HIV and your body

Periods

As well as affecting your immune system, HIV may also cause menstrual problems. You are more likely to experience menstrual changes if you have a low CD4 cell count and/or high viral load or if you use (or have used) illegal drugs.

Some of the menstrual changes you may experience include:

• Long intervals between periods.

• Missed periods without pregnancy.

It's thought that these changes can occur because the damage HIV is causing to your immune system can alter your hormone balance. If you have been ill, have lost a lot of weight, or have anaemia, you may also find that these cause changes to your menstrual cycle.

Make sure that you tell your doctor if you notice any changes to your periods. It could be a warning sign that HIV is damaging your immune system and that you need to consider taking anti-HIV treatment (antiretroviral therapy). Changes in your menstrual cycle can also be a symptom of health problems. But remember that a missed period might also mean that you are pregnant.

Abnormal bleeding (for example after sex) after the menopause, or very heavy periods should also be reported to your doctor. Heavy periods can be caused by several factors, including fibroids (growths that develop from the smooth muscle layer of the uterus). If left untreated, the blood loss from heavy periods could lead to anaemia.

 

Menopause

It's thought that HIV can interfere with your body’s ability to produce the hormones oestrogen and progesterone. This may lead to an early menopause (the ending of the ability to become pregnant), particularly if your CD4 cell counts are low.

Symptoms of the menopause include:

• Less frequent periods, which then stop completely.

• A dry vagina and vulva.

• Hot flushes.

• Reduced, or lack of, sexual desire.

• Depression and other mood problems.

• Sleep problems.

• Aging skin, dry skin or spotty skin.

• Increased frequency of urination (occurring over the long-term).

Weakening of the bones (osteoperosis) can be a long-term complication associated with the menopause. This can be of particular concern as HIV-positive individuals tend to have lower bone mineral density than people who are not HIV-infected. This could be due to several factors such as the inflammatory effects of HIV, disrupted hormone production, increased levels of cigarette smoking and drug use seen in people with HIV, or the effects of some anti-HIV drugs. These factors place menopausal, HIV-infected women at an even higher risk of low bone mineral density (osteopenia) than comparable HIV-negative women.

 

It is recommended that HIV-positive women entering the menopause should be screened for bone weakness. Calcium and vitamin D therapy may be required if early problems are detected.

 

You can help look after the health of your bones by light weight training, by losing weight if you are overweight, and by making sure that you don't drink too much alcohol.

Some women take hormone supplements to replace those they are losing naturally. This is called hormone replacement therapy (HRT) or oestrogen replacement therapy (ERT) and can relieve the symptoms of the menopause. HRT can have many complications and long-term risks include heart disease, stroke, and breast cancer, and it is only recommended to relieve menopausal symptoms or for premature menopause.
HRT can also be effective if you are HIV-positive but there might be other risks involved. This is particularly the case if you are taking antiretroviral therapy, as some of these drugs have been associated with an increased risk of heart disease and stroke.

If you are thinking about HRT, then talk it over with your doctor. You might also want to ask for a referral to a specialist menopause clinic.

Reproductive health issues

Certain  reproductive health (gynaecological) problems occur more frequently in women with HIV. These include recurrent vaginal yeast infections (thrush/candida) and severe pelvic inflammatory disease. While these can occur in all women, they can be more common, more severe, or harder to treat if you have HIV. Some studies also suggest a small increase in the risk of cervical cancer developing in HIV-positive women. This small risk increase in HIV-positive women has been known since affective antiretroviral treatment became available and is likely to be linked to the fact that women with HIV are now living longer. Anti-HIV drugs do not cause cervical cancer.

Pelvic inflammatory disease (PID) is always a serious condition, particularly so if you have HIV. While it can be treated with antibiotics, there is a risk of long-term pain and the recurrence of the condition. PID can also result in infertility. It can be caused by untreated sexually transmitted infections such as gonorrhoea and Chlamydia, as well as other bacteria and infections such as tuberculosis. Symptoms include pain in the lower abdomen, vaginal discharge, cramping during sex, deep internal pain, fever, vomiting, tiredness and unusual bleeding from the vagina. A general sexual health check-up will include tests to see if you have gonorrhoea or Chlamydia. Scans may be needed to see if you have any cysts or abscesses that indicate that you have PID. An examination called a laparoscopy, which involves having a tiny camera put into the pelvic cavity through a small surgical cut below the navel, maybe used if you have complicated PID. If you have PID you will be treated with a combination of antibiotics. If it becomes severe, you might need to be admitted to hospital and have treatment with intravenous antibiotics.

Your sexual partners will need to have a sexual health screen before you have sex again, so that they can have any infections diagnosed and treated

HIV-positive women may be more likely to have abnormal cervical cells caused by human papilloma virus (HPV) which can lead to cervical cancer. It’s very important that you have regular cervical PAP smear tests to check for these cells so that you can receive prompt treatment to remove them. HIV-positive women are much less likely than HIV-negative women to naturally clear HPV infection. All HIV-positive women should have a PAP smear soon after they are diagnosed with HIV, again after six months and then every year. Treatment for abnormal cervical cells is highly effective, provided they are detected early.

 

Different types of HPV can cause warts on the sexual organs (genital warts) but they don’t always leave visible signs.

 Attacks of genital herpes (herpes simplex virus-2, or HSV-2) can last longer and be more painful if you have HIV. The antiviral drug aciclovir can help shorten the duration of attacks, and if you are getting regular attacks of herpes then you may wish to consider taking aciclovir every day to prevent this.

 

Although there is an increased risk of fungal infections if you are HIV-positive, such as vaginal candidiasis (thrush), a yeast infection, treatment works just as well.

Bacterial vaginosis is an overgrowth of bacteria in the vagina that occurs in many women, regardless of their HIV status. It can increase the risk of mother-to-baby transmission of HIV. Its symptoms include a discharge which has a "fishy" odour. It can be treated with antibiotics. Using scented or strong soaps on the genital are should be avoided to prevent irritation. Excessive washing of the vagina (douching) increases your risk of developing bacterial vaginosis.