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Depression Common in Transition to Menopause

October 25, 2012

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Bear in Mind

The researchers are not certain why symptoms of depression were more severe in perimenopause. However, the WIHS team is conducting long-term research, monitoring the impact of changing cycles on the health of HIV-positive women.


Reconsidering Hormone Therapy

A Danish clinical trial monitoring women who received hormone therapy was recently completed. In that study, Danish researchers recruited 1,006 HIV-negative women around the age of 50 and randomly assigned half to receive hormone therapy. The randomized phase of the trial lasted for 10 years. After this, the women were monitored for six more years, for a total of 16 years of observation. The research team found a reduced risk of death without an increased risk for heart attack or cancer among the women who received hormone therapy compared to those who did not. This beneficial effect occurred during the first 10 years of the study and was maintained. This finding was somewhat surprising because past randomized controlled trials of hormone therapy have not found such therapy to be beneficial; in fact, hormone therapy was associated with an increased risk of harm (heart attacks, stroke, cancer).

Also, researchers have recently completed re-analyses of previous clinical trials of hormone therapy for women who were undergoing menopause. Those re-analyses suggest that hormone therapy may be safer than previously thought when restricted only to women who are just entering menopause, who are relatively young (around the age of 50) and who are otherwise in good health.

Both the Danish study and the re-analyses have prompted renewed interest and debate about the safety of hormone therapy for women. Some researchers are now suggesting that hormone therapy might be appropriate when started in the early stages of menopause. However, it will take months, perhaps years, for this debate to be settled, as doctors and patients weigh the risk and benefits of hormone therapy.


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Hormones and HIV -- Caution Needed

Note that nearly all studies about intervening with estrogen (and other hormones and therapies) to treat mood disorders that can occur during the menopause transition have enrolled generally healthy HIV-negative women.

The WIHS team warned that estrogen-based therapies are known to cause an increased risk for unnecessary blood clots, which can lead to a heart attack or stroke. Infection with HIV in people and infection with the closely related virus SIV in susceptible monkeys is also associated with an increased risk for cardiovascular disease. Therefore, caution is needed when conducting clinical trials of or prescribing estrogen-based therapy in HIV-positive women who are in the transition to menopause.


References

  1. Maki PM, Rubin LH, Cohen M, et al. Depressive symptoms are increased in the early perimenopausal stage in ethnically diverse human immunodeficiency virus-infected and human immunodeficiency virus-uninfected women. Menopause. 2012; in press.
  2. Schierbeck LL, Rejnmark L, Tofteng CL, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ. 2012; in press.
  3. Hodis HN, Collins P, Mack WJ, et al. The timing hypothesis for coronary heart disease prevention with hormone therapy: past, present and future in perspective. Climacteric. 2012 Jun;15(3):217-28.
  4. Rossouw JE, Prentice RL, Manson JE, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. Journal of the American Medical Association. 2007 Apr 4;297(13):1465-77.
  5. Manson JE, Bassuk SS. Chapter 348. The Menopause Transition and Postmenopausal Hormone Therapy. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012.
  6. Musselwhite LW, Sheikh V, Norton TD, et al. Markers of endothelial dysfunction, coagulation and tissue fibrosis independently predict venous thromboembolism in HIV. AIDS. 2011 Mar 27;25(6):787-95.
  7. Rasmussen LD, Dybdal M, Gerstoft J, et al. HIV and risk of venous thromboembolism: a Danish nationwide population-based cohort study. HIV Medicine. 2011 Apr;12(4):202-10.
  8. Ledwaba L, Tavel JA, Khabo P, et al. Pre-ART levels of inflammation and coagulation markers are strong predictors of death in a South African cohort with advanced HIV disease. PLoS One. 2012;7(3):e24243.
  9. Funderburg NT, Mayne E, Sieg SF, et al. Increased tissue factor expression on circulating monocytes in chronic HIV infection: relationship to in vivo coagulation and immune activation. Blood. 2010 Jan 14;115(2):161-7.
  10. Pandrea I, Cornell E, Wilson C, et al. Coagulation biomarkers predict disease progression in SIV-infected nonhuman primates. Blood. 2012 Aug 16;120(7):1357-66.
  11. Asztalos BF, Mujawar Z, Morrow MP, et al. Circulating Nef induces dyslipidemia in simian immunodeficiency virus-infected macaques by suppressing cholesterol efflux. Journal of Infectious Diseases. 2010 Aug 15;202(4):614-23. PLoS One. 2012;7(3):e24243.
  12. Shannon RP, Simon MA, Mathier MA, et al. Dilated cardiomyopathy associated with simian AIDS in nonhuman primates. Circulation. 2000 Jan 18;101(2):185-93.
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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication CATIE News. Visit CATIE's Web site to find out more about their activities, publications and services.
 
See Also
Depression and HIV
Feeling Good Again: Mental Healthcare Works!
More Research on Depression and HIV/AIDS

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