- People with HIV who experience menopause can have earlier and more severe symptoms
- A study of cisgender women with HIV found vaginal application of estrogen reduced symptoms
- The researchers recommend studying earlier initiation of estrogen during menopause
Menopause looks different in people living with HIV. Studies have found that cisgender women with HIV can enter menopause earlier than cisgender women without HIV. Also, people with HIV have disclosed more severe symptoms of menopause. A recent study found that cisgender women with HIV who were older than 47 “tended to have much higher levels of inflammation than men with HIV,” which may contribute to more severe symptoms of menopause. People with symptoms of menopause can experience reduced quality of life.
Furthermore, researchers who conducted a study with 109 cisgender women with HIV in Vancouver found that “menopausal symptoms may undermine ART adherence.” A decrease in adherence to ART (antiretroviral therapy) can lead to poorer health and other consequences. All these findings are good reasons why menopause in HIV requires more attention.
Focus on vaginal and urinary tract symptoms
According to researchers in New York City, people experiencing menopause can develop “vulvovaginal symptoms of dryness, itching, irritation, soreness and [pain during intercourse].” They added that many people who have symptoms of menopause do not receive treatment for it.
In cisgender women without HIV, studies have found that vaginal application of estrogen is generally safe and useful in relieving menopausal symptoms affecting the vagina and urinary tract. However, there have not been studies in people with HIV.
To begin to fix this gap in data, a team of researchers in New York City conducted a clinical trial with cisgender women who were having vulvovaginal symptoms of menopause. Specifically, the women were experiencing at least one of the following symptoms:
- dryness
- itching
- irritation
- soreness
- pain during intercourse
All women underwent pelvic examinations and were surveyed about their symptoms, and menopause was confirmed.
Researchers randomly assigned participants to receive the following:
- 25 women – a tablet of estrogen for insertion into the vagina (Vagifem, 10 micrograms). The tablets were supplied with applicators. For the first two weeks, women applied estrogen once daily. After this, the tablets were inserted twice weekly for 10 consecutive weeks.
- 26 women – no intervention
Participants were assessed at the start of the study and at weeks six and 12, focusing on safety, vaginal symptoms, adherence to the study protocol, and so on. At these time points they underwent pelvic exams and had vaginal swabs.
At the end of the study, participants were provided with a letter to share with their healthcare provider about treatment options for menopause.
On average, participants were cisgender women aged 59 years, most were Black, and all were taking ART.
Results
Although women in both study groups had a reduction in vaginal symptoms associated with menopause, statistical analysis found that those who received estrogen had what the researchers described as a “significantly greater” reduction in symptoms compared to women who did not receive estrogen. In particular, dryness and itching decreased in severity among women who used estrogen. Researchers are unsure why some women who did not receive estrogen had a reduction in symptoms.
The researchers stated that women who were younger were more likely to have an improvement in symptoms; this has not been reported in studies of menopausal cisgender women without HIV.
There was no significant impact of estrogen on the balance of bacteria in the vagina. The researchers propose that perhaps either earlier initiation or longer use of estrogen might be needed to effect a change in the balance of bacteria in the vagina in people with HIV who have had a long duration of menopause. Studying the bacteria in the vagina is important, as studies in cisgender women without HIV have found that the use of estrogen during menopause can shift the balance of bacteria to one that is likely more beneficial for their health.
The study’s results are promising, and the researchers called for larger studies to confirm their results.
—Sean R. Hosein
Resource
Menopoz & you: A guide to menopause – CATIE
REFERENCES:
- Murphy K, Gromisch M, Connolly J, et al. Impact of vaginal estradiol on the genitourinary syndrome of menopause, vaginal microbiome and mucosal immune mediators in women living with HIV. Clinical Infectious Diseases. 2026; in press.
- Abelman RA, Schnittman SR, Faraj Murad N, et al. Age modifies the association between sex and the plasma inflammatory proteome in treated HIV. Journal of Clinical Investigation. 2026; in press.
- Duff PK, Money DM, Ogilvie GS, et al. Severe menopausal symptoms associated with reduced adherence to antiretroviral therapy among perimenopausal and menopausal women living with HIV in Metro Vancouver. Menopause. 2018 May;25(5):531-537.
- Furman D, Campisi J, Verdin E, et al. Chronic inflammation in the etiology of disease across the life span. Nature Medicine. 2019 Dec;25(12):1822-1832.
- Lopez Angel CJ, Pham EA, Du H, et al. Signatures of immune dysfunction in HIV and HCV infection share features with chronic inflammation in aging and persist after viral reduction or elimination. Proceedings of the National Academy of Sciences USA. 2021 Apr 6;118(14):e2022928118.