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Menopause and HIV

July 2002

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

Often called the change of life, menopause is a natural event that happens to every woman, but affects each woman uniquely. Menopause can happen "naturally" or be induced through surgery or therapy. At menopause, several changes happen to the female reproductive system: 1] the ovaries stop producing the female sex hormone, estrogen; 2] a woman stops menstruating (her period stops); and 3] a woman can no longer bear children.

Menopause can begin anywhere between 40 and 55. It is a slow and gradual process, occurring over 3-5 years. During this time you may have infrequent and/or inconsistent periods. Pre-menstrual symptoms (PMS) may intensify or change. Menopause is complete when you have not menstruated for 12 months in a row. Women living with HIV may experience irregularities in their cycles, even if they're not going through menopause. It's important you discuss this with your doctor, so you can tell if the changes are related to HIV, menopause or some combination.

The body changes that occur and the decrease in estrogen during menopause express themselves in many ways. For some women the physical signs are mild and they are able to cope with them. For others, menopausal symptoms are very severe and difficult to cope with. The decision to take treatment is yours. It may or may not be the right choice for you. Discuss your concerns and questions with your doctor. He or she can help you weigh the risks and the benefits.

Any type change in life can be difficult on you and those around you. For women with HIV, many of these life changes from aging are similar to the impact that HIV can have on your physical and emotional health. Take time to make yourself aware of these possible changes and encourage others to do the same.

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The following chart can help you understand menopause symptoms, how they're similar to HIV, the treatments and how to relieve symptoms.


Skin and Hair Changes

The skin becomes less firm and drier. Hair becomes thinner and more brittle.
HIV Connection
  • Sudden or abnormal hair loss can result from taking anti-HIV meds, for example, indinavir (Crixivan).
  • Other medications to treat cancers, circulatory disorders, ulcers and arthritis can also cause hair loss.

    Other Things You Can Do
  • Avoid excessive hair dyeing, perming, straightening, braiding, and using hair dryers.
  • Stress can also affect your hair growth and the health of your hair. Take steps to reduce stress and anxiety.
  • B-complex vitamins can help relieve dry skin and hair.

  • Insomnia

    Insomnia and night sweats can be very uncomfortable, making it difficult to sleep at night.
    HIV Connection
  • Insomnia is very common with HIV for many reasons. Receiving an HIV diagnosis can be overwhelming, making it difficult to sleep well.
  • Insomnia has also been associated with anti-HIV meds, like d4T (Zerit) and saquinavir (Fortovase).

  • Other Things You Can Do
  • Wear clothes that are made with breathable fabric (cotton, linen) and are cooler to sleep in.
  • Avoid flannel sheets.
  • Keep the window slightly open or keep a fan the room.
  • Drink at least eight cups of water a day and keep a glass by the bed.

  • Fatigue

    Fatigue is a feeling of being constantly tired or having low energy even with enough rest. Activities like climbing stairs may be difficult. Fatigue can also be psychological, like having a hard time concentrating.
    HIV Connection
  • A very common symptom of HIV.
  • A side affect of anti-HIV meds.
  • Associated with anemia, also side effect of anti-HIV meds.

  • Other Things You Can Do
  • Try going to sleep at night and waking in the morning at the same time.
  • A little exercise can ease stress and make you feel stronger and more energetic.
  • Keep easy-to-prepare foods on hand for times when you're too tired to cook.

  • Emotional Changes and/or Mild Depression

    You may experience highs and lows in your moods: one minute you're happy and the next you're irritable or feeling anxious.
    Treatment
  • HRT/ERT may improve mood and psychological well-being.

  • HIV Connection
  • Depression is associated with HIV and some specific anti-HIV meds and anti-hepatitis therapy. Women living with HIV experience more depression than men.

  • Other Things You Can Do
  • Let your family and friends know that you may not always feel good.
  • Exercise can help ease and improve your mood swings.
  • Meditation can also help.

  • Hot Flashes

    A hot flash is a sensation of heat in the face or moving across the upper half of the body. They last 30 seconds to several minutes and often times hot flashes are accompanied by a rapid heart beat. Your skin may have a tingly sensation and you may experience chills, sweats or be unable to breathe well.
    Treatment
  • Hormone Replacement Therapy (HRT) is the combination of estrogen and progestin (a synthetic form of progesterone). Progesterone can protect against developing endometrial cancer (cancer of the uterine lining). HRT relieves hot flashes and night sweats.
  • There are different schedules for taking HRT in pill form. You could take estrogen every day for a set number of days, add progestin for 10-14 days, and then stop taking one or both for a specific period of time. You would repeat the same pattern monthly. This cyclic schedule can cause light menstrual bleeding.
  • You can take estrogen and progestin together every day of the month without any break. This continuous pattern can stop monthly bleeding after about six months of treatment. However, problem spotting may continue for longer. Talk with your doctor about the schedule that is best for you.
  • Estrogen Replacement Therapy (ERT) is estrogen alone. Take as pill or tablet, vaginal creams, vaginal ring inserts, implants, shots or patches that stick to the skin and the body absorbs estrogen.
  • Depending on your symptoms your doctor will suggest a certain form.

  • Things to Know
  • Women who have NOT had a hysterectomy (removal of uterus, including ovaries) can take HRT.
  • HRT is known to worsen liver disease in some cases. Depending on the severity of liver damage, HRT may or may not be an option for you if you have liver disease. Discuss this with your doctor.
  • Women with these conditions can talk with their doctors about the risks and benefits of HRT/ERT: high levels of triglycerides (fat in the blood), a personal or family history of blood clots and/or breast cancer and abnormal uterine bleeding.
  • Side effects for both HRT/ERT include: vaginal bleeding, breast tenderness (this will go away after several months), nausea, bloating, headaches, dizziness and depression.
  • Depending on the form, HRT/ERT can be stopped and started again. If you stop, their protective effects will stop and the side effects may continue.
  • Your decision about hormone therapy should be reviewed each year with your doctor at your annual checkup.

  • HIV Connection
  • Night sweats are associated with HIV and HIV-related conditions.
  • Side effects caused by HRT/ERT are also side effects caused by anti-HIV medications particularly nausea, bloating, headaches, dizziness and depression.
  • Lipodystrophy affects many people living with HIV. Lipodystrophy refers to changes in fat distribution in the body and irregularities in certain blood tests (increase in triglycerides, "bad" cholesterol levels, risk of diabetes and elevated blood pressure). Discuss the risks and benefits of HRT and ERT with your doctor if you are experiencing lipodystrophy.

  • Other Things You Can Do
  • Avoid small spaces, caffeine, alcohol, spicy foods and hot humid weather.
  • Vitamin E helps to relieve hot flashes.
  • Drink plenty of water (at least eight cups a day).
  • Women living with HIV often experience abnormal uterine bleeding. Talk with your doctor if you are having uterine bleeding and find out what the cause may be. It could be an infection that needs to be treated immediately.
  • Read Dealing with Drug Side Effects, Lipodystrophy and GYN Conditions, available at 1-800-822-7422.

  • Memory Loss or Lack of Concentration

    You may have trouble remembering things like what you just did, or what you said to someone. It may be difficult for you to concentrate on one thing for long periods of time.
    HIV Connection
  • Dementia is a brain disorder that affects a person's ability to think clearly and can impact his or her daily activities. AIDS dementia complex (ADC) -- dementia caused by HIV infection -- is a complicated syndrome made up of different nervous system and mental symptoms. These symptoms are somewhat common in people with HIV disease. Studies show that older HIV-positive people experience AIDS dementia more frequently than younger people.
  • Some symptoms resembling forms of dementia can also be side effects of certain anti-HIV drugs.

  • Other Things You Can Do
  • Make lists of things to do and cross them out as you complete them.
  • Ask a friend, family member or someone you trust to remind you about appointments, meds, etc.
  • Do things that you do everyday at the same time.
  • Talk with your doctor about getting tested for ADC.
  • Read AIDS Dementia Complex or call 1-800-822-7422.

  • Urinary Tract Infections

    The walls of the urethra become thin which increases the chance of urinary tract infections. As the muscles, which support the bladder and the urethra weaken, urine leakage is more common.
    Treatment
  • ERT vaginal ring (see Hot Flashes).

  • HIV Connection
  • None.

  • Vaginal Dryness

    The vagina becomes dry and the vaginal walls become thin causing pain. Intercourse may be painful.
    Treatment
  • ERT vaginal cream (see Hot Flashes).

  • HIV Connection
    None.

    Other Things You Can Do
  • Use water-based lubricant during intercourse. While not proven, vaginal gels containing wild yams have been used to relieve vaginal dryness. What ERT and these gels will do to HIV levels in the vagina is unknown.

  • Heart Palpitations

    Heart palpitations occur when the heart beats irregularly or misses one or two beats.
    HIV Connection
  • None.

  • Other Things You Can Do
  • Discuss this with your doctor; to be sure, be screened for heart disease.
  • Entering menopause, women are at higher risk for heart disease. This symptom may be related to menopause or another cause.

  • Osteoporosis

    Osteoporosis is a disorder where a significant amount of bone mineral decreases, causing a loss of bone mass and strength. This loss is referred to as low bone mineral density. The bones become thinner and more likely to break from a fall or minor stress. Post-menopausal osteoporosis is very common in women. Estrogen protects your bones; so with the decrease in estrogen production, there is less protection of your bones. This puts you at risk for having weak bones.
    Treatment
  • HRT/ERT can reduce the risk of osteoporosis. Treatments for osterporosis include: Alendronate Sodium (Fosamax), Risendronate (Actonel), Raloxifene (Evista), and Calcitonin (Miacalcin). Calcitonin is available as a nasal spray or injection.

  • Things to Know
  • Side effects for osteoporosis meds can include: Fosamax can cause abdominal or musculoskeletal pain, nausea, heartburn, irritation of the esophagus; Actonel can cause stomach upset, constipation, diarrhea, bloating, gas and headaches; and Miacalcin can cause an allergic reaction, skin rash and runny nose.

  • HIV Connection
  • Recent studies have found that people living with HIV have low bone mineral density. However, the causes and significance of lower bone mineral density for HIV-positive people remains unclear. The data are conflicting as to whether this is related to specific anti-HIV treatments or all of them.
  • Similar side effects are caused by anti-HIV meds.

  • Other Things You Can Do
  • Get a Bone Mineral Density test to measure the density of your bones (bone mass). It can determine whether you need medication to help maintain your bone mass, prevent further loss and reduce fracture risk. The test is painless and non-invasive.
  • Weight-bearing exercises.
  • Read Bone Problems or call 1-800-822-7422.

  • Phytoestrogens come from plants, herbs and seeds that have a similar structure to estrogen and can ease symptoms like hot flashes and vaginal dryness. Making phytoestrogens a part of your diet may help ease some symptoms. It is unknown how much and how often these should be taken. Examples: tofu, tempeh, soymilk and roasted soy nuts.


    Back to the Project Inform WISE Words July 2002 contents page.

    A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!



      
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    This article was provided by Project Inform. It is a part of the publication WISE Words. Visit Project Inform's website to find out more about their activities, publications and services.
     
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