HIV and the Menopause Transition

December 01, 2023.

medically reviewed by Patricia Shelton, MD.

How can HIV-positive women manage their menopausal symptoms?

In the past, HIV was almost always fatal. People infected with the virus would inevitably develop AIDS. Fortunately, this is no longer true. With the right treatment, people with HIV can expect to live a normal lifespan, roughly as long as people without HIV. This means that women who acquire HIV when they’re younger are very likely to live into their menopausal years. In addition, 

For women living with HIV, they may wonder what will happen when they start going through menopause. If you’re HIV-positive and menopausal, how can you manage your symptoms? How might HIV affect your journey through peri and menopause?

HIV and the journey through menopause

One of the major challenges for women living with HIV is that they often have irregular periods already, while they’re in their reproductive years. This is not a direct consequence of HIV infection, but it’s commonly related to the medical issues that are often related to HIV. HIV can cause weight loss, which can lead to irregular or absent periods. It also puts a major physiological stress on the body, which can also interrupt the menstrual cycle.

As a result, doctors may not realize that an HIV-positive woman is in perimenopause. They often assume that her irregular periods are due to other issues. Other symptoms associated with peri may be attributed to medication side effects or infections related to HIV. As a result, women with HIV may wait longer to receive treatment for their peri symptoms.

Some studies have reported that HIV-positive women go through menopause about three years earlier than HIV-negative women do. The research on this has not been conclusive, and better-designed studies are needed to be sure about this. However, if an HIV-positive woman goes through menopause earlier than expected, this further increases the chances that both the woman herself and her doctor will falsely attribute her symptoms to another cause, rather than realizing that she’s going through menopause.

There has also been some research indicating that the symptoms of peri tend to be more severe in HIV-positive women. For example, women with HIV have been found to have more severe vasomotor symptoms (such as hot flashes) than those without the virus. There have been very few studies on this topic, but HIV-positive women may want to be prepared to experience symptoms as they go through peri.

Menopause may affect the immune system

Another important factor to take into consideration is that the shift in hormone levels that occurs during the menopausal transition can affect all parts of the body – including the immune system. Some studies have reported that postmenopausal women with HIV generally have lower CD4 cell counts than HIV-positive premenopausal women. CD4 cells are a type of immune system cell, and HIV targets these cells and destroys them. Lower CD4 counts generally lead to more health issues associated with HIV.

It’s important to note that these studies have not been conclusive, and more research is needed to clarify whether menopause causes CD4 counts to decline. However, this is a reason to take menopause seriously in HIV-positive women. Research also indicates that the antiretroviral medications used to control HIV remain effective in women after menopause, and it’s crucial that an HIV-positive woman continues to receive adequate treatment for the virus as she goes through menopause. 

Can you take Hormone Therapy if you’re HIV-positive?

In general, HIV infection is not a contraindication to receiving hormone therapy for symptoms related to menopause. It’s considered safe for HIV-positive women to receive HRT. It’s important to check for any potential interactions between a specific medication that a woman is taking and hormone therapy – although this is important for any medication, not just antiretroviral medications. However, in general, hormone therapy is an option for HIV-positive women.

In fact, women living with HIV may particularly benefit from hormone therapy. HIV infection itself, as well as many HIV medications, can put women at risk for bone loss. Taking hormone therapy can help to protect bone tissue, so HIV-positive women may want to consider taking it to help reduce the risk of osteoporosis (low bone density).

HIV-positive women may also experience more bothersome vasomotor symptoms like hot flashes. Hormone Therapy is highly effective at relieving these symptoms. Women who are taking HIV medications may already be experiencing side effects of these, along with the effects of the virus itself. They may not want to experience perimenopausal symptoms on top of all of this, and may choose hormone therapy to help relieve those.

Many people living with HIV experience mental health challenges, such as anxiety. Peri can have an impact on a woman’s mental health, and may worsen these challenges. Some women find that taking hormone therapy helps to relieve anxiety. Although the research on this has not been consistent, it may be an additional reason for HIV-positive women to consider hormone therapy.

Menopause in HIV-positive women

In general, HIV-positive women may tend to go through menopause a little earlier and have more severe symptoms than those who are HIV-negative. They may already be facing challenges related to their HIV infection and the side effects of the medications used to control it. Taking HRT is considered to be a safe option for HIV-positive women, and may help to prevent long-term health issues like osteoporosis along with relieving the symptoms associated with peri.


Disclaimer: This is no medical advice

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Patricia Shelton

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