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Women with HIV at increased risk of early onset menopause

11 November 2019:  

Thanks to medical advancements, HIV-positive women now have a longer life expectancy, exposing them to numerous midlife health issues such as menopause. A new Canadian study demonstrates that women with HIV are more likely to enter the menopause transition at an average age of 48 years, 3 years younger than the general population. 

Newly diagnosed HIV-positive patients who adhere to the latest therapy protocols are expected to live into their mid-70s or longer. That means these patients are now faced with aging issues that affect sexual and reproductive health, including menopause.

The average age of menopause in Canada and the United States is between 50 and 52 years. Previous studies have shown that women living with HIV are at an increased risk of early (age between 40 and 45 y) and premature (age <40 y) menopause (also known as primary ovarian insufficiency). However, this study from Canada is the first known study to determine the average age of menopause for HIV patients, the prevalence of early menopause (between 40 and 45 y) and premature menopause (before 40 y), and other correlates influencing age at menopause.

Study researchers confirmed that women living with HIV experience menopause at a younger age, specifically 48 years, roughly 3 years earlier than uninfected women. This population additionally had higher rates of early menopause and premature menopause. In addition, lower education and hepatitis C coinfections were also shown to influence the risk of early menopause, with other possible modifying factors including marital status and region of birth.

Because menopause is associated with changes in mood, sexual function, reduced quality of life, and increased the risk of developing other comorbidities such as heart disease and osteoporosis, a woman's increased risk of early menopause has implications for healthcare practitioners planning their care.

Abstract

OBJECTIVE:

Menopause is a pivotal transition for women. Previous studies have suggested increased risk of early menopause (40-45 years) and premature menopause (<40 years) for women with HIV. We aimed to determine age of menopauseprevalence of early menopause and premature menopause, and risk factors for menopause <45 years in Canadian women with HIV.

METHODS:

This was a cross-sectional analysis from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study. Analyses were restricted to biologically female participants reporting being postmenopausal (regardless of etiology). Primary outcome was median age at menopause. Predetermined variables, and those with P < 0.10 in univariable analyses were considered for inclusion into multivariable logistic regression model, to determine independent correlates of menopause <45 years.

RESULTS:

229 women were included. Median age of menopause was 48 years (interquartile range 43, 51); 29.7% of women experienced menopause <45 years: 16.6% with early menopause and 13.1% with premature menopause. In univariable analyses, menopause <45 years was more likely (P < 0.05) with birth in Canada, white ethnicity, less than high-school education, smoking, recreational drug use, and hepatitis C co-infection. In multivariable modeling, less than high-school education (adjusted odds ratio [aOR] 2.45, 95% confidence interval [CI] 1.22-4.93) and hepatitis C co-infection (aOR 1.90, 95% CI 1.04-3.50) were independently associated with menopause <45 years.

CONCLUSIONS:

In Canadian women with HIV, median age of menopause was 48 years; 3 years younger than the general population. Only lower education and hepatitis C co-infection were independently associated with menopause <45 years, highlighting importance of socioeconomic factors and comorbidities. These findings have implications for counseling and management of women with HIV.

Reference

Andany N, Kaida A, de Pokomandy A, Yudin MH, Wang L, Kennedy VL, Webster K, Loutfy M; CHIWOS Research Team. Prevalence and correlates of early-onset menopause among women living with HIV in Canada. Menopause. 2019 Nov 4. doi: 10.1097/GME.0000000000001423. [Epub ahead of print]

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