Hot Flashes and Healthful Living: Health Concerns for Women Growing Older With HIV/AIDS
March 28, 2013
Switching gears a little bit, can you talk about the connection, if there is any, between uterine fibroids and menopause? Can they contribute in any way to the early onset of menopause, or have any effect on its progression, or vide versa?
Fibroids are very common. They can be small, or they can be large. They can cause abnormal bleeding. Sometimes they can cause a lot of pain. So it's important to know what's going on with that fibroid -- to have it looked at, to make sure there's no cancer hiding in there. Usually, doctors will want to do little biopsies, or something like that, to make sure that it's safe.
Fibroids are really problematic when a woman is trying to get pregnant. It can disrupt the uterine lining, the surface of the uterus; and then it's hard for the egg to implant.
As a woman gets older and her estrogen levels are dropping, the fibroids may actually get smaller over time. It's the estrogen that feeds the fibroid; with time, they may not need the surgery. The pain may go away; the abnormal bleeding may go away; and they might be able to get through.
I would say to women: If you have a large fibroid that's causing problems, just wait till you go through menopause, and it may get better. Every single time a woman has abnormal bleeding, like heavy bleeding or irregular periods, and they have a fibroid, they need the fibroid to be looked at. But I wouldn't rush under the knife if there are no signs of cancer.
Are there any differences in management or treatment of fibroids between women who are living with HIV and HIV-negative women?
Not really. I would say the one thing is, if surgery is in the picture, that the CD4 count really should be a healthy CD4 -- say, above 200 -- because the postoperative recovery period is much better when the CD4 count is higher, and you lessen the risk of postoperative infections.
Have you seen, in research or in practice, whether women of color are more or less likely to have fibroids?
I have not seen it in research; but in my practice, in which probably 99 percent of the women are of color -- fibroids are very common. Over half of my women have fibroids. I don't know how that compares to the world of people without HIV infection. But women of color may be more likely to have fibroids.
A recent study came out that found that women who are experiencing menopause and were living with HIV were more likely to experience symptoms of depression than their HIV-negative counterparts. The study was actually not able to discern why. Could you shed some light on the topic, and what you'd recommend to women who are experiencing an increase in depression?
Overall, people with HIV experience increased rates of depression, as compared to the general population. But a lot of people don't know -- a lot of women don't know -- that help is available.
There is a lot of stigma to having depression. So that's another question I throw out there to my patients: "Are you having any depression?" Some women don't know what depression means. So I'll put it in terms of, "Are you feeling down, depressed or hopeless?" "Have you lost interest in doing things?" Those kinds of general questions will usually get a woman to open up.
They need to be able to talk about it. Often the provider has to open the conversation because of the stigma around mental illness, especially among people of color.
Also, some women will not talk about being depressed because they think the only answer is going on antidepressant medication. But there are things to try, like talk therapy, or psychotherapy. I'm a strong believer in getting back to healthful living, and just following the basics. We know that sunshine and fresh air does a lot for the mood, so I really push the healthful style of living with my patients, especially when they're depressed. Get out of that dark room. People who are depressed tend to stay in bed with the covers over their head, and keep the drapes closed. But sometimes it can help to get up and get out.
Is there any other information you'd like to share with women who may be facing menopause, or just generally growing older, with HIV?
I would like to talk about the relationship between aging and breast cancer. While cervical cancer rates go down as a woman gets older, breast cancer rates go up, especially after menopause. So women should be paying attention to making sure that they're up to date with their mammograms.
What's the current recommendation as far as how often a woman should get a mammogram, and at what age?
If a woman is 50 or older, she should have a mammogram every year. At the age of 40 she should at least have a breast cancer screening, and then talk to her doctor about the regularity with which she needs to do that mammogram.
Do you recommend that women do breast self-exams?
I would say just be aware of what's going on with your breasts. Check them in the shower. There used to be a recommendation that women check their breasts once a month in the shower. But women actually check their breasts more often. So I would recommend that women check their breasts on a regular basis, looking for any lumps or bumps or areas of discomfort.
If you could just share one general piece of advice with a wide swath of women living with HIV and anticipating menopause, what would that advice be?
For the smokers, I would say address the smoking issue and quit using tobacco. Smoking complicates everything, and it makes it difficult for women to develop effective coping strategies: Instead of coping, they'll smoke, when they may need psychotherapy, or some other intervention. I would say stop smoking; that's the main thing. Stop smoking and get back to basics with healthful living.
This transcript has been edited for clarity.
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