Gynecological Problems and HIV/AIDS

Pelvic Inflammatory Disease (PID)

PID refers to inflammation in the upper genital tract. (The genital tract includes your vagina, cervix, ovaries, uterus, and fallopian tubes.) PID is often caused by a number of common infections, including the sexually transmitted diseases (STDs) gonorrhea and chlamydia. PID starts after these infections travel up from the vagina to other organs in the body, where they can cause serious damage.

The most common symptoms of PID are lower abdominal pain, irregular menstrual cycles, non-menstrual bleeding, vaginal discharge, and painful or frequent urinating. HIV-positive women who develop PID should be carefully followed by their doctors as they may need to be hospitalized and treated with antibiotics.

Menstrual (Period) Problems

Although there is little conclusive research regarding HIV-positive women and menstruation, many HIV-positive women report menstrual irregularities or worse premenstrual syndrome (PMS). Some women have excessive bleeding while others stop menstruating altogether (amenorrhea). If you have any of these symptoms, seek medical attention to determine the cause.

It is important to check into all possible causes of amenorrhea. These may include anemia, pregnancy, ovarian cysts, opportunistic infections, menopause or other GYN conditions. Other factors may include using some side effects of HIV drugs and other meds (like megestrol), street drugs (especially heroin and marijuana), and poor nutrition. Finally, body weight changes, stress and too much exercise can interrupt the menstrual hormone necessary for normal periods to occur.

Anemia is very common among HIV-positive women and may be related to abnormal menstrual cycles. Since anemia has been shown to be a risk factor for progression of HIV disease, it is important to talk to your doctor about whether you are anemic and what treatments or preventive measures you can take.

If you have menstrual problems your doctor may prescribe birth control pills to help regulate your cycles. Birth control pills interact with many HIV drugs. Some interactions can cause the birth control pill to stop working and increase your risk for pregnancy. Others can cause decreased levels of HIV drugs and put you at risk for rising levels of HIV in your body and drug resistance. It is important to discuss drug interactions with your doctor before taking birth control pills or any other hormones.

Menopause

Menopause usually occurs in women at 38-58 years of age because of natural changes occurring in the body, including the declining production of estrogen. Symptoms of menopause include heavier or abnormal periods, hot flashes, and vaginal dryness.

Some studies have suggested that women with HIV may experience menopause earlier than HIV-negative women. This may be due to one or more of many factors including anemia, decreased hormone production, illness, weight loss, effects of HIV drugs, effects of street drugs, or smoking.

Many women undergo hormone replacement therapy (HRT) in order to replace the estrogen lost during menopause. As with any therapy, HRT has its risks and benefits. It is very important for you to discuss with your doctor all the potential risks and benefits of HRT before you consider this therapy.

Pap Smears

HIV-positive women are 10 times more likely to have abnormal Pap smears than HIV-negative women. An abnormal Pap smear can indicate inflammation, infection, dysplasia, or cancer. These abnormal Paps are usually associated with low CD4 cell counts and HPV. It is very important for HIV-positive women to have regular Pap smears. The Centers for Disease Control (CDC) recommend the following:

• HIV-positive women should have a complete gynecological examination, including a Pap smear, when they are first diagnosed and when they first seek care during pregnancy.
• HIV-positive women should have another Pap six months later.
• If both tests are negative, yearly screening is recommended.
• Women who have symptomatic HIV infection or who have had dysplasia in the past should receive a Pap smear every 6 months.

Finding Good Care

Regular GYN exams and Pap smears are crucial to your health since many GYN conditions do not have obvious symptoms and can get worse without your realizing it. Detection and treatment in the early stages can prevent a GYN condition from progressing.

Tell your doctor about any problems you are experiencing and have regular GYN exams to look for problems that you might not know exist. If your doctor isn't skilled at screening and diagnosing GYN conditions, or you would rather see a specialist, ask for a referral to a gynecologist who is experienced in treating women with HIV. Be sure that your HIV doctor is aware of results from GYN screening tests and any treatments you might be on for GYN conditions. Make sure that your gynecologist is aware of what medications you are taking for other conditions.

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3. October 2005. Gynecological conditions and HIV/AIDS. The Body. Retrieved from www.thebody.com/content/art5000.html on July 21, 2006.
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