Women, HIV and older age
July 2002 View PDF En
español
Menopause and HIV
Often called the change of life, menopause is a natural event that
happens to every woman, but affects each woman uniquely. Menopause
can happen “naturally” or be induced through surgery
or therapy. At menopause, several changes happen to the female reproductive
system: 1] the ovaries stop producing the female sex hormone, estrogen;
2] a woman stops menstruating (her period stops); and 3] a woman
can no longer bear children.
Menopause can begin anywhere between 40 and 55. It is a slow and
gradual process, occurring over 3–5 years. During this time
you may have infrequent and/or inconsistent periods. Pre-menstrual
symptoms (PMS) may intensify or change. Menopause is complete when
you have not menstruated for 12 months in a row. Women living with
HIV may experience irregularities in their cycles, even if they’re
not going through menopause. It’s important you discuss this
with your doctor, so you can tell if the changes are related to
HIV, menopause or some combination.
The body changes that occur and the decrease in estrogen during
menopause express themselves in many ways. For some women the physical
signs are mild and they are able to cope with them. For others,
menopausal symptoms are very severe and difficult to cope with.
The decision to take treatment is yours. It may or may not be the
right choice for you. Discuss your concerns and questions with your
doctor. He or she can help you weigh the risks and the benefits.
Any type change in life can be difficult on you and those around
you. For women with HIV, many of these life changes from aging are
similar to the impact that HIV can have on your physical and emotional
health. Take time to make yourself aware of these possible changes
and encourage others to do the same.
The following chart can help you understand menopause symptoms,
how they’re similar to HIV, the treatments and how to relieve
symptoms.
Skin and hair changes
The skin becomes less firm and drier. Hair becomes thinner and more
brittle.
HIV Connection
- Sudden or abnormal hair loss can result from taking anti-HIV
meds, for example, indinavir (Crixivan).
- Other medications to treat cancers, circulatory disorders, ulcers
and arthritis can also cause hair loss.
Other things you can do
- Avoid excessive hair dyeing, perming, straightening, braiding,
and using hair dryers.
- Stress can also affect your hair growth and the health of your
hair. Take steps to reduce stress and anxiety.
- B-complex vitamins can help relieve dry skin and hair.
Insomnia
Insomnia and night sweats can be very uncomfortable, making it difficult
to sleep at night.
HIV Connection
- Insomnia is very common with HIV for many reasons. Receiving
an HIV diagnosis can be overwhelming, making it difficult to sleep
well.
- Insomnia has also been associated with anti-HIV meds, like d4T
(Zerit) and saquinavir (Fortovase).
Other things you can do
- Wear clothes that are made with breathable fabric (cotton, linen)
and are cooler to sleep in.
- Avoid flannel sheets.
- Keep the window slightly open or keep a fan the room.
- Drink at least eight cups of water a day and keep a glass by
the bed.
Fatigue
Fatigue is a feeling of being constantly tired or having low energy
even with enough rest. Activities like climbing stairs may be difficult.
Fatigue can also be psychological, like having a hard time concentrating.
HIV Connection
- A very common symptom of HIV.
- A side affect of anti-HIV meds.
- Associated with anemia, also side effect of anti-HIV meds.
Other things you can do
- Try going to sleep at night and waking in the morning at the
same time.
- A little exercise can ease stress and make you feel stronger
and more energetic.
- Keep easy-to-prepare foods on hand for times when you’re
too tired to cook.
Emotional changes and/or mild depression
You may experience highs and lows in your moods: one minute you’re
happy and the next you’re irritable or feeling anxious.
Treatment
- HRT/ERT may improve mood and psychological well-being.
HIV Connection
- Depression is associated with HIV and some specific anti-HIV
meds and anti-hepatitis therapy. Women living with HIV experience
more depression than men.
Other things you can do
- Let your family and friends know that you may not always feel
good.
- Exercise can help ease and improve your mood swings.
- Meditation can also help.
Hot Flashes
A hot flash is a sensation of heat in the face or moving across
the upper half of the body. They last 30 seconds to several minutes
and often times hot flashes are accompanied by a rapid heart beat.
Your skin may have a tingly sensation and you may experience chills,
sweats or be unable to breathe well.
Treatment
- Hormone Replacement Therapy (HRT) is the combination of estrogen
and progestin (a synthetic form of progesterone). Progesterone
can protect against developing endometrial cancer (cancer of the
uterine lining). HRT relieves hot flashes and night sweats.
- There are different schedules for taking HRT in pill form. You
could take estrogen every day for a set number of days, add progestin
for 10–14 days, and then stop taking one or both for a specific
period of time. You would repeat the same pattern monthly. This
cyclic schedule can cause light menstrual bleeding.
- You can take estrogen and progestin together every day of the
month without any break. This continuous pattern can stop monthly
bleeding after about six months of treatment. However, problem
spotting may continue for longer. Talk with your doctor about
the schedule that is best for you.
- Estrogen Replacement Therapy (ERT) is estrogen alone. Take as
pill or tablet, vaginal creams, vaginal ring inserts, implants,
shots or patches that stick to the skin and the body absorbs estrogen.
- Depending on your symptoms your doctor will suggest a certain
form.
Things to know
- Women who have NOT had a hysterectomy (removal of uterus, including
ovaries) can take HRT.
- HRT is known to worsen liver disease in some cases. Depending
on the severity of liver damage, HRT may or may not be an option
for you if you have liver disease. Discuss this with your doctor.
- Women with these conditions can talk with their doctors about
the risks and benefits of HRT/ERT: high levels of triglycerides
(fat in the blood), a personal or family history of blood clots
and/or breast cancer and abnormal uterine bleeding.
- Side effects for both HRT/ERT include: vaginal bleeding, breast
tenderness (this will go away after several months), nausea, bloating,
headaches, dizziness and depression.
- Depending on the form, HRT/ERT can be stopped and started again.
If you stop, their protective effects will stop and the side effects
may continue.
- Your decision about hormone therapy should be reviewed each
year with your doctor at your annual checkup.
HIV connection
- Night sweats are associated with HIV and HIV-related conditions.
- Side effects caused by HRT/ERT are also side effects caused
by anti-HIV medications particularly nausea, bloating, headaches,
dizziness and depression.
- Lipodystrophy affects many people living with HIV. Lipodystrophy
refers to changes in fat distribution in the body and irregularities
in certain blood tests (increase in triglycerides, “bad”
cholesterol levels, risk of diabetes and elevated blood pressure).
Discuss the risks and benefits of HRT and ERT with your doctor
if you are experiencing lipodystrophy.
Other things you can do
- Avoid small spaces, caffeine, alcohol, spicy foods and hot humid
weather.
- Vitamin E helps to relieve hot flashes.
- Drink plenty of water (at least eight cups a day).
- Women living with HIV often experience abnormal uterine bleeding.
Talk with your doctor if you are having uterine bleeding and find
out what the cause may be. It could be an infection that needs
to be treated immediately.
- Read Dealing with Drug
Side Effects, Lipodystrophy
and GYN Conditions, available
at 1-800-822-7422.
Memory loss or lack of concentration
You may have trouble remembering things like what you just did,
or what you said to someone. It may be difficult for you to concentrate
on one thing for long periods of time.
HIV Connection
- Dementia is a brain disorder that affects a person’s ability
to think clearly and can impact his or her daily activities. AIDS
dementia complex (ADC)—dementia caused by HIV infection—is
a complicated syndrome made up of different nervous system and
mental symptoms. These symptoms are somewhat common in people
with HIV disease. Studies show that older HIV-positive people
experience AIDS dementia more frequently than younger people.
- Some symptoms resembling forms of dementia can also be side
effects of certain anti-HIV drugs.
Other things you can do
- Make lists of things to do and cross them out as you complete
them.
- Ask a friend, family member or someone you trust to remind you
about appointments, meds, etc.
- Do things that you do everyday at the same time.
- Talk with your doctor about getting tested for ADC.
- Read AIDS Dementia Complex
or call 1-800-822-7422.
Urinary Tract Infections
The walls of the urethra become thin which increases the chance
of urinary tract infections. As the muscles, which support the bladder
and the urethra weaken, urine leakage is more common.
Treatment
- ERT vaginal ring (see Hot Flashes).
HIV Connection
Vaginal dryness
The vagina becomes dry and the vaginal walls become thin causing
pain. Intercourse may be painful.
Treatment
- ERT vaginal cream (see Hot Flashes).
HIV Connection
Other things you can do
- Use water-based lubricant during intercourse. While not proven,
vaginal gels containing wild yams have been used to relieve vaginal
dryness. What ERT and these gels will do to HIV levels in the
vagina is unknown.
Heart palpitations
Heart palpitations occur when the heart beats irregularly or misses
one or two beats.
HIV Connection
Other things you can do
- Discuss this with your doctor; to be sure, be screened for heart
disease.
- Entering menopause, women are at higher risk for heart disease.
This symptom may be related to menopause or another cause.
Osteoporosis
Osteoporosis is a disorder where a significant amount of bone mineral
decreases, causing a loss of bone mass and strength. This loss is
referred to as low bone mineral density. The bones become thinner
and more likely to break from a fall or minor stress. Post-menopausal
osteoporosis is very common in women. Estrogen protects your bones;
so with the decrease in estrogen production, there is less protection
of your bones. This puts you at risk for having weak bones.
Treatment
- HRT/ERT can reduce the risk of osteoporosis. Treatments for
osteoporosis include: Alendronate Sodium (Fosamax), Risendronate
(Actonel), Raloxifene (Evista), and Calcitonin (Miacalcin). Calcitonin
is available as a nasal spray or injection.
Things to know
- Side effects for osteoporosis meds can include: Fosamax can
cause abdominal or musculoskeletal pain, nausea, heartburn, irritation
of the esophagus; Actonel can cause stomach upset, constipation,
diarrhea, bloating, gas and headaches; and Miacalcin can cause
an allergic reaction, skin rash and runny nose.
HIV Connection
- Recent studies have found that people living with HIV have low
bone mineral density. However, the causes and significance of
lower bone mineral density for HIV-positive people remains unclear.
The data are conflicting as to whether this is related to specific
anti-HIV treatments or all of them.
- Similar side effects are caused by anti-HIV meds.
Other things you can do
- Get a Bone Mineral Density test to measure the density of your
bones (bone mass). It can determine whether you need medication
to help maintain your bone mass, prevent further loss and reduce
fracture risk. The test is painless and non-invasive.
- Weight-bearing exercises.
- Read Bone Problems or call
1-800-822-7422.
Phytoestrogens come from plants, herbs and seeds that have a similar
structure to estrogen and can ease symptoms like hot flashes and
vaginal dryness. Making phytoestrogens a part of your diet may help
ease some symptoms. It is unknown how much and how often these should
be taken. Examples: tofu, tempeh, soymilk and roasted soy nuts.
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