NAPWA

Menstrual irregularities are not uncommon in women, regardless of HIV status. If you experience menstrual irregularities, it is important to remember that HIV or HIV treatment may not be to blame.

Often, the problems are caused by hormonal changes that occur naturally in most women over time. They may also be due to conditions not related to HIV. However, HIV and antiviralA medication or substance which is active against one or more viruses. May include anti-HIV drugs, but these are more accurately termed antiretrovirals. drugs can have some effects on your menstrual cycle. You are more likely to experience HIV-related menstrual irregularities if your CD4 count is low and/or your viral loadA measurement of the quantity of HIV RNA in the blood. Viral load blood test results are expressed as the number of copies (of HIV) per milliliter of blood plasma. is high.

Although the effect of HIV on female hormone function has not been extensively studied, it is thought that changes in the immune system could cause hormonal changes and lead to menstrual irregularities.

Any abnormal bleeding, such as bleeding after sex or very heavy periods, should be reported to your doctor.

Menstrual problems sometimes experienced by positive women

A number of menstrual problems are reported by some positive women. These can include:

• Heavier than usual bleeding (called hypermenorrhoea);
• Lighter than usual bleeding (called oliogomenorrohea);
• Periods which are more painful than usual (dysmenorrhoea);
• A worsening of premenstrual symptoms;
• Irregular or ‘breakthrough’ bleeding;
• No bleeding at all (amenorrhoea).

Amenorrhoea is common in women who have been diagnosed with a chronic illness, or who have had severe weight loss or anaemiaA lower than normal number of red blood cells.. Women with serious illness such as AIDS may experience amenorrhoea. Women who miss their periods may have pelvic pain, swollen breasts or hot flushes.

It is possible that there may be other causes (for example, if you do not have a period, you could be pregnant). It’s important to report any changes in your menstrual cycle to your doctor or women’s health specialist. Your health practitioner should take a full gynaecological history, a pelvic examination, and some blood tests may be necessary. Menstrual problems can affect your physical and psychological well-being, but they are usually readily diagnosed and treated.

What causes menstrual problems?

Many women with HIV report changes in their menstrual cycle. Causes of menstrual changes can include:

• Weight loss (particularly if the body mass index falls below 20);
• Poor nutrition;
• Chronic disease;
• LiverA large organ, located in the upper right abdomen, which assists in digestion by metabolising carbohydrates, fats and proteins, stores vitamins and minerals, produces amino acids, bile and cholesterol, and removes toxins from the blood. disease (related to HCVHepatitis C virus. infection);
• Significant use of illegal drugs, especially heroin and marijuana;
• Plausibly the protease inhibitorA type of anti-HIV drug that works by preventing the production of an enzyme, protease, that HIV needs to replicate. ritonavir (a small study has shown a connection, but it is not proven).

Inadequate research has been done on the effects of treatment on a woman’s menstrual cycle to date, and much of the information available is inconclusive.
This can make it difficult to assesswhether the problem is directly related
to HIV, to treatments, or has some other cause.

It is important to do something about abnormally heavy bleeding, since it can lead to anaemia. Anaemia means that your blood cannot transport enough oxygen to the body’s tissues. It can be caused by an abnormally low level of red blood cells. Unusually or extremely heavy bleeding can deplete the numbers of these crucial cells. There have also been reports of the ARVA medication or other substance which is active against retroviruses such as HIV. drugs AZT, d4T and ddI changing menstrual patterns.

Anaemia can cause seriouscomplications, especially for HIV positive women. If you experience excessively heavy menstrual periods, tell your doctor as soon as possible, get a full blood count taken, and have your iron levels checked as well.

Menstruation and pregnancy

If you are having irregular or problem periods, it may be diffi cult for you to become pregnant. If bleeding occurs at irregular times it will be harder to monitor your menstrual cycle and to predict when ovulation (egg release) will occur. If you are trying to get pregnant check with your doctor that the irregularities you are having are normal, and will not interfere with a pregnancy.

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