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HIV and the Menopause

Menopause and HIV

Because of the very effective treatments that are now available, people living with HIV have a normal life expectancy. This means that the number of people with HIV living into old age is growing, and with this, more cis women and trans men are entering the menopause.
Some studies suggest that menopause in people with HIV may start earlier and have more severe symptoms than menopause in people who don’t have HIV, but not all studies show this. Because some menopause symptoms are a bit like HIV symptoms (e.g. sweats, feeling hot and cold, aches and pains, feeling “not quite right”), many people experiencing the menopause worry that their HIV isn’t under control anymore, even though they’ve been taking their treatment correctly. This means that they end up going back and forth between their GP and their HIV specialist trying to figure out what’s wrong until someone realises that it’s the menopause!
HIV and the menopause can affect one another in other ways. Both may increase the risk of weaker bones (osteoporosis) in some people, and certain HIV treatments may also do this. We know that the risk of heart disease increases as we get older, and HIV may also increase this risk, although it’s possible that the risk is lower in people whose HIV is well controlled (i.e. with an undetectable viral load). This is one reason that it’s important to take treatment properly.

Can people living with HIV take HRT?

Yes! As is the case with people who don’t have HIV, HRT is safe for most people living with HIV.
When discussing HRT with your healthcare provider, you’ll be asked about risk factors such as smoking, high blood pressure, history of blood clots and breast cancer, for example, but most people will be fine to take it if they wish to do so.
Because people with HIV have a slightly higher risk of blood clots in the legs (deep vein thrombosis) and lungs (pulmonary embolism), the oestrogen in HRT should be given as a patch or gel rather than a tablet because these carry a lower risk.

What about HRT and HIV treatment?

It’s important to speak to your HIV specialist if you’re thinking about starting HRT because some HIV medications may interact or mix badly with HRT. This can lead to side-effects of the HRT or mean that it won’t work so well. The good news is that HRT doesn’t affect HIV medicines.
If you’re taking a HIV medicine that affects your HRT, your doctor or nurse may need to adjust the HRT until the right dose is found. They may also check the levels of HRT with a blood test. Sometimes if the right dose can’t be found, it might be necessary to think about switching to a different HIV medicine that doesn’t interact with HRT. This will only be done if it’s safe to do so and you are happy to switch. There are lots of newer HIV medicines available now that don’t interact with HRT and for many people, it’s fine to switch.

Where can I get HRT or discuss it further?

Most people get their HRT from their GP, but some hospitals have specialist menopause clinics that your GP can refer you to if necessary. Chelsea and Westminster Hospital in London has a specialist HIV menopause clinic with a lot of experience in looking after people on HIV medicines who are thinking about, or taking, HRT. To come to this clinic, you need a referral from your GP, but it’s important to know that most people can get HRT without needing to go to a specialist clinic. Your GP might want to have a chat with your HIV specialist to ask about interactions, but your treatment would be pretty much the same as someone who didn’t have HIV.
By Dr Nneka Nwokolo, Honorary Consultant HIV Physician, Chelsea and Westminster Hospital, London and Senior Global Medical Director, ViiV Healthcare