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HIV and your body

Periods (your menstrual cycle)

As well as affecting your immune system, HIV may affect your hormonal system. You may experience menstrual changes if you have a low CD4 cell count and/or high viral load, and also if you use (or have used) recreational drugs.

Some of the menstrual changes you may experience include:

  • long intervals between periods
  • missed periods without pregnancy.

Tell your doctor if you notice any changes to your periods. It could mean that you need to consider starting to take antiretroviral therapy. Changes in your menstrual cycle can also be a symptom of other health problems. But remember that a missed period might also mean that you are pregnant.

Abnormal bleeding (for example, after sex), bleeding 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 (a lack of red blood cells).

Fertility and menopause

HIV can affect your body’s ability to produce the hormones oestrogen and progesterone. This can affect your fertility (your ability to become pregnant) or lead to an early menopause (and the ending of your fertility), particularly if your CD4 cell counts are low.

Hormone replacement therapy (HRT) can be prescribed to prevent or lessen some symptoms of menopause, or to treat the early onset of menopause. HRT is generally not used as a long-term treatment because it may increase the risk of developing other conditions such as breast cancer.

HRT can be taken with HIV treatment; ask your doctor if there are any interactions between HRT and the anti-HIV drugs you are on. HIV clinics don’t provide HRT, so you will need to have it prescribed by your GP or another doctor.

If you have questions about symptoms of the menopause, or possible interactions between treatments, talk to your healthcare team. You could also ask about attending a menopause clinic. 

Osteoporosis

Osteoporosis – weakening of the bones through loss of bone density – is more common in all women who have gone through the menopause, because of the high level of hormonal changes which occur during menopause.

People with HIV tend to have lower than normal bone density. It’s not entirely clear why this is, but it seems likely that it is caused both by HIV itself and by the effects of treatment, as research suggests that certain anti-HIV drugs may cause bone loss. (You can find out more about different types of drugs in NAM’s booklet Anti-HIV drugs.)

Bone mineral density can be measured painlessly with a scan known as DEXA (for dual energy X-ray absorptiometry). You may have been offered this scan as part of your HIV health monitoring, but if you haven’t, and you are HIV-positive and menopausal, ask to have one done.

There are a number of things you can do to reduce loss of bone density and its effects. These include taking some weight-bearing exercise (such as walking, running, or climbing stairs) and having a healthy diet, with plenty of calcium and vitamin D. Oily fish and eggs are a good source of vitamin D (as is sunlight); calcium can be found in dairy products, green leafy vegetables, nuts, soya beans and food made with fortified flour.

You may want to consider taking calcium and vitamin D supplement tablets, particularly if your diet does not include many of the foods containing these nutrients. Taking too much of a supplement can be harmful, so it is a good idea to talk to someone at your HIV clinic, or your GP, before you start. You could also ask to talk to a dietician, to find out if you can adapt your diet to increase the calcium and vitamin D it provides.

Smoking and heavy drinking can increase your risk of osteoporosis.

Your healthcare team can give you more advice on changes to your treatment and lifestyle that may help. There are also some treatments available to improve bone density and they can talk to you about those if necessary.

The Nutrition booklet in this series provides information on food, nutrition, exercise and HIV, and could be a good place to start if you have questions about any of these issues.

Reproductive health issues

Some reproductive health (gynaecological) problems happen more often in women with HIV, and can be more severe, or harder to treat.

Regular screening for sexually transmitted infections (STIs) is an important part of your health care. If you have an infection that can be transmitted sexually, your sexual partners will need to have a sexual health screen before you have sex again so that they can also have any infections diagnosed and treated.

Pelvic inflammatory disease (PID) is always a serious condition, especially if you also have HIV. It can be caused by untreated STIs such as gonorrhoea and chlamydia, as well as other bacteria and infections such as tuberculosis. PID can make you infertile (unable to get pregnant).

Symptoms include:

  • pain in the lower part of your stomach area
  • vaginal discharge
  • cramping during sex
  • deep internal pain
  • fever
  • vomiting
  • tiredness
  • unusual bleeding from the vagina.

A general sexual health check-up will include tests to see if you have gonorrhoea or chlamydia. You may need a scan to see if the PID has caused any cysts or abscesses, or an examination called a laparoscopy. This procedure involves a surgeon making a small cut in the stomach to insert a tube that allows them to see inside the abdomen and the pelvis. It is done under a general anaesthetic.

If you have PID you will be treated with a combination of antibiotics. Getting help and treatment early is important to reduce the risk of long-term pain and recurrence of the PID.

Women living with HIV may be more likely to have abnormal cervical cells caused by the human papillomavirus (HPV). Some strains of this virus can lead to cervical cancer. It is possible for your body to clear HPV infection itself, but HIV-positive women are much less likely than HIV-negative women to do so.

Make sure you have regular cervical screening (smear test) to check for these cells so that you can receive prompt treatment to remove them. All HIV-positive women should have a cervical screen soon after they are diagnosed with HIV, again after six months and then every year after that. Treatment for abnormal cervical cells is highly effective, provided they are detected early.

Other strains of HPV can cause genital warts, but these don’t always leave visible signs. They can be detected by cervical screening and treated by applying a cream, or by freezing or burning them off.

Genital herpes (herpes simplex virus-2, or HSV-2) can last longer and be more painful if you have HIV. The anti-viral drug aciclovir can help shorten the duration of herpes episodes. If you are getting regular episodes of herpes, 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), treatment works 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 area should be avoided to prevent irritation. Excessive washing of the vagina (douching) increases your risk of developing bacterial vaginosis.

HIV & women

Published November 2010

Last reviewed November 2010

Next review December 2013

Contact NAM to find out more about the scientific research and information used to produce this booklet.

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.