Treatment Issues for Women

Period Problems

Many positive women experience an abnormal or changing menstrual cycle. Although it's easy to want to forget about them, we need to pay attention to our periods -- especially any changes in the amount of bleeding or pain. The following lists some of the most common menstrual changes and things to consider if you experience them:

Menstrual Symptom	Possible Causes	What to Do About It?
Lighter bleeding Missed periods No periods at all	Chronic infection like HIV Malnutrition Regular heroin, methadone, or amphetamine use AIDS-related wasting Steroid use Menopause Cysts and other problems in the ovaries	If you miss two or more periods in a row, have a pelvic exam and blood tests to identify possible infections in your reproductive tract. Check hormone levels. Get a pregnancy test.
Heavy bleeding	Low platelets Fibroid tumors A complication of PID Other genital tract infection Drugs used to treat HIV such as Norvir (ritonavir), Retrovir (AZT), Hivid (ddC), or others	Check your platelet counts through blood work. Review list of drugs and contraceptives you're taking with your doctor. Monitor closely for anemia. Your provider may want to do a sonogram. Check progesterone levels.
Bleeding between periods or after sex	Chlamydia in the cervix High-grade cervical dysplasia Problems with the pill Tearing from sex Atrophy (thinning or weakening of vaginal tissue)	Get a pelvic exam. Your doctor may need to look at your vagina/cervix to see where the bleeding's coming from. Have a sonogram or colposcopy. Check hormone levels.

Menstrual Symptom

Possible Causes

What to Do About It?

Lighter bleeding

Missed periods

No periods at all

Chronic infection like HIV
Malnutrition
Regular heroin, methadone, or amphetamine use
AIDS-related wasting
Steroid use
Menopause
Cysts and other problems in the ovaries

If you miss two or more periods in a row, have a pelvic exam and blood tests to identify possible infections in your reproductive tract.
Check hormone levels.
Get a pregnancy test.

Heavy bleeding

Low platelets
Fibroid tumors
A complication of PID
Other genital tract infection
Drugs used to treat HIV such as Norvir (ritonavir), Retrovir (AZT), Hivid (ddC), or others

Check your platelet counts through blood work.
Review list of drugs and contraceptives you're taking with your doctor.
Monitor closely for anemia.
Your provider may want to do a sonogram.
Check progesterone levels.

Bleeding between periods or after sex

Chlamydia in the cervix
High-grade cervical dysplasia
Problems with the pill
Tearing from sex
Atrophy (thinning or weakening of vaginal tissue)

Get a pelvic exam.
Your doctor may need to look at your vagina/cervix to see where the bleeding's coming from. Have a sonogram or colposcopy.
Check hormone levels.

Since too much blood loss can lead to anemia, it's important to identify all possible sources of heavy bleeding and try to correct the problem. Heavy bleeding -- along with bleeding between periods -- may signal an infection in your cervix, vagina, or ovaries. If you have any of the above symptoms, be sure to discuss them with both your GYN and HIV medical providers.

Special Considerations for Women Using Birth Control Pills

Birth control pills are often used in HIV to regulate abnormal menstrual cycles or for women entering menopause. The pill comes in many different formulations; some contain progesterone, others contain both estrogen and progesterone. Every woman responds differently to the pill, and you may need to try several types or doses before you find the best fit.

Combined pills contain high amounts of ethinyl-estradiol, a synthetic version of the strongest estrogen in your body. While necessary to prevent pregnancy, high doses lead to side effects in many women and are not safe if you're over 50. If you use the pill to regulate periods rather than to prevent pregnancy, you can consider much lower-dosed tablets.

Many of the currently prescribed anti-HIV drugs interact with ethinyl-estradiol, the main ingredient in most birth control pills. If you're taking Norvir, Kaletra, Viracept, Viramune or, possibly, Agenerase, the pill may be less effective. Crixivan, Sustiva and, possibly, Rescriptor can increase ethinyl-estradiol to levels that are higher than you need. Remember, many women take these drugs in combinations, where the effect on the pill is even less clear.

If you're using the pill with any of these drugs, ask your doctor about whether you need to alter the dose of your pill in order to maintain effectiveness or to reduce side effects from the pill. If a dose adjustment isn't possible and you're using the pill to prevent pregnancy, you'll need to use condoms or another form of contraception.

As you can see, there's the potential for drug interactions in almost every HIV treatment decision. That's why it's so important to tell your provider about any medications, methadone, street drugs, herbs or hormones you're taking along with your HIV regimen. Any time you are prescribed a new medication, be sure to ask your doctor and pharmacist about possible interactions. As part of the drug dispensing service, all pharmacies are required to help you identify potential drug interactions. Don't be afraid to use this service.