Menstrual Changes and HIV
October 24, 2015
- Pelvic inflammatory disease (PID): Untreated infections in your vagina (birth canal) or cervix (entrance to the womb) can sometimes lead to heavy bleeding, bleeding between periods, or bleeding after sex. This type of bleeding may signal a complication like PID, which can threaten your health and ability to get pregnant.
- Cervical dysplasia or cervical cancer: Bleeding after having vaginal sex (and not being on your period at the same time) or bleeding between periods (spotting) may be signs of cervical dysplasia or cervical cancer. Cervical dysplasia refers to abnormal cells that can become cancerous; therefore these cells are often called pre-cancerous.
Cervical cancer takes years to develop. Often women who have cervical cancer - and who have not had a Pap test, VIA test (Visual Inspection with Acetic Acid), or DNA test looking for cervical cancer - do not know they have it until it is quite advanced. This is why getting a test done regularly is so important.
- Street drugs: Using recreational or street drugs can lead to missed periods or periods that stop altogether. Drug use can also lead to stress, poor nutrition, and severe weight loss, all of which can cause missed periods. Street drugs that may cause menstrual changes include:
- Marijuana (more than several joints a day)
- Prescribed and over-the counter drugs: Prescribed and over-the counter drugs can also change your menstrual cycle in the following ways:
- These drugs may cause irregular periods
- Reglan (metroclopromide)
- Tricyclic antidepressants (Elavil or Tofranil)
- Antipsychotics (Mellaril, Compazine and Thorazine)
- Atypical antipsychotics (Clozaril, Zyprexa, Risperidone, Invega)
- Some birth control methods can cause irregular periods, initial heavy bleeding, or eventual loss of periods
- Depo-Provera injection
- Birth control pills containing only progestin, no estrogen
- Intrauterine devices (IUDs) containing levonorgestrel (e.g., Mirena, Skyla, Liletta)
- Paragard IUD ("Copper T")
- Implanon and Nexplanon, implants containing only progestin
- These drugs may cause irregular periods
When dealing with menstrual problems, your provider will likely:
- Treat any underlying infections, cervical problems, or cysts
- Address any nutritional problems (e.g., low iron), anemia, or unexplained weight loss
- Review all the drugs, vitamins, and supplements you are taking (including medications for HIV and HIV-related conditions, street drugs, and birth control pills)
- Suggest hormonal contraceptives such as birth control pills if there is a need to restore balance to your hormones and regulate menstrual cycles; however, it is important to know that some hormonal contraceptives interact with HIV drugs
- Discuss any non-prescription remedies for menstrual symptoms that you may be taking, like herbs or dietary supplements. It is important that you be careful with any herb or food that has estrogen-like qualities, like soy, which may contribute to menstrual irregularities. Common supplements taken for menstrual problems include:
- Omega-3 fatty acids: For menstrual cramps, bloating, swollen breasts, and mood changes
- Magnesium: For cramps and irritability
- Vitamin B complex or calcium: For bloating
- Vitamin E: For hot flashes or swollen breasts
- Talk to you about your sleep and physical activity -- getting enough of each can help keep your periods regular. Your provider may also suggest some alternative therapies such as acupuncture, and/or yoga to provide some relief from pre-menstrual symptoms.
Even though menstrual problems are common, suffering with them is not a normal part of HIV. In most cases, it is possible to find the cause of your symptoms and to treat or manage the problem. Try to keep track of the start/end dates of your periods each month. It is important to get regular gyn exams as part of your routine health care, and to report any changes in your menstrual cycle to your health care provider.
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