Gynecological conditions and HIV / AIDS

October 2005     View PDF     En español

Menstrual changes

Changes in periods are common, for both HIV-positive and negative women. For HIV-positive women, these changes can include irregular, heavier or lighter periods; worsening of symptoms from pre-menstrual syndrome (PMS); darkening of menstrual blood; and no periods for more than 90 days (amenorrhea). In some studies, amenorrhea was more frequent among women with CD4+ cell counts below 50.

It is not known exactly how HIV disease affects the reproductive system, hormones and menstrual cycles. It is also not known how the female hormones, estrogen and progesterone, interact with the immune system. Studies show that substance abuse, chronic illness and major weight loss can impair the hypothalamus. (The hypothalamus is the part of the brain that controls sex hormone secretion and can affect menstruation.) It is presumed that problems with a woman’s immune system due to HIV cause changes in her hormones and results in menstrual problems.

HIV-positive women with changes in menstrual bleeding should seek medical attention to determine its cause. Heavy bleeding or painful periods can be associated with PID. They may also be explained by low platelets (the part of the blood involved in clotting and immune response) from HIV infection.

Your doctor can order a complete blood count (CBC) to determine your platelet count. If your platelet count is low (under 50,000), be sure to review your meds with your doctor. Some medications, including aspirin and ibuprofen, may affect your body’s blood clotting process. Many treatments are used for platelet counts below 20,000, including AZT, corticosteroids, intravenous gamma globulins and platelet transfusions. Alcohol should also be avoided because it may block platelets and interfere with normal blood clotting.

Anemia is also common among HIV-positive women and can cause fatigue. Heavy and/or frequent menstrual bleeding (dismenorrhea) can cause anemia, or low red blood cells, which can also lead to amenorrhea. While the symptoms of dismenorrhea and amenorrhea are opposite, they both may be caused by anemia. Anemia can be treated with Epogen (Epoetin alfa).

It is important to check into all possible causes of amenorrhea. These may include anemia, pregnancy, ovarian cysts, opportunistic infections, menopause or other GYN conditions. Other factors may include using some anti-HIV therapy and other meds (like megestrol), street drugs (especially heroin and marijuana) and poor nutrition. Finally, body weight changes, stress and too much exercise can interrupt the menstrual hormone necessary for normal periods to occur.

There are several ways to ease many of the symptoms that come with common menstrual problems. Cramping before and during periods usually responds to over-the-counter medications like aspirin, ibuprofen (Motrin, Advil) or naproxen (Aleve). Some women choose to treat their symptoms with hormone replacement therapy or herbal and nutritional therapies. Birth control pills that mimic normal menstrual cycles are also used. Finally, reducing your stress, adding vitamins to your diet, exercising regularly and maintaining good nutrition can be included in any treatment plan.