Menstrual Changes and HIV

What Else Can Cause Menstrual Problems?

• Pelvic inflammatory disease (PID): Untreated infections in your vagina or cervix can sometimes lead to heavy bleeding, bleeding between periods, or bleeding after sex. This type of bleeding may signal a complication like PID, which can threaten your health and ability to get pregnant.
• Cervical dysplasia or cervical cancer: Bleeding after having vaginal sex (and not being on your period at the same time) or bleeding between periods (spotting) may be signs of cervical dysplasia or cervical cancer. Cervical dysplasia refers to abnormal cells that can become cancerous; therefore these cells are often called pre-cancerous. It is important to act quickly, see your health care provider, and have a full exam.
• Street drugs: Using recreational or street drugs can lead to missed periods or periods that stop altogether. Drug use can also lead to stress, poor nutrition, and severe weight loss, all of which can cause missed periods. Street drugs that may cause menstrual changes include:
  • Heroin
  • Opiates
  • Methadone
  • Amphetamines
  • Marijuana (more than several joints a day)
  • Cocaine
• Prescribed and over-the counter drugs: Prescribed and over-the counter drugs can also change your menstrual cycle in the following ways:
  • These drugs may cause irregular periods
    • Reglan (metroclopromide)
    • Tricyclic antidepressants (Elavil or Tofranil)
    • Phenothiazines (Mellaril, Compazine and Thorazine)
    • Atypical antipsychotics (Clozaril, Zyprexa, Risperidone, Invega)
  • Some birth control methods can cause irregular periods, initial heavy bleeding, or eventual loss of periods
    • Depo-Provera injection
    • Birth control pills containing only progestin, no estrogen
    • Mirena intrauterine device (IUD)
    • Paragard IUD ("Copper T")

Dealing With Menstrual Problems

When dealing with menstrual problems, your provider will likely:

1. Treat any underlying infections, cervical disorders, or cysts
2. Address any nutritional problems (e.g., low iron), anemia, or unexplained weight loss
3. Review all the drugs, vitamins, and supplements you are taking (including medications for HIV and HIV-related conditions, street drugs, and birth control pills)
4. Suggest hormonal contraceptives such as birth control pills if there is a need to restore balance to your hormones and regulate menstrual cycles; however, it is important to know that some hormonal contraceptives interact with HIV drugs
5. Discuss any non-prescription remedies for menstrual symptoms that you may be taking, like herbs or dietary supplements. It is important that you be careful with any herb or food that has estrogen-like qualities, like soy, which may contribute to menstrual irregularities. Common supplements taken for menstrual problems include:
   • Omega-3 fatty acids: For menstrual cramps, bloating, swollen breasts, and mood changes
   • Magnesium: For cramps and irritability
   • Vitamin B complex or calcium: For bloating
   • Vitamin E: For hot flashes or swollen breasts
6. Try to get enough sleep and regular physical activity. Your provider may also suggest some alternative therapies such as acupuncture, and/or yoga to provide some relief from pre-menstrual symptoms.

Taking Care of Yourself

Even though menstrual problems are common, suffering with them is not a normal part of HIV. In most cases, it is possible to find the cause of your symptoms and to treat or manage the problem. Try to keep track of the start/end dates of your periods each month. It is important to get regular exams, including annual Pap smears, as part of your routine health care, and to report any changes in your menstrual cycle to your health care provider.