Lower Education, Hepatitis C Co-Infection Linked to Earlier Menopause in HIV

In women with HIV, lower education and hepatitis C co-infection are independently associated with the onset of menopause before age 45 years, according to study results published in Menopause.

To better understand the prevalence of and correlates with early menopause in HIV, researchers conducted a study of Canadian women living with HIV who reported being postmenopausal, regardless of etiology (N=229). Women who experienced a period within the preceding 12 months were excluded from the study.

At baseline, women completed an extensive questionnaire that included questions related to sociodemographic characteristics, medical history, menstruation, and menopause. The study’s primary outcome was median age at menopause. To determine independent correlates of menopause before age 45 years, the researchers performed multivariable logistic regression modeling using both predetermined variables and those with P <.10 in univariable analyses.

The median age at menopause was 48 years (interquartile range, 43-51 years). Of all the women, 29.7% (95% CI, 23.7%-35.7%) experienced menopause before age 45 years: 16.6% had early menopause (age 40-45 years), and 13.1% had premature menopause (age <40 years) according to their survey responses.

After performing univariable analyses, the researchers found that birth in Canada, white ethnicity, less than high school education, history of smoking, recreational drug use, and hepatitis C co-infection were associated with onset of menopause before age 45 years (all P <.05).

In multivariable analysis, less than high-school education (adjusted odds ratio, 2.45; 95% CI, 1.22-4.93; P =.012) and hepatitis C co-infection (adjusted odds ratio, 1.90; 95% CI, 1.04-3.50; P =.038) were independently associated with menopause onset before age 45 years.

The study had several limitations, including its cross-sectional design. The researchers also acknowledged that age at menopause and prevalence of early/premature menopause could not be attributed to HIV infection given the lack of an HIV-negative control group.

“[O]ccurrence of early menopause among women living with HIV has implications for medical practitioners caring for these women, as it may impact counseling and management,” wrote the researchers.

“[D]etermination of whether biochemical confirmation of menopause should be required in the setting of HIV infection is a dilemma that warrants further investigation and consideration,” they concluded.

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Reference

Andany N, Kaida A, de Pokomandy A, et al. Prevalence and correlates of early-onset menopause among women living with HIV in Canada [published online November 4, 2019]. Menopause. doi:10.1097/GME.0000000000001423