therapy (HRT). Data on the presentation and management of menopause in older women living with HIV have been limited. Unanswered questions that remain include the impact of HIV on the timing and presentation of menopause, and the optimal management strategy in the era of highly active antiretroviral therapy (HAART) and no HRT.
To try to shed more light on this issue, Fantry and colleagues interviewed 120 women living with HIV to better understand the timing of menopause and its associated symptoms in these women. Areas covered included obstetrical history, symptoms, demographics and drug use. Women were chosen who were pre-, peri- and post-menopausal, and were over the age of 40. Post-menopausal was defined as having no menses, peri-menopausal as having 1-11 menses and pre-menopausal as having 12 menses in the past year.
Among the women interviewed, the average age was 45.5 (range 40-57). The study population included 95% African Americans and 58% on antiretroviral therapy. Forty-nine percent of the women were pre-menopausal, 26% peri-menopausal and 25% post-menopausal. The median age at menopause was reported as 50.
The authors examined a number of symptoms in the 3 groups of women. Vaginal dryness was reported more frequently among post-menopausal compared with peri- and pre-menopausal women (55% vs. 37% and 22%, respectively; P = .015), as were hot flashes (87% vs. 74% and 62%, respectively; P = .049). There were no differences in a number of other symptoms, including irritability, insomnia and headaches, many of which were common in all 3 groups.
|Overall Rates of Other Symptoms in the Study Population|
Compared with pre- and peri-menopausal women, post-menopausal women had similar CD4+ cell counts, body mass indices, and rates of antiretroviral use, pregnancy, cigarette smoking, and use of oral contraceptives. Menopausal women did have increased rates of drug use, including cocaine, heroin, marijuana and methadone, but only methadone use was associated with increased rates of menopause (hazard ratio: 3.3, 95% confidence interval: 1.6-6.8).
The study did have some limitations. The authors were not able to make any conclusions about the impact of HIV on age at menopause, given the absence of an HIV-uninfected control cohort. In addition, no significant conclusions could be drawn about the association of methadone and menopause, given the absence of models controlling for potentially confounding factors associated with increased risk of menopause (such as age). This finding must be further analyzed and repeated with other cohorts.
While limited in its scope, the study does provide some helpful information to the very slowly growing knowledge base about menopause in women with HIV. The authors show that non-specific symptoms that may be associated with menopause are common among all women living with HIV, while more specific symptoms are seen at higher rates among post-menopausal women. This finding is important for providers caring for these women, as the providers will need to be educated about the potential relationship between many of these symptoms and menopause, and will need to address those symptoms more likely associated with hormonal changes. The optimal management strategy is not clearly known at this time.