Menopause is a normal part of a woman’s life. Often called “the change of life,” it is a series of body changes that can last from one to 10 years. Once your body has completed these changes, and you have not had your period for 12 months in a row, you have passed through menopause.

Women usually experience menopause between the ages of 38 and 58, and most women begin menopause around the age of 51. There is some evidence that HIV+ women may experience menopause earlier. However, the symptoms of menopause appear to be the same for both HIV+ and HIV- women.

The changes of menopause begin when your ovaries naturally begin decreasing production of the female sex hormones:

• Estrogen
• Progesterone

When you near menopause, estrogen levels drop. The reproductive organs (uterus, ovaries, fallopian tubes) gradually shut down until your periods end and you can no longer get pregnant.

A woman can usually tell she is approaching menopause because her periods start changing. This time is called "perimenopause." During perimenopause and menopause hormone levels fluctuate and you can expect to experience symptoms such as:

• Increasingly irregular periods
• Hot flashes
• Night sweats
• Mood swings
• Depression
• Irritability
• Vaginal dryness
• Forgetfulness
• Trouble sleeping
• Fatigue
• Lack of sexual desire
• Frequent urinating
• Skin changes including: thinner skin, wrinkling, and acne
• Some women have lower CD4 counts after menopause

 HIV+women who experience hot flashes at night may be misdiagnosed as having night sweats that are common with HIV, as well as other related conditions such as  "wasting" .Vaginal dryness  can be mistaken for a yeast infection. It's important to keep track of your cycles and report your suspicions to your doctor to avoid misdiagnosis or hormonal treatments that may not be necessary.

HIV+ women may experience irregularities in their menstrual cycles even if they're not going through menopause. Speak to your doctor if you are having any of the symptoms described above to find out if they are related to HIV, menopause, or some combination. It may be helpful to have your hormone levels checked as well.

There are also some serious medical concerns related to menopause, such as:

• Osteoporosis (bone weakness)
• Coronary artery (heart) disease
• Decreased cognition (difficulty thinking clearly)
• These are also conditions that can be brought on by HIV or HIV drugs.

Many women want to replace the estrogen their body is losing because it relieves the symptoms of menopause. However, estrogen increases the risk of uterine cancer if taken alone.

• If a woman has had her uterus removed, she can take estrogen by itself. This is called estrogen replacement therapy or ERT.
• Women who still have a uterus usually take a combination of estrogen and progesterone. This is called hormone replacement therapy (HRT).

Taking HRT may relieve menopausal symptoms, reduce bone loss, and decrease the risk of colon cancer. However, HRT has risks. It should not be used for long-term prevention of heart disease. Taking HRT increases, rather than reduces, the risk for heart disease and stroke. It also increases the risk of breast cancer and blood clots.  It is important that each woman discuss her individual symptoms and medical history with her doctor to determine if HRT is appropriate in her case.

Some HIV+ women will benefit from HRT to relieve the symptoms of menopause. However, the risks may outweigh the benefits if you smoke, are overweight, or have had blood clots, breast cancer, diabetes, high cholesterol levels, liver problems, or a family history of heart disease. 

HIV+ women who choose to go on HRT should speak to their doctors about drug interactions. Research on birth control pills containing estrogen and or progesterone has shown that they interact with many HIV drugs. Some HIV drugs can cause decreased or increased levels of hormones. Estrogen can also cause decreased levels of some HIV drugs and put you at risk for viral rebound and drug resistance.

There are other therapies available to treat menopausal symptoms. However, these may also have undesirable side effects or interact with HIV drugs. If you choose alternative therapies it is best to consult a skilled practitioner and let your doctor know exactly what you are doing.

Other treatments include:

• Herbs such as black cohosh
• Soy foods
• Vitamins
• Chinese Medicine
• Antidepressant drugs and/or counseling
• Fosomax (prescription drug) for bone loss

Your risk of bone loss, bone fractures, heart disease, and other conditions increases as you age. HIV+ women may face an increased risk of these diseases if they are experiencing metabolic changes due to HIV drugs, such as high cholesterol and triglycerides, and glucose (sugar) related abnormalities.

Things you can do to stay healthy after menopause:

• Eat a healthy diet
• Supplement your diet with calcium daily (helps to prevent bone loss)
• Quit or try to cut down on smoking
• Use alcohol moderately
• Exercise for 30 minutes three times a week
• Have a yearly mammogram
• Have a GYN exam at least once a year with a Pap smear
• Have your cholesterol and triglycerides checked regularly

If your cholesterol is high, you may need cholesterol-lowering drugs.

The symptoms of menopause are different for each woman. For some, the symptoms are mild and tolerable. For others, the symptoms are so severe that they impact quality of life. Decisions about treatment options are yours to make. Discuss your concerns and questions with your doctor. He or she can help you weigh the risks and benefits.

1		Arnsten, J.H., et al. (2002). Bone mineral density and protease inhibitor use in older HIV-infected women. 9th Conference on Retroviruses and Opportunistic Infections, Seattle. Abs. 717T: Retrieved July 2003 from http://www.retroconference.org/2002/Abstract/13080.htm
2		Van Benthem, B.H.B. et. al. (2001). The impact of pregnancy and menopause on CD4 counts in HIV-infected women. 8th Conference on Retroviruses and Opportunistic Infections. Abs. 205: Retrieved July 2003 from http://www.retroconference.org/2001/abstracts/abstracts/abstracts/205.htm.
3		Combination Therapy:Health Providers Seek to Understand the Compounded Effects of Menopause With HIV Disease By Bob Adams HIV PlusFrom the May 2005 issue Retrieved May 2007 from http://hivplusmag.com/column.asp?ID=575&categoryid=1 Menopause Clinic
4		North American Menopause Society
5		Hormone Foundation