Menopause and HIV -- Their Impact on Cognition
As women age, their bodies undergo complex changes that affect many aspects of their health. Menopause is one such change, driven by altered hormonal levels. The ovaries produce estrogens, estradiol and estrone, and at around age 35 they begin to shrink. On average, by the age of 50, the production of estrogen has significantly decreased while the production of other hormones, LH and FSH, are on the rise. As women approach menopause, changing hormone levels can cause symptoms such as the following:
Some women have reported the following symptoms as they transition through menopause:
The intensity and duration of these symptoms associated with the body's entry to menopause can vary considerably from one woman to another.
Research on Menopause
Scientists across the U.S. have been studying the intersection of menopause in women with HIV and in women at high risk for this infection. In particular, research teams have focused on the impact of menopause on neurocognitive functioning and mental and emotional health. They found that HIV-positive women undergoing menopause who had symptoms of anxiety were more likely to perform poorly on assessments of neurocognitive functions. The negative effect of anxiety was greater than that of HIV in this study. The researchers encourage doctors caring for HIV-positive women to screen them for anxiety and, if present, to treat it.
Researchers in the following cities enrolled women with HIV and women at heightened risk for this infection:
For this study the researchers focused on the following women:
Women underwent surveys, interviews, neurocognitive assessments, physical exams and blood tests. This report will focus on the outcomes in HIV-positive women.
At the time of the study (between April 2007 and April 2008) the average profile of the HIV-positive women was as follows:
Results -- Stages of Menopause
The distribution of women in the different stages of menopause was as follows:
Here are the proportions of women with different symptoms associated with menopause:
When researchers analysed the symptoms of menopause and linked these symptoms to stages of menopause, they found the following:
Results -- Neurocognitive Assessments
Researchers found that HIV-positive women who had what they described as "elevated anxiety symptoms" performed poorly on several different assessments of neurocognitive functioning compared to other HIV-positive women without symptoms of anxiety. These differences were statistically significant, that is, not likely due to chance alone. The negative effect of anxiety was greater than that of depression among HIV-positive women.
Furthermore, among HIV-positive women, researchers found that the impact of anxiety on assessments of neurocognitive functioning was "generally" greater than the impact of HIV.
Researchers sought to identify specific anxiety-related feelings that were linked to poorer neurocognitive functioning. They found that the following emotions were mentioned by women:
Bear in Mind
The present study was cross-sectional in nature. This type of study is analogous to a snapshot taken at one point in time. Cross-sectional studies are sometimes done as a first step to explore a research question. The results can sometimes provide the justification needed for a larger, longer and more expensive study. However, cross-sectional studies cannot provide definitive conclusions about health conditions. For instance, in the present study, researchers assumed that symptoms of anxiety and depression led to decreased neurocognitive functioning. However, it is possible that in some women, problems with neurocognitive functioning could have occurred before the onset of anxiety and depression.
The U.S. researchers now have a long-term study underway to better understand why some HIV-positive women develop neurocognitive problems and the impact of menopause on these issues.
They also encourage doctors caring for HIV-positive women to screen them for anxiety and, if present, to offer treatment.
Rubin LH, Sundermann EE, Cook JA, et al. Investigation of menopausal stage and symptoms on cognition in human immunodeficiency virus-infected women. Menopause. 2014; in press.
This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication TreatmentUpdate. Visit CATIE's Web site to find out more about their activities, publications and services.
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