Resilience and psychosocial factors linked to symptom experience during the menopause transition for women living with HIV

Menopause: an opportunity to optimize health and well being for people with HIV

PURPOSE OF REVIEW

Menopause, defined as 12 months without menstruation, is a complex biopsychosocial transition. This review synthesizes current knowledge on menopause in individuals living with HIV, highlighting its clinical significance, research gaps, and approaches for optimizing care.

RECENT FINDINGS

Women and people with ovaries with HIV may experience menopause earlier, and with more severe vasomotor, mood, and musculoskeletal symptoms compared to people without HIV. Increasing severity of symptoms is associated with reduced quality of life and poorer engagement in HIV care. Additionally, estrogen depletion combined with HIV increases the risk of cardiometabolic disease and osteoporosis. Biomarkers like AMH have shown promise for assessing ovarian reserve in this population, but current evidence remains inconclusive. Menopause remains under-recognized in HIV care, with low rates of menopausal hormone therapy use and limited provider confidence in menopause management.

SUMMARY

Addressing menopause in people with HIV is vital for improving quality of life, supporting engagement in HIV care, and reducing comorbidity risk. Integrated and holistic care models, peer support, and focused research are essential to meet the needs of this growing population and close existing gaps in care.

Rural residence and health-related quality of life in a sample of Spain perimenopausal women

BACKGROUND

The prevalence and severity of perimenopausal symptoms are typically associated with multiple factors, including demographic characteristics. The sociodemographic characteristics of women living in rural areas differ from those residing in urban areas, and it has been suggested that these differences could potentially influence the prevalence of symptoms experienced during perimenopause.

OBJECTIVES

To evaluate if perimenopausal women living in Spanish rural areas have a higher prevalence of perimenopausal symptoms and assess their influence on health-related quality of life.

METHODS

A cross-sectional study was conducted in a sample of 270 perimenopausal women residing in rural and urban areas. The participants completed the Cervantes Scale Short Version and Beck Depression Inventory 2.

RESULTS

Perimenopausal women in rural areas reported a higher incidence of perimenopausal symptoms and a lower perception of health-related quality of life compared to those in urban areas, as evidenced by higher scores on the total Cervantes Scale Short Version scale (33.2 (±16.2) vs. 26.4 (±18.1), p = .001). No differences in the Beck Depression Inventory 2 score were detected.

CONCLUSIONS

Perimenopausal women residing in rural areas of Spain reported a higher prevalence of perimenopausal symptoms and experienced a poorer Health-Related Quality of Life compared to those living in urban areas of Spain.

Sexual Satisfaction of Midlife Women Living With HIV in Canada: A Prospective Cohort Analysis

BACKGROUND

Although sexual activity and function decline in older women living with HIV, positive dimensions of sexual health, such as satisfaction, are relatively unexplored. We evaluated the prevalence of sexual satisfaction for midlife women with HIV and assessed its relation to women's physical, mental, and sociostructural experiences.

SETTING

We studied women in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) over 3 survey waves (2013-2018).

METHODS

We included women living with HIV aged ≥45 years who reported ever having consensual sex. Sexual satisfaction was assessed using an item from the Sexual Satisfaction Scale for Women and was dichotomized into satisfactory ("completely/very/reasonably satisfactory") and not satisfactory ("not very/not at all satisfactory"). Probable depression was based on CES-D ≥10. Multivariable logistic regression and fixed effects models determined correlates of sexual satisfaction. Reasons for sexual inactivity and alternate forms of sexual expression were also explored.

RESULTS

Among 508 midlife women, 61% were satisfied with their sexual lives at baseline. Women with probable depression had lower odds of sexual satisfaction than those without (aOR: 0.44; 95% CI: 0.27 to 0.71) and worsening depressive symptoms over time were associated with poorer sexual satisfaction ( P = 0.001). Increased sexual activity was associated with higher sexual satisfaction (aOR: 2.75; 95% CI: 1.54 to 4.91); however, 51% of women reporting sexual satisfaction were sexually inactive. Sexually inactive women engaged in alternate forms of sexual expression such as self-pleasure (37%) and intimate relationships without sex (13%).

CONCLUSION

Midlife women with HIV have high rates of sexual satisfaction, even in the absence of sexual activity. Depressive symptoms were closely associated with sexual dissatisfaction, alerting providers to the importance of screening for depression and sexual health together.