Menstrual Changes and HIV

Table of Contents

• HIV and Menstrual Problems
• How Does HIV Cause Problems?
• Can HIV Drugs Affect the Menstrual Cycle?
• Finding the Cause of Menstrual Problems
• What Else Can Cause Menstrual Problems?
• Dealing With Menstrual Problems
• Taking Care of Yourself

HIV and Menstrual Problems

Many women living with HIV (HIV+) experience menstrual changes (changes in their periods). It is important to discuss any changes with your health care provider.

The changes HIV+ women may experience include:

• Irregular periods:
  • Different in frequency (how often)
  • Different in duration (how long)
  • Different in amount (lighter or heavier)
• Missed periods
• No period for more than 90 days (amenorrhea)
• Spotting (spots of blood between periods)

Studies have found that menstrual irregularities (changes to your menstrual cycle) are less common if you have a high CD4 cell count and are taking HIV drugs. Menstrual irregularities are more common if you have a high viral load or are significantly below your ideal body weight.

How Does HIV Cause Problems?

As HIV progresses, changes in your immune system can affect the way your body makes and maintains levels of different hormones including testosterone, estrogen, and progesterone. Changes in the amount of estrogen or progesterone could result in a number of menstrual symptoms for HIV+ women.

In the course of HIV, many women lose weight, become anemic (have decreased red blood cell counts), or develop nutritional problems. Each of these conditions can also affect the hormonal systems that regulate your menstrual cycle.

Can HIV Drugs Affect the Menstrual Cycle?

Yes, but research is lagging behind the experiences of women in this area. Many of the original trials that led to the approval of the first HIV drugs enrolled very few women, and the women in those studies were not asked about their periods. As a result, until several years ago, there were hardly any clinical data on which drugs cause menstrual side effects.

A small study conducted some time ago suggested that women using Norvir (ritonavir) or the combination of Norvir and Fortovase (saquinavir) could be at greater risk for anemia due to excessive menstrual bleeding. Women using Crixivan (indinavir) may be more likely to experience irregular bleeding, bleeding between periods, or heavy bleeding.

Researchers have since started using newer technologies to study how drug levels of protease inhibitors change throughout the course of the menstrual cycle. This will give us important information about how HIV therapy and the menstrual cycle affect one another.

In the meantime, keep in mind that the lack of research doesn't make your symptoms any less real. If you're taking HIV therapy, watch out for any changes in your bleeding, and be sure to tell your health care provider if you have heavier, prolonged, or more/less frequent periods.