Predisposing risk factors include less than a high school education and hepatitis C coinfection.
With advancements in HIV treatment leading to longer life expectancies in patients newly diagnosed with the disease—antiretroviral therapy can now suppress viral loads to undetectable levels, with patients living into their 70s—age-related issues have become an important consideration in the continuum of their care. For women, who account for 22% to 25% of individuals living with HIV in the United States and Canada, as well as more than 50% globally, menopause is one such issue, and it factors strongly into their sexual and reproductive health and quality of life.
Women living in the United States and Canada typically enter menopause between 50 and 52 years of age. Knowing that previous study results suggest the risk for early and premature menopause is greater among women with HIV, a recent Canadian study that appeared in Menopause, the journal of the North American Menopause Society, wanted to determine the average age menopause occurs, the prevalence of both early-onset (40-45 years) and premature menopause (before 40 years), and risk factors that could precipitate menopause in women younger than 45 years.
Using self-reported data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) on women aged 16 and older living with HIV, 229 women who reported they were postmenopausal (no period in the 12 months before consenting to the questionnaire to enroll in CHIWOS), when menopause occurred, female sex at birth, had at least 1 period in their lifetime, and were not pregnant or taking hormonal contraception were included in the present analysis. Being postmenopausal also included 3 subcategories of reason: spontaneous, induced (from surgery, chemotherapy, or radiotherapy), and unknown.
Compared with the usual age for menopause mentioned above, the investigators found a median age of 48 years in their study. More women also reported early menopause than premature menopause (16.6% vs 13.1%, respectively)—compared with 5% and 1% in the general population—and induced menopause was more often the cause in the premature menopause group compared with those who underwent early menopause or menopause at aged 45 and older. This finding mirrors results from studies carried out in Brazil and Thailand, in which the average age of menopause of women with HIV was also younger than among the general population.
For risk factors related to any early-onset menopause, the authors first performed a univariate analysis. Having less than a high school diploma, history of smoking, recreational drug use, white ethnicity, longer duration of HIV, and history of hepatitis C were related to a greater likelihood of menopause before reaching 45. They then carried out a multivariate analyses, finding that having less than a high school diploma and hepatitis C were related risk factors for women living with HIV.
The authors caution that due to the self-reported nature of the data they used, their results may not paint a complete picture of the association of early menopause and women living with HIV. Plus, their study population “has well-controlled HIV infection, with the vast majority being on antiretroviral therapy, having an undetectable viral load, and having a normal CD4 count.” Extrapolating to the general population of women living with HIV in Canada may not be possible.
Therefore, they point out, “determination of whether biochemical confirmation of menopause should be required in the setting of HIV infection is a dilemma that warrants further investigation and consideration.”
Andany N, Kaida A, de Pokomand A, et al; CHIWOS Research Team. Prevalence and correlates of early-onset menopause among women living with HIV in Canada [published online November 4, 2019]. Menopause. doi: 10.1097/0000000000001423.