If you are troubled by the symptoms of menopause or if they interfere
with your day to day life, then treatments are available. The aim of treatments
is to relieve symptoms and improve your quality of life.
therapy (HRT) is the main treatment. As symptoms such as hot flushes,
vaginal dryness and osteoporosis are related to low levels of the hormone
oestrogen, HRT relieves symptoms by replacing oestrogen levels that naturally
fall in menopause.
Guidelines from the National Institute for Health and Care
Excellence (NICE) recommend HRT for women with hot flushes. Although there have
been some concerns about HRT being linked with an increased risk of breast
cancer and heart disease, this applies mostly to women taking particular types
of HRT over a long period of time.
NICE concluded that the benefits of HRT outweigh the risks. As
well as lessening symptoms, HRT helps with muscle strength and lowers the risk
of bone problems.
The benefits and risks of HRT in HIV-negative women are
thought to apply to women with HIV as well. It’s useful to tell the doctor who
is prescribing your HRT about your HIV treatment as the dose of your HRT may
need to be adjusted. HRT is usually prescribed by your GP but your HIV doctor
or HIV pharmacist can give you advice on this too.
For most women, combination HRT containing two hormones
(oestrogen and progestogen) is suitable. Different forms of HRT combine
different amounts of these two hormones, and your GP can help you find the form
of HRT that is best for you. The lowest effective dose should be taken. While
HRT is available in tablets, other forms such as implants, skin patches, and a
gel to rub into the skin may be less likely to raise the risk of blood clots.
If you have had a hysterectomy, oestrogen-only HRT is
recommended. If you have had the menopause before the age of 40, HRT is always
To relieve vaginal dryness, oestrogen can be administered directly to the
vagina using a vaginal cream, tablet or ring. This releases a small amount of oestrogen
(the equivalent of one hormone tablet a year) which raises local hormone levels
but does not affect the whole body.
treatments may help. These include cognitive behavioural therapy (to help
with low mood or anxiety), testosterone supplements (to help with low libido)
and clonidine (to help with hot flushes and night sweats).
Regular exercise, reducing your intake of caffeinated drinks
and reducing your intake of alcohol can all also help reduce symptoms.
While some women use the herbal product St John’s Wort to
relieve hot flushes and night sweats, this can reduce the effectiveness of some
anti-HIV drugs – ask your HIV doctor or pharmacist if it is safe for you to
Similarly, the herbal product black cohosh can have an impact on the
liver. If your doctor knows you are taking black cohosh, he or she can keep an
eye on your liver function.
Bone health. As
well as managing the symptoms associated with the menopausal transition, it’s
also important to take care of your bone health in the years after menopause. The
British HIV Association recommends that HIV doctors regularly check the bone
health of all women with HIV who have gone through the menopause. This is
because both HIV and the menopause raise the risk of bone problems.
Regularly getting some weight-bearing exercise, stopping
smoking, drinking less alcohol, including calcium in your diet and getting
enough vitamin D are lifestyle changes that can improve your bone health. For
more information, read NAM’s factsheet Bone problems and HIV.