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HIV & MENSTRUAL IRREGULARITIES
Sep 7, 2000

Dear Dr.Squires, A lot of HIV positive women seem to be experiencing problems with their periods and unfortunately I can not seem to find the answers I am looking for on this issue. I have stopped menstruating yet my hormone levels do not indicate the onset of menopause. My gyn provider suggested provera which I tried but did not help. Could it be dangerous to go for long periods of time without menstruating? Could it result in developing "atypical" pap smears? Any insights? Thanks for your help.

Response from Dr. Squires

First, let me apologize for the delay in answering your questions. I am also going to have to beg forgiveness once again because I do not have any definitive answers for you. Although many patients and clinicians have reported that menstrual irregularities are common in HIV-infected women, there is no "hard" data from studies that have verified these reports. This is being studied in the WIHS Study (this is an observational study -- means that the patients do not receive treatment through the study -- of HIV-infected women or women at risk of HIV infection which has been ongoing for >5 years) so maybe we will have a better idea about the extent of the problem soon. Your physician appropriately measured your hormone levels to see if you are still making progesterone and estrogen. If these levels, specifically the estrogen is relatively normal, you will continue to be protected against such conditions as osteoporosis, etc. You do not need to worry that the lack of menstrual periods will increase your risk of abnormal pap smears. Infection with another virus, Human Papilloma Virus (not related to HIV), is the most common cause of abnormal pap smears. Other forms of this virus cause warts, most commonly found on the hands, face or sometimes the external genital areas. One last caution: if you are not menstruating but are ovulating it is possible for you to become pregnant. Do not rely on the lack of a period as evidence that you do not need to worry about practicing safe sex.

Hope that this is helpful.

KS

Kathleen E. Squires, M.D.



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