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HIV+ Women May Experience More Severe Menopause Symptoms

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Women with HIV on average experience more severe hot flashes around the time of menopause than HIV negative women, and they interfere more with daily life, according to a study described in the July 1, 2013, advance online edition of the journal Menopause.

As effective antiretroviral therapy (ART) has enabled people with HIV to live longer, age-related issues have become a growing concern. Over the course of the epidemic several studies have suggested that women with HIV may undergo menopause sooner or experience more severe symptoms. But some of these analyses were done pre-ART -- when HIV positive women were much sicker than those on effective treatment today -- and more recent data have been conflicting.

Sara Looby and Steven Grinspoon from Massachusetts General Hospital and colleagues conducted a study looking at hot flash severity and related interference with daily function, mood, and quality of life among women with HIV.

The study included 33 HIV positive and 33 HIV negative women of similar age (median 47 years); 36% of the HIV positive and 48% of the HIV negative women were white. The women were in perimenopause -- the years before cessation of menstruation when patterns start to change -- and reported an average of 5-6 periods during the prior year.

Participants completed the standardized Menopause Rating Scale to assess hot flash severity and other menopausal symptoms, and the Hot Flash Related Daily Interference Scale (HFRDIS) to rate how they affected their everyday life.

Results

  • Perimenopausal women with HIV reported significantly more severe hot flashes than HIV negative women.
  • Average hot flash severity was 2 (moderate) for HIV positive women (range 1 to 3) compared with 1 (mild) for HIV negative women (range 0 to 3).
  • HIV positive women also reported much greater hot flash interference, with total HFRDIS scores of 37 (range 10 to 60) compared to just 6 (range 0 to 20) for HIV negative women.
  • Women with HIV reported more sleep disruption, depression, irritability, and anxiety than HIV negative women, as well as a greater likelihood of related difficulties affecting their work, social, and personal lives.
  • HIV positive women were also more likely to report that menopausal symptoms had a detrimental effect on relationships and overall quality of life.

"Perimenopausal HIV-infected women experience greater hot flash severity and related interference compared with non-HIV-infected perimenopausal women," the study authors concluded.

"Increased distress secondary to hot flashes may reduce quality of life and negatively impact important health-promoting behaviors, including adherence to antiretroviral therapy, in HIV-infected women," they added.

The investigators were unable to explain why HIV infection might be associated with more severe hot flashes, but recommended that more study is needed and clinicians should include monitoring of menopause symptoms as part of their care for middle aged women with HIV.

8/1/13

Reference

SE Looby, J Shifren, I Corless, et al. Increased hot flash severity and related interferences in perimenopausal human immunodeficiency virus-infected women. Menopause. July 1, 2013 (Epub ahead of print).