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Women’s Health Committee Releases Guidelines On Addressing Menstrual Irregularities In HIV-Positive Women

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Published: Oct 7, 2010 5:06 pm
Women’s Health Committee Releases Guidelines On Addressing Menstrual Irregularities In HIV-Positive Women

New guidelines have been released for assessing menstrual irregularities in HIV-positive women. The guidelines emphasize that women with HIV should have yearly Pap smears and should follow up with their doctor if they develop any abnormal bleeding or stop having periods.

The guidelines were released by the Women’s Health Committee of the New York State Department of Health AIDS Institute.

The Committee recommends that HIV-positive women undergo the same routine physical and gynecological visits as uninfected women. All infected women should obtain an annual Pap test, a gynecological exam that checks for cancers or abnormalities in the cells of a woman’s cervix.

Women with irregular or absent menstrual periods who are pre-menopausal should obtain a pregnancy test, since pregnancy is the most common cause of absent periods in women. Irregular periods may indicate pregnancy complications such as a miscarriage or ectopic pregnancy, in which an embryo implants somewhere other than in the uterus.

The guidelines also recommend that women with abnormal bleeding keep a record of their menstrual and bleeding patterns for three months, including dates, amount of blood, and any other symptoms such as fever or pain.

Finally, as a precaution, the Committee recommends that HIV-positive women with abnormal bleeding or absent menstrual periods of unknown cause contact a gynecologist who is experienced with HIV for diagnosis and treatment.

The guidelines note that, for the most part, studies have shown that women with HIV have menstrual problems at similar rates as women without HIV. HIV-specific causes of abnormal uterine bleeding are rare.

However, there is some evidence that rates of two menstrual disorders, oligomenorrhea and amenorrhea, are higher in women with HIV, particularly in women with advanced HIV infections.

In oligomenorrhea, a woman’s menstrual period is infrequent and lighter. In amenorrhea, a woman’s menstrual period is absent altogether for three months or more.

Researchers have also found that women with HIV tend to have a higher occurrence of certain chronic conditions and diseases associated with menstrual irregularities, such as sexually transmitted diseases or cervical cancer.

In addition, factors such as smoking, poor diet, and emotional stress are more common in HIV-positive women and can be associated with the onset of menstrual disorders.

The guidelines include common gynecologic causes of menstrual irregularities in HIV-positive women, such as:

  • Pregnancy
  • Polycystic ovarian syndrome (PCOS), a hormonal disorder in which a woman’s eggs may fail to mature, resulting in lack of ovulation
  • Ovarian insufficiency, a disorder in which women’s ovaries do not function properly
  • Pelvic inflammatory disease, an inflammation of the uterus or other reproductive organs that can cause scarring and infertility
  • Sexually transmitted infections
  • Certain cancers, such as cervical cancer.

Common non-gynecologic causes of menstrual irregularities include:

  • Stress
  • Too much exercise
  • Eating disorders
  • Thyroid/pituitary disease
  • Adrenal disease
  • Weight loss
  • Chronic diseases, such as diabetes, inflammatory bowel disease, or chronic immune suppression
  • Certain medications, such as methadone, some psychiatric medications, and possibly protease inhibitors.

In general, studies have shown that infected women on antiretroviral therapy have fewer menstrual abnormalities than infected women not taking antiretrovirals.

For more information, please see the Women’s Health Committee guidelines at the New York State Department of Health AIDS Institute website.

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