Menstrual ChangesPublished on The Well Project(https://www.thewellproject.org)

Menstrual Changes [1] Submitted on Dec 13, 2021

Table of Contents

HIV and Menstrual ProblemsHow Does HIV Cause Menstrual Problems?Finding the Cause of Menstrual ProblemsWhat Else Can Cause Menstrual Problems?Dealing with Menstrual ProblemsTaking Care of Yourself

HIV and Menstrual ProblemsMany women living with HIV who get their periods experience menstrual changes (changes in theirperiods). It is important to discuss any changes with your health care provider.

These changes may include:

Irregular periods:Different frequency (how often)Different duration (how long)Different amount (lighter or heavier)

Missed periodsNo period for more than 90 days (amenorrhea)

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Spotting (spots of blood between periods)

Studies have found that menstrual irregularities (changes to your menstrual cycle) are less commonif you have a high CD4 cell [2] count and are taking HIV drugs. Menstrual irregularities are morecommon if you have a low CD4 cell count or high viral load [3] or are significantly below your idealbody weight.

How Does HIV Cause Menstrual Problems?We are not sure exactly how HIV affects women's menstrual cycles. However, we do know that, asHIV gets worse, changes in your immune system [4] can affect the way your body makes andmaintains levels of different hormones, including testosterone, estrogen, and progesterone. Changesin the amount of the sex hormones estrogen or progesterone could result in a number of menstrualchanges for women living with HIV.

Research has shown that women with more advanced HIV disease (CD4 counts below 200) are morelikely to have irregular menstrual cycles. Women with signs of advanced HIV — such as wasting andloss of body fat, or with anemia and nutritional problems — anemia [5] and nutritional problems[6] may also experience menstrual changes because these conditions affect the hormones thatcontrol the menstrual cycle. It is important to know that the same issues also affect the menstrualcycles of women who are HIV-negative. For example, women with very low body fat (e.g., eliteathletes), women with chronic illnesses not related to HIV, and women with low iron (one cause ofanemia) are more likely to have irregular periods or no periods at all.

Finding the Cause of Menstrual ProblemsBecause there are many possible reasons for menstrual changes, it is very important to have regularcheck-ups with your sexual and reproductive health care provider (often known as a "gynecologist"or "GYN") and to discuss any changes to your menstrual cycle. For more information about GYN care,see our fact sheet Gynecologic Care and HIV: What to Expect and Preparing for Appointments [7].

If you miss two or more periods in a row, have heavy bleeding, or have bleeding between periods,see your GYN care provider for a pelvic examination, a test for cervical cancer, and blood tests.These blood tests may check your red blood cell and platelet counts [8] as well as your estrogen andprogesterone levels. They will likely test for pregnancy and common sexually transmitted infections [9] (such as chlamydia [10]) that can affect your reproductive system. Your health care provider mayalso use additional tests such as ultrasound (sonography) to check for causes of irregular periods.

Possible causes for irregular periods include:

Ovarian cystsUterine fibroidsPregnancy [11]Opportunistic infections [12]Unwanted weight lossPre-menopause or menopause [13]Polycystic ovary syndrome, or PCOS

What Else Can Cause Menstrual Problems?

Pelvic inflammatory disease (PID): Untreated infections in your vagina (birth canal) orcervix (entrance to the womb) can sometimes lead to heavy bleeding, bleeding betweenperiods, or bleeding after sex. This type of bleeding may signal a complication like PID, whichcan threaten your health and ability to get pregnant.Cervical dysplasia or cervical cancer: Bleeding after having vaginal sex (and not being

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on your period at the same time) or bleeding between periods (spotting) may be signs ofcervical dysplasia or cervical cancer. Cervical dysplasia refers to abnormal cells that canbecome cancerous; therefore, these cells are often called pre-cancerous.

Because women living with HIV are more likely to acquire human papillomavirus (HPV) [14], whichcan cause cervical cancer [15], it is recommended that women living with HIV be regularly tested forcervical cancer. Cervical cancer takes years to develop. Often women who have cervical cancer - andwho have not had a Pap test, VIA test (Visual Inspection with Acetic Acid), or DNA test looking forHPV - do not know they have it until it is quite advanced. This is why getting a test done regularly isso important.

Street drugs: Using recreational or street drugs can lead to missed periods or periods thatstop altogether. Sometimes the drug directly affects the hormones that regulate periods, andsometimes drug use can lead to stress, poor nutrition, and severe weight loss, all of whichcan cause missed periods. Street drugs that may cause menstrual changes include:

HeroinMethadone [16]Other opioids (including prescription painkillers such as OxyContin, Percocet, Vicodin,Percodan, and Demerol)Amphetamines (meth, speed; also includes prescription drugs such as Adderall andRitalin)Marijuana (more than several joints a day)Cocaine

Prescribed and over-the counter drugs: Prescribed and over-the counter drugs can alsochange your menstrual cycle in the following ways:

These drugs may cause irregular periodsReglan (metroclopromide)Tricyclic antidepressants (Elavil or Tofranil)Antipsychotics (Mellaril, Compazine and Thorazine)Atypical antipsychotics (Clozaril, Zyprexa, Risperidone, Invega)

Some birth control [17] methods can cause irregular periods, initial heavy bleeding,or eventual loss of periods

Depo-Provera injectionBirth control pills containing only progestin, no estrogenIntrauterine devices (IUDs) containing levonorgestrel (e.g., Mirena, Skyla,Liletta)Paragard IUD ("Copper T")Implanon and Nexplanon, implants containing only progestin

Dealing with Menstrual ProblemsWhen dealing with menstrual problems, your provider will likely:

1. Diagnose and monitor any underlying infections, cervical problems, or cysts2. Address any nutritional problems (e.g., low iron), anemia, or unexplained weight loss3. Review all the drugs, vitamins, and supplements [18] you are taking (including drugs for HIV

and HIV-related conditions, street drugs, and birth control pills)4. Suggest hormonal contraceptives such as birth control pills [17] to restore balance to your

hormones and regulate menstrual cycles; however, it is important to know that somehormonal contraceptives interact [19] with HIV drugs

5. Discuss any non-prescription remedies for menstrual symptoms that you may be taking, likeherbs or dietary supplements. It is important that you be careful with any herb or food thathas estrogen-like qualities, such as soy, which may contribute to menstrual irregularities.Common supplements taken for menstrual problems include:

Omega-3 fatty acids: For menstrual cramps, bloating, swollen breasts, and moodchangesMagnesium: For cramps and irritability

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Vitamin B complex or calcium: For bloatingVitamin E: For hot flashes or swollen breasts

6. Talk to you about your sleep and physical activity [20] – getting enough of each can helpkeep your periods regular. Your provider may also suggest some alternative therapies [21]such as acupuncture and/or yoga to provide some relief from pre-menstrual symptoms.

Taking Care of YourselfEven though menstrual problems are common, suffering with them is not a normal part of HIV. Inmost cases, it is possible to find the cause of your symptoms and to treat or manage the problem.Try to keep track of the start/end dates of your periods each month. It is important to getregular gynecological exams as part of your routine health care, and to report any changes in yourmenstrual cycle to your health care provider.

Tags: menstrual changes and HIV [22]HIV and menstrual problems [23]menstrual problems [24]menstrual changes [25]periods [26]irregular periods [27]missed periods [28]causes of menstrual problems [29]HIV drugs and menstrual problems [30]menstrual irregularities HIV [31]menstrual AIDS [32]menstrual HIV [33]period HIV [34]missed period HIV [35]period viral load [36]missed period AIDS [37]

Additional ResourcesSelect the links below for additional material related to menstrual changes.

Menstrual Health and HIV (AIDSmap) [38]Menstrual Changes (CATIE) [39]HIV and Women’s Health: HIV and the Menstrual Cycle (womenshealth.gov) [40]Menstruation (Terrence Higgins Trust) [41]HIV and Problems with Your Periods (Healthgrades) [42]Here's How Drugs and Alcohol Really Affect Your Period (and the Research Is Fascinating) (Helloflo)[43]

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Source URL: https://www.thewellproject.org/hiv-information/menstrual-changes

Links[1] https://www.thewellproject.org/hiv-information/menstrual-changes[2] https://www.thewellproject.org/hiv-information/understanding-cd4-cells-and-cd4-cell-tests[3] https://www.thewellproject.org/hiv-information/women-and-viral-load[4] https://www.thewellproject.org/hiv-information/understanding-immune-system[5] https://www.thewellproject.org/hiv-information/anemia-and-women[6] https://www.thewellproject.org/hiv-information/nutrition-and-hiv[7] https://www.thewellproject.org/hiv-information/caring-womans-body-care-and-prevention-gyn-problems[8] https://www.thewellproject.org/hiv-information/understanding-lab-tests-i-complete-blood-count-and-blood-chemistry[9] https://www.thewellproject.org/hiv-information/sexually-transmitted-infections-or-diseases-stis-or-stds[10] https://www.thewellproject.org/hiv-information/chlamydia[11] https://www.thewellproject.org/hiv-information/pregnancy-and-hiv[12] https://www.thewellproject.org/hiv-information/what-are-opportunistic-infections[13] https://www.thewellproject.org/hiv-information/menopause-and-hiv[14] https://www.thewellproject.org/hiv-information/human-papillomavirus-hpv[15] https://www.thewellproject.org/hiv-information/cancers[16] https://www.thewellproject.org/hiv-information/treatment-opioid-addiction[17] https://www.thewellproject.org/hiv-information/birth-control-and-hiv[18] https://www.thewellproject.org/hiv-information/vitamins-and-supplements[19] https://www.thewellproject.org/hiv-information/drug-interactions[20] https://www.thewellproject.org/hiv-information/physical-activity-exercise-and-hiv[21] https://www.thewellproject.org/hiv-information/complementary-therapies[22] https://www.thewellproject.org/tags/menstrual-changes-and-hiv[23] https://www.thewellproject.org/tags/hiv-and-menstrual-problems[24] https://www.thewellproject.org/tags/menstrual-problems[25] https://www.thewellproject.org/tags/menstrual-changes[26] https://www.thewellproject.org/tags/periods[27] https://www.thewellproject.org/tags/irregular-periods[28] https://www.thewellproject.org/tags/missed-periods[29] https://www.thewellproject.org/tags/causes-menstrual-problems[30] https://www.thewellproject.org/tags/hiv-drugs-and-menstrual-problems[31] https://www.thewellproject.org/tags/menstrual-irregularities-hiv[32] https://www.thewellproject.org/tags/menstrual-aids[33] https://www.thewellproject.org/tags/menstrual-hiv[34] https://www.thewellproject.org/tags/period-hiv[35] https://www.thewellproject.org/tags/missed-period-hiv[36] https://www.thewellproject.org/tags/period-viral-load[37] https://www.thewellproject.org/tags/missed-period-aids[38] http://www.aidsmap.com/HIV-and-your-body/page/1550306/#item1550326[39] https://www.catie.ca/a-practical-guide-to-hiv-drug-side-effects/menstrual-changes[40] https://www.womenshealth.gov/hiv-and-aids/living-hiv/hiv-and-womens-health[41] https://www.tht.org.uk/hiv-and-sexual-health/living-hiv-long-term/menstruation[42] http://healthguides.healthgrades.com/coping-with-an-hiv-diagnosis/hiv-and-problems-with-your-periods[43] http://helloflo.com/heres-how-drugs-and-alcohol-really-affect-your-period/

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