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Undertreated midlife symptoms for women living with HIV linked to lack of menopause discussions with providers - menopausal hormone therapy under-utilized
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Menopause Is Associated With Immune Activation in Women With HIV - (01/19/22)
JAIDS Dec 23 2021 King, Elizabeth M. MD1,2; Kaida, Angela MSc, PhD2,3; Mayer, Ulrike PhD2; Albert, Arianne PhD2; Gormley, Rebecca MPH3,4; de Pokomandy, Alexandra MD5; Nicholson, Valerie3; Cardinal, Claudette3,4; Islam, Shaz6; Loutfy, Mona MD, MPH6,7; Murray, Melanie C. M. MD, PhD1,2,8
Background:
Increasingly, women living with HIV are entering menopause (i.e., cessation of menses for ≥1 year) and experiencing midlife symptoms. Menopausal hormone therapy (MHT) is first-line therapy for bothersome hot flashes and early menopause (i.e, before age 45), however, its use in women living with HIV is poorly described. We conducted a cross-sectional assessment of MHT uptake and barriers to use in this group.
Setting:
This study was conducted across three Canadian provinces from 2015-2017.
Methods:
Perimenopausal and postmenopausal women living with HIV (≥35 years) in the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) who answered questions related to MHT use were included. Univariable/multivariable logistic regression evaluated factors associated with MHT use, adjusted for age and contraindications.
Results:
Among 464 women, 47.8% (222/464) had a first-line indication for MHT, however, only 11.8% (55/464) reported ever using MHT and 5.6% (26/464) were current users. Only 44.8% had ever discussed menopause with their provider despite almost all women having regular HIV care (97.8%).
African/Caribbean/Black women had lower unadjusted odds of MHT treatment compared to white women (odds ratio [OR] 0.42 [0.18-0.89]; P=0.034). Those who had discussed menopause with their provider had higher odds of treatment (OR 3.13 [1.74-5.86]; P<0.001). In adjusted analyses, only having had a menopause discussion remained significantly associated with MHT use (OR 2.97 [1.62-5.61]; P<0.001).
Conclusion:
Women living with HIV are seldom prescribed MHT despite frequent indication. MHT uptake was associated with provider-led menopause discussions underscoring need for provider education on menopause management within HIV care.
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