Menstrual Problems in HIV Infection
What kinds of menstrual problems occur?
HIV-positive women have reported all types of changes in their periods.
This includes irregular periods, more or less frequent periods,
heavier or lighter periods, more painful periods and a worsening
of premenstrual syndrome (PMS). Also, women have reported passing
clots or menstrual blood that is darker than usual.
The most common menstrual problem reported by HIV-positive women
is the loss of their periods altogether. This condition is called
Amenorrhea. Women who miss their periods experience pelvic pain,
swollen breasts or hot flashes.
Heavy periods can result in excessive blood loss, which could lead
to low red blood cells or anemia. Anemia can make you feel tired,
weak and short of breath. Since HIV infection itself as well as
many of the medications used to treat it can also cause anemia,
it is important to carefully look for this problem.
Does HIV disease cause menstrual problems?
It is not known for sure. The female reproductive system and the
menstrual cycle are very complicated. It is known that female hormones
(estrogen and progesterone) can communicate with parts of the immune
system. It is also known that the male hormone testosterone may
be lower than normal in HIV-positive men. So it is logical to guess
that problems in the immune system may cause changes in female hormones
that could result in menstrual irregularities.
Studies of testosterone levels have been conducted in HIV-positive
men. Men with low levels of testosterone often have muscle loss,
weight loss, and decreased sexual drive. Testosterone replacement
is available in shots or by patch. Men with low testosterone often
gain weight, regain sexual drive and feel better with therapy. On
the other hand, female hormone function has not been adequately
studied in HIV-positive women.
Chronic illness and weight loss also cause women to stop having
periods. So, many women with AIDS who are very ill and have lost
a lot of weight may stop having periods.
How are menstrual problems diagnosed?
If you are having any changes in your menstrual cycle report them
to your doctor. You should also see a women's health specialist
such as a gynecologist (commonly called a GYN) or a gynecology trained
nurse practitioner. It is important to have a pelvic examination.
Blood tests check for hormonal problems and may be needed to see
where the problems got started. Menstrual problems can affect your
physical and emotional health but they can be diagnosed and treated.
How are menstrual problems treated?
There are many causes for menstrual problems, so a correct evaluation
is very important. If the female hormone estrogen is low you may
be entering menopause. Menopause normally occurs between the ages
of 45-55. If you enter menopause before age 40, it is called "premature
menopause." The symptoms of menopause may include hot flashes, loss
of sexual interest, dryness in the vagina, painful urination, insomnia
and moodiness. Symptoms of menopause can be treated by hormone replacement
therapy (estrogen, progesterone or both). Hormone replacement can
provide relief from these bothersome symptoms and has been shown
to be good for women's bone strength and cardiac system. Estrogen
use alone has been found to increase a woman's risk of uterine cancer
and may present a small increase in risk of developing breast cancer.
PMS can be treated in many ways and the treatment should include
more rest, stress reduction, vitamin supplementation and regular
exercise. Herbal or prescribed diuretics (water pills) can be used
with your doctor's supervision to prevent bloating and breast pain.
Small doses of antidepressants help some women cope with mood swings.
Premenstrual or menstrual pain (dysmenorrhea) usually respond to
medications including aspirin, ibuprofen (Motrin or Advil) or naproxen
(Naprosyn, Anaprox or Aleve) all of which can be purchased over
the counter.
Can street drugs affect the menstrual period?
Some street drugs will affect your period. Heroin can cause a woman
to miss periods. Methadone is less likely to have this effect. Marijuana
(more than a few joints a day) sometimes can cause a milky breast
discharge and a missed period. Cocaine does not seem to have these
effects. However, poor nutrition and weight loss may cause missed
periods. So if a drug habit is causing you to neglect your nutrition
the result might be menstrual problems.
Do any medications used for HIV affect the menstrual period?
Megace, a drug which is approved for HIV wasting syndrome, is a
female hormone called progesterone. The Megace clinical studies,
which led to its approval only enrolled ten women. All ten of the
women reported menstrual problems. The most common side effect of
progesterone is irregular, constant or sometimes heavy bleeding.
Women using progesterone for birth control (depo-provera or Norplant)
report headaches, bloating or depression.
Other AIDS drugs may cause menstrual problems, including the antiviral
medications such as AZT, ddI, ddC and d4T. However, many of the
original trials enrolled very few women and the women who were enrolled
were not asked about their periods.
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