Reflections on a specialist HIV menopause service

Abstract

Objectives We describe here characteristics and clinical outcomes of women living with HIV attending an HIV menopause service. Methods This was a retrospective case note review of women attending the monthly HIV menopause clinic from January 2015 to July 2018. Results In all, 55 women attended the service. The overall mean age was 49 years; 50% were black and 20% had a previous AIDS‐defining condition. All were on antiretroviral therapy (ART); the median CD4 count was 678 cells/µL; 93% had a viral load < 50 copies/mL; 7% had previous hepatitis C infection; 27% had a history of smoking; 45% had risk factors or existing cardiovascular disease; 24% had a mental health condition. The median duration of symptoms before clinic attendance was 18 months. Vasomotor symptoms (84%), menstrual cycle changes (62%), psychological (56%) and urogenital symptoms (29%) were reported. Twenty‐two per cent had early menopause or premature ovarian insufficiency. The mean age at attendance of women diagnosed with menopause (n = 24) was 52 years. However, their average duration of symptoms prior to review was 28 months. A total of 61% had osteopenia/osteoporosis, 73% received menopausal hormone therapy (MHT), and 73% had symptomatic improvement, although 58% of these required higher doses of MHT. Median time on MHT was 10 months. Five patients had their ART modified. No serious MHT adverse effects were observed. Conclusions Menopausal hormone therapy uptake was high, with most women observing an improvement in symptoms. Comorbidities were common, highlighting the need for integrated care based on a woman's needs. The long delay from initial symptoms to treatment demonstrates the need for better access to specialist advice for women experiencing menopause.

Collection of menopause data in studies of women living with HIV: A systematic literature review

“…The most common definition of menopause was amenorrhea for ≥12 months, in accordance with WHO (n = 20/37) [21]. Fourteen of the HIC studies [7,8,13,36,42,43,45,[52][53][54][55][56]58,59] and six of the LMIC studies [3,62,[66][67][68][69]] used this definition. Some studies used additional criteria, including age >40 years or hormone levels such as follicle-stimulating hormone (FSH) >25 IU/L [36,58].…”

“…A total of five studies used other tools, including the MENQOL questionnaire [25,51,68], the Women's Health Questionnaire [63,70], and the GCS [7,26,61]. Ten of the HIC [36,43,45,48,50,[55][56][57][58][59] and two of the LMIC [67,69] studies used a study-specific tool created by the study group to assess menopausal symptoms. The level of detail included in these tools varied.…”

“…The level of detail included in these tools varied. In several cases, the authors noted that a questionnaire on menopausal symptoms was administered to subjects but did not list the specific questions in the article [43,59,67]. In other cases, subjects were asked to list their top menstrual/menopausal symptoms of the day [49].…”

“…The majority of studies (n = 29/37) reported psychological symptoms to some degree, chiefly anxiety and depression [2,[7][8][9]12,13,[34][35][36][37]42,43,[47][48][49][50][51]53,55,56,60,[62][63][64][65][66][67][68][69]. In about one-third of the studies (n = 10/37), these symptoms were included in the menopausal symptom rating scale, such as MRS or MENQOL.…”

“…Most studies (n = 31/37) recorded data on whether or not a participant was using ΜΗΤ, including 23 HIC studies [2,8,9,12,13,[34][35][36]43,[45][46][47][48][49][50][51]53,55,56,[58][59][60][61] and eight LMIC studies [3,37,62,63,65,[67][68][69], whereas only five studies included details on the type of ΜΗΤ [35,43,48,62,65]. A total of 11 studies excluded women using ΜΗΤ from their analyses [2,9,47,49,53,55,56,58,60,63,69]…”