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Menstrual Irregularities: WIHS Study Sheds A Little Light

Fall 1996

Women with HIV have noted many complaints about abnormal menses (periods). This study examined menstrual abnormalities in a large group of HIV infected women and an uninfected control group.

The purpose was to compare the prevalence and origin of amenorrhea in women with and without HIV, and to describe menstrual abnormalities in HIV positive women.

The study was conducted within the Women's Interagency HIV Study (WIHS), a national multi-site study of disease progression in women. Data for this analysis was available for 2214 women.

The Women In Study

The majority of participants were African American and Latina, in their mid-thirties with a history of high risk sexual activity and injecting drug use. The HIV positive and HIV negative groups are similar. At entry, they had an average CD4 count of 335.

We compared the prevalence of amenorrhea (absence of periods) and other abnormalities by serostatus ( whether a woman was HIV positive or HIV negative), looked at variables like drug use, weight loss, age, obstetrics (whether a woman was pregnant or not, if she had just given birth or never given birth, etc.), albumin levels (a protein manufactured in the liver - used to measure nutritional status), and alcohol use, and measured estrogen levels of women with amenorrhea.

We defined amenorrhea as being present in women who reported no periods for at least 90 days. Results show that the overall rate of amenorrhea was seven percent. When we looked at this by serostatus, 7-percent of the HIV positive and 5-percent of the negative women were amenorrheic. This wasn't significant.

No Period For 90 Days

We looked at the rate of amenorrhea in women with HIV by their CD4 counts to see if there was a relationship. We found that although there was a higher rate of amenorrhea with lower CD4 counts, there wasn't a significant trend. We then looked at several variables. We selected serum albumin (a simple water soluble protein found in blood serum) as a measure of nutritional status. There was a significant increase in amenorrhea in women with low albumin levels. Twelve percent of women who used heroin had amenorrhea.

Masked Results?

Women who had a live birth in the past year also had a significantly high rate of amenorrhea. We were concerned that the greater percentage (6-percent) of recent live births for the negative group, compared to 3-percent in the HIV positive group, might have masked other associations.

To examine the possibility that the higher percentage of recent live births in the HIV negative group was masking other associations with amenorrhea, we analyzed further. Causes of a-menorrhea include heroin and amphetamine use, age, live birth in the past year, low albumin levels and HIV status. The analysis revealed that in fact HIV infection is independently associated with amenorrhea with an odds ratio of 2.8, compared with uninfected women. This means that women with HIV infection are 3 times more likely to get amenorrhea than negative women.

The Cause

The central or pituitary origin of amenorrhea was significantly more common in women with HIV infection, compared to women without HIV. (the pituitary is a small oval endocrine gland attached to the base of the brain which secretes several hormones including those that control body growth). Almost 80-percent of women with HIV had the central (pituitary) cause. Meaning that amenorrhea was caused from malfunctioning of the pituitary gland, not from problems in the ovaries.

Irregularity of periods in the past 6 months, and spotting or bleeding between periods was analyzed, abnormalities were found to be common, but not significantly different in HIV infected and HIV negative women.

Study Limitations

The limitations of this study were that the menstrual activity was measured by participant recall. Measurements did not include multiple sampling. Moreover, progesterone levels were not measured to determine when ovulation occurred. We concluded that women with HIV are nearly 3 times more likely to get amenorrhea after adjusting for important variables. Amenorrhea was more frequent in women with lower CD4 counts. Albumin less than 3, current heroin and amphetamine use were significantly associated with amenorrhea in women with and without HIV infection. The cause of amenorrhea was most often due to abnormal pituitary function in women with HIV infection.

Need More Data

The implications of our findings are that HIV infection causes central mechanism dysfunction, resulting in low estrogen, manifested by amen-orrhea. Providers should be attuned to the increased prevalence of this symptom in women with HIV. The effect of low estrogen on immune markers warrants additional study in women with HIV infection and AIDS. The WIHS has now begun to examine the effects of the menstrual cycle on the immune system and the virus itself in this group of women.

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This article was provided by Women Alive. It is a part of the publication Women Alive Newsletter.