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Ask the Experts: Meno-POZ

Winter 2016

What can I expect as an HIV-positive woman who is entering menopause? Will menopause be different for me because of my HIV status?

-- P.W., Twillingate, NL


colorful leaves


Valerie Nicholson

Person living with HIV
Vancouver

I am an Indigenous woman living with HIV since 2004. When I was 54 years old, my periods (moon time) became irregular, and when they did come they were very heavy. Then I hit menopause.

When I was going through "the change," I started to dislike the word menopause. What do men have to do with it?! I decided to call it o-pause instead.

I had gone almost a year without my moon time and I was excited, as this is a sign that o-pause is ending. But then I woke up one morning -- it was Christmas morning -- to moon time. Another year went by and I woke up to another moon time, this time on my birthday! These irregular periods lasted for three and a half years.

O-pause is a time when our bodies are letting go of our menstrual cycle. It's a time to pause and acknowledge that our life-giving journey is finished and a new way of life is emerging. A time to pause and say: "This is OK and I will make it."

My hot flashes were so severe that I would pull my clothes off and stand in front of a fan. A few times I lifted my shirt in front of the grocery store freezer just to feel the cool air. I never got night sweats but my irritability was rampant.

There was no change in my libido and I continued to enjoy sex, though I did experience vaginal dryness. My doctor recommended a lubricant. When I asked her what else I could do to get through menopause, she replied, "You made it through puberty without help. You will make it through menopause!"

When I started having heart palpitations, I got real scared. My doctor sent me for some tests. The diagnosis: menopause, not a heart attack or heart problems. So if you get heart palpitations during menopause, my advice is to see your doctor right away. Peace of mind is better than the stress of worrying about your health.

Using the medicine wheel helped me to understand that o-pause is part of the circle of life for a woman. I started on my life journey without my moon time and I am completing it that way. A full circle. Every woman has her own journey and circle of life.

I have osteoarthritis, urinary incontinence, poor memory and liver problems. Was my experience of menopause affected by HIV, my meds or my heritage? I'm not sure, and I'll never know. My grandmother never spoke of this time and my mother never had a chance to go through menopause, as she had a hysterectomy when she was in her thirties.

Today I am a very different woman than I was before o-pause. I am mellower and have a deeper understanding of myself. I have more of a connection with Mother Earth and I love being a grandmother. I see the world through my grandchildren's eyes. I jump in puddles and blow bubbles. I feel wiser and more peaceful.


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Dr. Cyndi Gilbert

Naturopathic doctor and author
Toronto

Many patients see me for help with reducing menopausal symptoms. A person's HIV status alone has not been shown to impact the timing of menopause or the experiences of hot flashes, sleep problems, depression, irritability and anxiety sometimes associated with menopause.

In my clinical experience, these things can often be managed using natural approaches and therapies. Exercise, a healthy diet, mindfulness or meditation, reducing or quitting smoking and limiting alcohol are the basic foundations for transitioning through menopause. These lifestyle changes can also reduce the risks of osteoporosis and coronary heart disease.

Calcium and magnesium supplements, vitamin D3 and other nutrients may be needed. Fish oil has been shown to reduce high levels of triglyderides (a fatty substance in the blood), which are sometimes caused by protease inhibitors, sometimes by HIV itself.

To reduce hot flashes, regular acupuncture treatments may be helpful. Soy products, such as tofu and soy milk, which mimic the natural estrogens that decrease after menopause, may help provide some relief from hot flashes. I also try to teach my patients techniques to better manage their stress, insomnia, depression and anxiety.

Some people find that certain herbs help reduce hot flashes, alleviate sleep disturbances and improve sexual desire. Because some supplements can interact with medications you're taking, it's important to always speak to your doctor and pharmacist before taking any of these. For example, St. John's wort reduces the effectiveness of many drugs, including certain HIV meds (particularly protease inhibitors and non-nukes). Therapeutic doses of garlic supplements may reduce drug levels of ritonavir (Norvir) and the older drug saquinavir (Invirase), although more research is needed to confirm these interactions. Before starting any complementary therapy, always consult your healthcare providers about potential interactions.


Dr. Isabelle Boucoiran and Dr. Marc Boucher

M.D.s, obstetrics and gynecology, Ste-Justine Hospital
Montreal

Menopause is a natural phase for women. [Ed's note: The term women is used here to refer to cisgender women, or women whose gender aligns with with the one they were assigned at birth. Some of the information may not apply to trans women; conversely, some of it may apply to trans men.]

Large gaps exist in our understanding of the effect of HIV on the aging process and menopause. In our clinical experience, HIV-positive women seem to experience as many menopausal symptoms as HIV-negative women. However, a recent small study found that HIV-positive women are more likely to experience more severe hot flashes, which can interfere more with daily life. Women with HIV are more likely to develop osteopenia, a loss of bone density that can lead to osteoporosis. Depression has also been associated with menopause in some HIV-positive women.

Some studies have shown that early menopause is more common among women living with HIV. However, many factors have to be considered when talking about menopause in HIV-positive women, such as ethnicity, CD4 count, smoking, body mass index, drug use and co-infections. It's challenging to distinguish the unique contribution, if any, of HIV among these other factors. We know a lower CD4 count is associated with a higher chance of becoming sick and dying, and managing one's HIV is critical for this reason. It appears that lower CD4 counts are also linked to early onset menopause.

When we see patients, we do an individualized risk/benefit assessment of the use of hormone replacement therapy (HRT) -- hormones given to replace estrogen loss. We take into consideration a person's symptoms, comorbidities, age and antiretroviral regimen.

Some studies have associated the use of HRT with an increased risk of breast cancer, blood clots and cardiovascular events. Women with HIV do not have an increased risk of breast cancer, but several studies have found higher rates of cardiovascular disease than in HIV-negative people [see TreatmentUpdate 189, "HIV and menopause"]. Alternatives to HRT are available, such as antidepressants for hot flashes and intravaginal estrogen cream for vaginal dryness.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication The Positive Side. Visit CATIE's Web site to find out more about their activities, publications and services.
 

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