Prolonged Amenorrhea and Resumption of Menses in Women with HIV

Cejtin, Helen E.; Evans, Charlesnika T.; Greenblatt, Ruth M.; Minkoff, Howard; Weber, Kathleen M.; Wright, Rodney; Colie, Christine; Golub, Elizabeth T.; Massad, L. Stewart

doi:10.1089/jwh.2018.7046

Cited by 18 publications

(11 citation statements)

References 52 publications

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“…Thus, psychological, psychogenic and metabolic stressors act synergistically in compromising reproduction (Marcus, Loucks, and Berga 2001;Giles and Berga 1993;Berga, Daniels, and Giles 1997;Warren et al 1999;Williams, Berga, and Cameron 2007;Berga 2008). In line with these findings, severe mental or infectious diseases such as HIV or Ebola infection have been found to add to the risk for FHA (Fava et al 1984;Cejtin et al 2018;Godwin et al 2019). On this background, the current SARS-CoV-2 pandemic will probably also influence the prevalence of FHA.…”

Section: Psychological and Psychogenic Factorsmentioning

confidence: 88%

Recovery of menses after functional hypothalamic amenorrhoea: if, when and why

Pape

Herbison

Leeners

2020

Human Reproduction Update

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BACKGROUND Prolonged amenorrhoea occurs as a consequence of functional hypothalamic amenorrhoea (FHA) which is most often induced by weight loss, vigorous exercise or emotional stress. Unfortunately, removal of these triggers does not always result in the return of menses. The prevalence and conditions underlying the timing of return of menses vary strongly and some women report amenorrhoea several years after having achieved and maintained normal weight and/or energy balance. A better understanding of these factors would also allow improved counselling in the context of infertility. Although BMI, percentage body fat and hormonal parameters are known to be involved in the initiation of the menstrual cycle, their role in the physiology of return of menses is currently poorly understood. We summarise here the current knowledge on the epidemiology and physiology of return of menses. OBJECTIVE AND RATIONALE The aim of this review was to provide an overview of (i) factors determining the recovery of menses and its timing, (ii) how such factors may exert their physiological effects and (iii) whether there are useful therapeutic options to induce recovery. SEARCH METHODS We searched articles published in English, French or German language containing keywords related to return of menses after FHA published in PubMed between 1966 and February 2020. Manuscripts reporting data on either the epidemiology or the physiology of recovery of menses were included and bibliographies were reviewed for further relevant literature. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria served to assess quality of observational studies. OUTCOMES Few studies investigate return of menses and most of them have serious qualitative and methodological limitations. These include (i) the lack of precise definitions for FHA or resumption of menses, (ii) the use of short observation periods with unsatisfactory descriptions and (iii) the inclusion of poorly characterised small study groups. The comparison of studies is further hampered by very inhomogeneous study designs. Consequently, the exact prevalence of resumption of menses after FHA is unknown. Also, the timepoint of return of menses varies strongly and reliable prediction models are lacking. While weight, body fat and energy availability are associated with the return of menses, psychological factors also have a strong impact on the menstrual cycle and on behaviour known to increase the risk of FHA. Drug therapies with metreleptin or naltrexone might represent further opportunities to increase the chances of return of menses, but these require further evaluation. WIDER IMPLICATIONS Although knowledge on the physiology of return of menses is presently rudimentary, the available data indicate the importance of BMI/weight (gain), energy balance and mental health. The physiological processes and genetics underlying the impact of these factors on the return of menses require further research. Larger prospective studies are necessary to identify clinical parameters for accurate prediction of return of menses as well as reliable therapeutic options.

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Section: Psychological and Psychogenic Factorsmentioning

confidence: 88%

Recovery of menses after functional hypothalamic amenorrhoea: if, when and why

Pape

Herbison

Leeners

2020

Human Reproduction Update

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“…We know that WLWH have an increased incidence of prolonged amenorrhea in the absence of menopause compared to the general population 36,37 . It is possible that studies in this systematic review are over-estimating the prevalence of POI and early menopause due to incorrect categorization of women as being menopausal when in fact they are experiencing prolonged amenorrhea due to another cause.…”

Section: Discussionmentioning

confidence: 97%

“…Across studies, factors that have been identified as being associated with earlier menopause among WLWH include: African ethnicity, early age at menarche (<11 y), HCV infection, smoking, and drug use. Some of these factors have also been found to be associated with earlier menopause in the general population 25,26,37 and many of these factors are more prevalent among WLWH. For example, age at menopause varies significantly by ethnicity, with African women typically experiencing an earlier age at menopause 14 .…”

Section: Discussionmentioning

confidence: 99%

“…11,12,34,35 We know that WLWH have an increased incidence of prolonged amenorrhea in the absence of menopause compared to the general population. 36,37 It is possible that studies in this systematic review are over-estimating the prevalence of POI and early menopause due to incorrect categorization of women as being menopausal when in fact they are experiencing prolonged amenorrhea due to another cause. For example, a study of 1,431 women enrolled in the Women's Interagency HIV Study (WHIS) found that WLWH were significantly more likely to report 12 months of amenorrhea without an FSH level diagnostic of menopause (FSH !…”

Section: Discussionmentioning

confidence: 99%

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Age at menopause in women living with HIV: a systematic review

2021

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Importance: With improved HIV care, more women living with HIV (WLWH) are aging and entering menopause. Understanding any increased risk conferred by a potentially earlier menopause transition is important for the care of these women. Objective: There is conflicting literature regarding the association between HIV and an earlier onset of menopause. We conducted a systematic review to summarize the literature on the association between HIV and age at menopause. Evidence Review: A search of Ovid MEDLINE, EMBASE, and Web of Science identified 894 articles. We included cohort studies that assessed age at menopause, primary ovarian insufficiency (POI), or early menopause among WLWH and used the World Health Organization definition of menopause as ≥12 months of amenorrhea. Findings: Nine studies were included and eight reported on age at menopause. Across studies, the age at menopause for WLWH fell between 46 and 50 years. Five of seven studies reported that WLWH had an earlier menopausal transition than HIV negative controls/the general population. Six studies reported on the prevalence of POI or early menopause among WLWH, with all studies demonstrating an increased prevalence of both among WLWH. Conclusions: Our systematic review summarizes the literature around HIV and age at menopause. Many studies reported a high prevalence of POI and early menopause among WLWH; a factor that may partially account for the observed lower age at menopause. As only one study included biochemical confirmation of menopause, it remains unclear whether individuals with early menopause or POI were truly menopausal or had prolonged amenorrhea due to other causes. Overall, our findings highlight the need for further investigation with studies that include an HIV negative control group and biochemical confirmation of menopause to better understand whether menopause truly is occurring earlier among WLWH.

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“…The lower age bound of 40 was selected to include women with early menopause yet reduce inaccurate inclusion of younger women with amenorrhea, given its higher prevalence in WLWH compared to the general population. 27 As reproductive phase was based around menstrual definitions, women were excluded if they had abnormal menstrual patterns for the following reasons: prior hysterectomy (without oopherectomy), prior bilateral oophorectomy, current pregnancy, current breastfeeding, or hormonal contraception that alters menstrual patterns (ie, progestin-eluting intrauterine device and depo-medroxyprogesterone). History of menopausal hormone therapy (MHT) use was only available for wave two of the study.…”

Section: Study Participantsmentioning

confidence: 99%

Resilience and psychosocial factors linked to symptom experience during the menopause transition for women living with HIV*

King

Kaida²,

Prior³

et al. 2022

Menopause

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Objective: Women living with HIV (WLWH) are commonly symptomatic during perimenopause and menopause (!1 y without menstruation), however, little is known of risks for symptoms and their timing. We analyzed these unwanted experiences to inform care.Methods: WLWH (!40 y) in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study rated midlife experiences for seven symptoms and a symptom composite (from 0 to 21). Timing was categorized into four phases: i) perimenopause (flow in the last year), ii) 1-2 years from final menstrual period (FMP), iii) 2-5 years post-FMP; and iv) >5 years post-FMP. Resilience (standardized out of 100) was assessed based on Wagnild's Resilience Scale. Univariable/multivariable mixed effects linear regression assessed correlates of symptom intensity by composite score.Results: Among 457 peri-/menopausal women mean age 54.7 (AE6.6) over two time points (703 observations), 88% experienced !1 mild symptom; 75% were of moderate and 55% severe intensity. The most frequently reported symptoms were joint/muscle stiffness (67%), depressed mood (67%), and hot flashes (57%). After adjusting for reproductive phase, we found that women with greater resilience had fewer/lower intensity symptoms (symptom score 1.37 [2.30 to 0.44] lower; P ¼ 0.004); those with depressive symptoms and recreational drug use (respectively) had more/higher intensity symptoms (scores 1.71 [0.61 to 2.82] [P ¼ 0.002]; 2.89 [2.09 to 3.77] [P < 0.001] higher). Symptoms were most intense in perimenopause and declined with increasing menopausal years (P ¼ 0.03).Conclusions: WLWH experiences a high burden of midlife symptoms, decreased by resilience and most intense during perimenopause. Unwanted experiences were linked to psychosocial and behavioral factors. These data encourage HIV providers to adopt a bio-psychosocial approach to midlife management.

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Prolonged Amenorrhea and Resumption of Menses in Women with HIV

Cited by 18 publications

References 52 publications

Recovery of menses after functional hypothalamic amenorrhoea: if, when and why

Recovery of menses after functional hypothalamic amenorrhoea: if, when and why

Age at menopause in women living with HIV: a systematic review

Resilience and psychosocial factors linked to symptom experience during the menopause transition for women living with HIV*

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