Your body

Menopause

Technically, menopause means stopping having monthly periods (menstruation). It marks the end of your fertility and is accompanied by significant hormonal changes. Most women begin to experience menopause somewhere between the ages of 38 and 58, with 51 being the average age for Australian women. Remember, menopause is a transition, not a disease.

Different women experience menopause very differently. Although menopause is not an illness, it does have ‘symptoms’. Hot flushes, mood changes, night sweats and fatigue are normal. You may become more prone to accidental urination. Sexual changes also accompany the end of menstruation including vaginal dryness, thinning of the vaginal walls and reduced libido. Some women experience loss of concentration, memory loss, anxiety or fatigue. Your risk of heart disease increases as does your risk of bone loss (osteoporosis) after menopause.

Menopause is usually a gradual process rather than an abrupt change. The first phase is called ‘peri-menopause’: periods become less frequent and other menopausal signs can appear.

If you are uncertain whether changes in your body are caused by the onset of menopause or something else, your doctor can do blood tests that check your hormone levels and can provide a clear answer.

For more general information about menopause (although not specific to women with HIV), check out About Menopause from Women’s Health Queensland. For information about HIV and menopause, see Your Body Blueprint.

Tips for living with menopausal symptoms

Dress lightly and in layers
Avoid caffeine, alcohol, and spicy foods
When a hot flush starts to come one, practice slow, deep breathing (about 6 breaths per minute)
Consider seeing an acupuncturist for treatment
Use relaxation techniques like yoga, tai chi, or meditation
Consider soy-based foods
Perform daily pelvic floor exercises to strengthen the muscles of your vagina and pelvis
Use water-based lubricants during sexual intercourse
Talk to other women, particularly positive women, about their experiences and strategies they have found useful
Always check with your doctor about the safety of any natural products you may want to take to relieve the symptoms of menopause. Some can be harmful.

Menopause and HIV

Some studies have shown that women with HIV undergo menopause at an earlier age but it is unclear if this is due to HIV or other lifestyle factors. Since successful HIV treatments have been used more widely, research suggests the experience of women with HIV does not differ much from that of uninfected women. Women with HIV do more commonly have irregularities in their menstrual cycle that may be mistaken for menopause.

Although the impacts of menopause on women with HIV are not fully understood, two key areas should be considered:

Bone density

Some health care providers suggest menopause can occur earlier in women with HIV. Early menopause can accelerate the loss of bone density, which increases the risk of early osteoporosis. HIV antiretroviral drugs such as Tenofovir may also contribute to loss of bone density.

Regular weight-bearing exercise and a calcium-rich (but not high fat) diet protect bone health. It is also important not to smoke. If you are concerned about your bone density, see your doctor. (For more information, see Osteoporosis).

Heart disease

Menopause does not cause heart disease, however, certain risk factors increase around the time of menopause. A decline in the natural hormone oestrogen may be one such factor. HIV treatments can increase fats in the blood, which may also increase risk of heart disease. The link between HIV treatments and menopausal factors increasing heart disease risk is not well understood.

Changing habits to decrease cardiovascular risk is an important way to increase your heart health: stopping smoking, improving your diet by reducing fat, and doing regular moderate exercise are the key factors here.

For more information on menopause and HIV, check out Your Body Blueprint.

Menopause: Improving Your Health

Protect bone health (diet, weight bearing exercise)
Maintain and improve fitness
Don’t smoke
Reduce alcohol consumption (more than a glass a day speeds bone loss)
Adopt a healthy heart diet
Supplement calcium
Practice pelvic floor exercises regularly
Check herbal/alternative supplements with your doctor for interactions with HIV drugs
Use lubricants for sex

To learn more about HIV and menopause, check out this great video from Positively UK I’m Taking Care of Me — Menopause. Although filmed in the UK, it provides insight into what a conversation about menopause between an HIV-positive woman and her doctor might look like.

Hormone replacement therapy (HRT)

Whether or not to take hormone replacement therapy (HRT) can be a major decision for women experiencing unpleasant menopausal symptoms.

Until 2002, HRT was touted as the solution for many menopausal problems until a major study found that it increased the risk of breast cancer and heart disease. More recent studies suggest the 2002 study was flawed because of the age of the women who participated in it.

Current evidence suggests hormone replacement therapy is relatively safe for women in their 50s, and is also safe for women to continue into their 60s. It is less safe if women initiate HRT in their 60s. It is currently recommended that HRT is safest if taken as a relatively short-term treatment, for example, for a few years. Your doctor can provide more specific advice.

HRT can be taken with HIV treatments but you should ask your doctor if there are any interactions between HRT and any specific antiretroviral drugs you are taking. For example, the HIV drug Ritonavir can affect the dosage of HRT required.

HRT is certainly not necessary for many women but is definitely worth discussing with your doctor based on your specific circumstances and symptoms of menopause. Your doctor can discuss any risks or benefits. The decision whether or not to start HRT remains yours.

Alternatives to HRT

Many positive women report good nutrition plays a key role in reducing menopausal problems.

Low dose antidepressant medications (lower than the doses used to treat depression) can be used to treat hot flushes. However, in some people, antidepressants can reduce sex drive or ability to orgasm.

Some women increase their consumption of soy products to treat menopausal problems. There is no research evidence proving the usefulness of these remedies, but in cultures where soy products are eaten in large quantities, menopausal problems are reported to be less severe.

Importantly, if you have had breast cancer or have a higher than average risk of breast cancer (assessed through family history), educators suggest you should avoid high-dose supplements of soy products where the active ingredients may be processed in a way that fuels oestrogen-receptor positive breast cancer. This is an issue to discuss with your doctor. Cancer Australia provides more detailed information about breast cancer.

There is a lack of research regarding the effectiveness of herbal preparations to help with menopausal symptoms and general enhancement of wellbeing but there are many preparations that have been reputed to be helpful, including black cohosh, dong qui, wild yam, evening primrose, ginseng, ginger, red clover and valerian for sleeping problems. Some of these products may be associated with other significant health problems, so check with your doctor before commencing.

When considering natural therapies, bear in mind:

Herbs can interact with HIV drugs — check with your doctor (St John’s Wort and garlic, for example, have proven negative interactions).
Discuss your circumstances, including use of any prescription drugs, with a good herbal practitioner.
Contact your local AIDS Council or PLWHA group if you would like to see a complementary medicine practitioner but you are unsure who to see or need financial assistance.
Set a budget and don’t exceed it.

Future research

Work is continuing to better understand the impact of menopause on HIV-positive women (and the impact of HIV on menopausal women). For example, an HIV Menopause Clinic has been established at St Miriam’s Hospital in the U.S. Ongoing research will provide more knowledge about how women with HIV manage menopause and particular issues that arise.