NAPWA

Menopause is often called the “change of life” and usually happens in women between 38 and 58 years of age. It is a slow and gradual process that can occur over three to five years while the ovaries slowly stop producing estrogen. This beginning phase is called peri-menopause, where periods become less frequent and some other menopausal signs can appear.

Menopause is considered complete when you have not menstruated for 12 months. This marks the end of your fertility and is accompanied by significant hormonal changes.

Prior to the advent of effective anti-HIV treatments, women with HIV reported getting menopause at an earlier age, and having a greater incidence and severity of associated symptoms.

Since treatments, there is less difference in the experience of menopause between HIV and non-HIV infected women, although some studies show the average age of menopause remains younger in women with HIV. It isunclear whether this difference is due to HIV, or because the other factors associated with earlier menopause (such as drug use or lower body weight) is more common in women with HIV. Further, there was a small proportion of women with HIV in these studies who did not menstruate for over 12 months but still had fully functioning ovaries.

Women with HIV more commonly have irregularities in their menstrual cycle that may be mistaken for menopause. Further, the symptoms of menopause are often hard to distinguish between other symptoms associated with long term HIV infection.

Common symptoms of menopause include:

• hot flushes and night sweats
• crawling or itching sensations under the skin
• vaginal dryness and thinning of the vaginal walls
• reduced libido (sex drive)
• urinary frequency or accidental urination
• tiredness & fatigue
• insomnia (difficulty sleeping)
• mood changes (irritability, forgetfulness, depression).

As menopause completes there are several changes that occur:

• skin changes (becomes more firm and drier)
• cognitive changes (thinking and understanding)
• hair changes (it becomes thinner and more brittle)
• you are at increased risk of bone loss (osteoporosis) and cardiovascular disease.

What can you do?

Find common ways to treat or diminish the impact of common symptoms

For example:

• if you are experiencing sleeping problems: keeping the windows open, wearing bed clothes made of breathable fabrics, drinking at least eight cups of water a day and keeping water by the bed may be useful
• if you are suffering from fatigue: a regular exercise program may make you feel more energetic and regular sleep is important. It may be necessary to prepare food for when you are too tired to cook
• hot flushes may be relieved by taking vitamin E. Foods like tofu and soy milk are often suggested because they contain phytoestrogens (chemicals
  similar to estrogen)
• vitamin B complex is useful for the skin and hair changes that accompany menopause (www.projectaware.org has a comprehensive list of menopausal symptoms and herbal remedies. However, check all herbal/alternative supplements with your doctor for any interactions with HIV treatments)
• avoid things which generally increase the risk of menopausal symptoms such as caffeine, spicy foods and excessive alcohol while menopausal.

If you experience uterine bleeding talk to your doctor

Women with HIV experience abnormal uterine bleeding quite commonly. During and after menopause the risk of urinary tract infections also increases. Many of these are immediately treatable so it is important to see your doctor if you notice either of these symptoms.

After menopause, take steps to address your increased risk of osteoporosis

If you have not had a hysterectomy and do not have severe liverA large organ, located in the upper right abdomen, which assists in digestion by metabolising carbohydrates, fats and proteins, stores vitamins and minerals, produces amino acids, bile and cholesterol, and removes toxins from the blood. disease, hormone replacement therapy may be an option for the short term treatment of menopausal symptoms. However, HIV makes the decision about whether to have HRT more complex due its potential for increasing the risk of other conditions common in older women with HIV, so you will need to discuss this with your doctor to tailor a solution to suit your individual needs. Also see the section on bone changes for some other steps you can take to reduce your risk of osteoporosis.

Living with menopausal symptoms

• Dress lightly and in layers
• Avoid caffeine, alcohol and spicy foods
• Practice slow deep breathing whenever a hot flush starts
• Consider an acupuncturist
• Use relaxation techniques like yoga, Tai Chi or meditation
• Increase your fitness and weight bearing exercises
• Don’t smoke
• Adopt a healthy heart diet
• Supplement calcium
• Perform Pelvic floor exercises daily to strengthen the muscles of your vagina and pelvis
• Use water-based lubricants during sex
• Talk to other positive women about their experiences and useful strategies.

Ahead of Time: A practical guide to growing older with HIV

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