Hot Flashes and Healthful Living: Health Concerns for Women Growing Older With HIV/AIDS
March 28, 2013
Nowadays, more and more women living with HIV are planning for a life stage they may once have thought they wouldn't live to see: menopause. Menopause is a normal part of a woman's life -- and its effects vary widely from woman to woman, regardless of HIV status. But are some of the variations of menopause more pronounced for women living with HIV? How can a woman tell if what she's experiencing is a common menopause symptom or a side effect of the virus or her meds? What can women expect to happen as they enter menopause, and what other health issues should they be aware of?
To get some answers, we sat down with L. Jeannine Bookhardt-Murray, M.D., chief medical director at Harlem United Community AIDS Center in New York City. Dr. Bookhardt-Murray has more than two decades of experience treating women living with HIV/AIDS. She breaks down the basics of menopause, as well as health concerns ranging from uterine fibroids to breast health to depression -- and suggests lifestyle changes that may alleviate some of the effects of aging for women living with HIV/AIDS.
Can you explain a bit about menopause, generally? What are some of the common signs that women begin to see, and at what age?
Women usually start going through menopause at around the age of 45 -- that's the average age. Physically, they may see their periods start to get lighter -- less flow; the number of days may decrease. If a woman usually had a five-day cycle prior to menopause, it may come down to three days, with a lighter flow. They may have a period this month, and next month none. Over time it will lessen and lessen. This time of transition is called perimenopause; these signs, as with others, are going to vary from woman to woman.
Some other signs that women may also see when they're going through menopause:
- They may gain weight.
- There may be mood changes. Some women say they're not feeling like they used to feel.
- Some women will report irritability. Whether or not that's related to menopause is always unclear. There may be other issues causing irritability or depression. But a lot of women say that they experience irritability when they're going through menopause.
- Of course, there are the hot flashes, which are among women's biggest problems with menopause. A woman will just be overcome with the sensation of heat, and then they'll chill. Sometimes they'll sweat. It seems to be worse at night for most women.
We used to use estrogen therapy for those physical symptoms; but that's infrequently used now because of the association with the development of uterine cancer and breast cancer.
The way I was taught to think about menopause is that, if a woman has gone through a whole year without a period, they've hit menopause. I'm talking about regular, natural menopause, not premature menopause that sometimes happens to 30-year-olds.
The process of having periods may be over, but the other symptoms -- the mood changes, the hot flashes -- may continue for a number of years, and they may continue for the rest of the woman's life. And it varies. There's no definitive textbook case of menopause, because it varies from one person to another.
The best thing a woman can do is talk to her mom, and find out what menopause was like for her mother. Usually the women in a given family -- mothers, sisters -- will follow the same kind of pathway through menopause. Of course, oftentimes someone's mother is not around, or has passed away, or the woman may have been adopted or something like that. But that's a good way to look at it: Find out what the women in their family went through with menopause.
Can you give a quick overview of what's going on internally in a woman's body that produces the signs and symptoms of menopause? Basically, what is menopause from the inside?
From the inside, the hormones are changing. Estrogen levels are decreasing. That's the main issue with menopause: You're not maintaining the same level of estrogen that you did as a younger woman. The amount of estrogen produced by the ovaries and the little bit of estrogen produced from the uterus: The amount is declining, and it leads to this hormonal imbalance.
Is it common for women to see their periods stop but to still experience the symptoms of their cycles every month?
It is. Even though they're not ovulating successfully, there may be hormonal changes, and it may result in some cramping, bloating, and the usual premenstrual symptoms that women feel. That can even go on after a woman completes menopause. She may be one to two years out after having her last period; and still, every month, she's getting these symptoms like she's going to have her period. In a couple of years or so it usually tapers off. But it's very annoying. It's this whole process of having to wonder, Is my period really coming or isn't it? And If it isn't, what should I do?
The other thing is that, if women do develop any kind of bleeding, even period-like bleeding, after their periods have stopped, they need to see their doctor and talk to them about it. Because that could be a sign that something's wrong, including cancers.
What are some of the other potential reasons for abnormal bleeding after menopause, besides cancers? Is there ever bleeding associated with fibroids, ovarian cysts or anything like that?
No, not really. But it could be a problem with the lining of the uterus. It could be infection. It could be cancer. But we're not talking about a hormonal cause for bleeding, at this point. It's likely a structural issue -- a growth of some kind. There could be a tumor that breaks down and there's bleeding. But it's not a normal period.
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