Women with HIV transitioning through menopause: Insights from the Swiss HIV Cohort Study. HIV Medicine
Hachfeld and Atkinson et al. determined the prevalence of menopause, the age of its onset, and risk factors for early menopause among women in the Swiss HIV Cohort Study (SHCS).
All women who reported menopause (defined as the absence of menstrual bleeding for at least 12 months) were included in the study. Onset before the age of 45 years was considered as early menopause, and before 40 years as premature ovarian insufficiency. The authors assessed the proportion of women in the SHCS with menopause over time and used multivariable logistic regression to explore risk factors for its early onset.
Reflecting the aging of the SHCS, the proportion of women in menopause rose from 11.5% in 2010 to 36% in 2018. For the present study, 1’130 women without menstrual bleeding for at least 12 months were included. Sixty-seven percent were Caucasian and 25% were of African origin, the median age at menopause was 50 years (range 32 – 55), 115 women (10%) were classified as having an early menopause, and 23 (2%) had premature ovarian insufficiency. Importantly, 27% of the study participants were diagnosed with depression or currently received psychiatric care. In multivariable analyses, women of African origin were most likely to have early menopause (adjusted odds ratio 4.2, 95% CI 2.5 – 7.2), whereas no other covariates (including HIV-associated factors such as CD4 cell count, viral suppression, or hepatitis coinfection) were significantly associated with the age of menopause onset. The authors also noted that within the 36 months after documentation of menopause, 11% of women received hormone replacement therapy, and 27% had a bone mineral density measurement to evaluate the risk for osteoporosis.
In summary, the present study highlights the importance of addressing menopause in the clinical care of people living with HIV. The high proportion of psychiatric conditions is concerning and warrants special attention in the care of menopausal women living with HIV. Although menopause onset occurred 2 years earlier in women living with HIV compared with HIV-negative women in Switzerland, these findings were mainly driven by the high proportion of women of African origin, whereas HIV-related factors seemed to play a lesser role. Finally, access to hormone replacement therapy and screening for osteoporosis should be improved for optimal treatment of women living with HIV.