Thanks to advances in treatment and care, people living with HIV are enjoying longer, healthier lives. This also means that more people living with HIV are going through the journey of menopause, a significant life transition that many cisgender women, and some trans men and non-binary people, experience*.
Despite a large number of women spending nearly half their lives in menopause, it is not commonly discussed as part of sexual and reproductive health, nor is it commonly discussed as part of HIV care. Added to this, many women do not feel they can seek out care for menopause, or when they do, it is not addressed adequately.
We need to break the silence and stigma about menopause. Healthcare and service providers can better support their patients and clients experiencing menopause, including those living with HIV, by learning more about menopause and how to provide care to people experiencing this important life transition.
*CATIE acknowledges that although menopause care has primarily been designed for cisgender women, people assigned female at birth who do not identify as women may also require menopause care that meets their needs.
What is menopause?
Most people are likely to begin the menopausal transition between the ages of 45 and 55, which occurs because of changes to the reproductive sex hormones estrogen and progesterone. For women living with HIV who are on effective treatment, the age at which menopause begins varies, but appears to be similar to HIV-negative women.
As women grow older, biological processes related to aging and changes to sex hormones lead to irregular, and then infrequent, menstrual periods and often a number of other symptoms. The first stage, perimenopause, involves the gradual change of ovarian function and can begin as early as 10 years before menopause. A person has reached menopause after 12 consecutive months without a period. During and after this transition, some symptoms may also occur, such as hot flashes, night sweats and vaginal dryness. Although there are some common symptoms, each person will have a unique experience as they go through menopause.
Hormone replacement therapy (HRT) products are the most common treatments for these menopausal symptoms, which include accelerated bone loss. HRT is made up of estrogen and progesterone, and it is available in several forms, including pill, patch, gel and vaginal ring.
A biomedical model sees menopause as the start of aging for a woman and the end of her reproductive years, but menopause is also a social experience that can vary based on social determinants of health. In a society that often categorizes women by their status as “young” or “old”, and by their status as a mother or without child, menopause represents not only a biomedical transition but also a change in how women are perceived. Some may mourn what this change represents and many will honour it. For women living with HIV, menopause can be a celebration of new experiences and enjoying a longer life.
Menopause and HIV
Many of the symptoms experienced by women living with HIV can become more severe during menopause. However, it can be difficult to tell whether these symptoms are caused by HIV, HIV treatment, menopause, a combination of these factors, or any of the other health conditions that come with growing older.
In order to help shed light on this, a team of Canadian researchers collected health-related information from 464 women living with HIV in British Columbia, Ontario and Quebec, who were perimenopausal or post-menopausal. While almost 50% of women had symptoms of the menopausal transition, only 12% had ever used HRT. Many women in the study had not discussed menopause or treatments with their healthcare providers to help relieve symptoms. The study also found that Indigenous, as well as African, Caribbean and Black women, were less likely to discuss menopause with their healthcare providers than White women.
Self-advocating for access to HRT can be difficult. However, women who did discuss menopause with their doctors were more likely to have received HRT, highlighting the importance of these discussions in clinical care, as well as the need for enhanced menopausal education among healthcare providers.
Supporting women living with HIV
There is very little information and very few resources to support people through the menopause journey, and until recently, there has been nothing specifically designed for women living with HIV in Canada. To respond to this important gap, a team of women living with HIV who have experienced menopause and researchers from BCC3 (British Columbia CARMA CHIWOS Collaboration) came together to create Menopoz and You: A Guide to Menopause. It provides useful information, including details about the different stages of this life transition, such as changes to expect and words of wisdom for managing them.
Women are starting to break the taboo of talking about menopause and healthcare needs to catch up. In addition to sharing this resource with their patients, healthcare providers can be more proactive about understanding and treating symptoms related to menopause, offering information about HRT, and educating themselves about menopause overall. They can also work with cisgender women and other folks who may experience menopause to manage changes to their bodies and any health issues that accompany them. Aging and living well with HIV also means living well with menopause.
Sugandhi del Canto is associate director, HIV and sexual health knowledge mobilization at CATIE. She has worked in HIV since 2002 and holds a PhD in community health and epidemiology from the University of Saskatchewan. She also knits a lot.
A practical clinical guide to counselling on and managing contraception, pre-conception planning, and menopause for women living with HIV – Journal of the Association of Medical Microbiology and Infectious Disease Canada
Women-Centred HIV Care – CHIWOS
Primary Care Guidelines – British Columbia Centre for Excellence in HIV/AIDS