Written by: Rhonda Thygesen, CBR Alumni
Edited by: Loulou Cai, PhD Candidate, Cote Lab
Paper: Associations of Early Prolonged Secondary Amenorrhea in Women With and Without HIV, lab of Dr. Hélène C F Côté, https://pubmed.ncbi.nlm.nih.gov/39301109/
Menstrual health serves as a key indicator of women’s overall well-being, and conditions like amenorrhea—characterized by the absence of menstruation—can point to serious underlying health concerns. Amenorrhea is defined as the absence of menstrual flow for 12 months or more post-menarche, not due to pregnancy, lactation, medication, or surgery2. New research from the UBC Centre for Blood Research and collaborators throughout UBC, examines the prevalence of early prolonged secondary amenorrhea in women with HIV and its associated biopsychosocial factors1.
The study, “Associations of Early Prolonged Secondary Amenorrhea in Women With and Without HIV,” compares menstrual health outcomes between women living with HIV and HIV-negative women. Findings reveal a higher prevalence of amenorrhea among women with HIV, alongside other modifiable risk factors such as substance use and food insecurity.
In this study, the definition of amenorrhea was broadened to include cases of early menopause or premature ovarian insufficiency. While amenorrhea can be part of natural life changes, prolonged absence of menstruation before menopause can increase the risk of morbidity and mortality, making it a serious concern for women’s health2,3.
The study analyzed data from two established HIV cohorts, focusing on women aged 16 and older who were not pregnant, lactating, or had a history of eating disorders like anorexia or bulimia nervosa. Out of 317 women with HIV and 420 women without HIV, the researchers found that 24% of women living with HIV experienced lifetime amenorrhea, compared to 13.3% of women who are HIV-negative.
This significant difference raises questions about how HIV influences menstrual health. According to the study’s multivariable analysis, HIV itself was found to be an independent predictor of amenorrhea, with an adjusted odds ratio of 1.70. This suggests that women with HIV may face a 70% greater likelihood of experiencing amenorrhea compared to women without HIV, even after accounting for other factors1.
In addition to HIV status, several biopsychosocial variables were identified as important risk factors for amenorrhea. These include:
- Older age: As expected, older women were more likely to experience amenorrhea, which may be related to natural declines in reproductive function.
- White ethnicity: Women of white ethnicity were more likely to report amenorrhea, though the reasons for this are not fully understood and warrant further investigation3.
- Substance use history: A striking finding was the strong association between substance use and amenorrhea, with women who had a history of substance use being over six times more likely to experience amenorrhea.
- Food insecurity: Women facing food insecurity were twice as likely to experience amenorrhea, highlighting the role of socioeconomic factors in menstrual health.
The study’s findings underscore the importance of regular menstrual health assessments in women with HIV. With nearly one-quarter of women with HIV reporting amenorrhea, healthcare providers should be aware of the higher risks in this population and consider the broader social and behavioral factors that may be contributing to menstrual disturbances.
The modifiable nature of many of the risk factors—such as substance use and food insecurity—suggests that targeted interventions could reduce the prevalence of amenorrhea and improve overall health outcomes for women with HIV. Addressing these socio-structural determinants is critical in ensuring better health and quality of life for women living with HIV.
Ultimately, this research calls for more than just clinical intervention. It highlights the need for broader societal efforts to address food insecurity and substance use in vulnerable populations. By advocating for change at the intersection of health, social policy, and economic conditions, healthcare providers can help mitigate the risks of amenorrhea and promote menstrual health equity for all women, especially those living with HIV.
References:
- Swann, S. A., King, E. M., Pang, D., Silva, M. A., Campbell, A. R., Prior, J. C., … & Murray, M. C. (2024, September). Associations of early prolonged secondary amenorrhea in women with and without HIV. In Open Forum Infectious Diseases (Vol. 11, No. 9, p. ofae493). US: Oxford University Press.
- Klein, D. A., Paradise, S. L., & Reeder, R. M. (2019). Amenorrhea: a systematic approach to diagnosis and management. American family physician, 100(1), 39-48.
- King, E. M., Albert, A. Y., & Murray, M. C. (2019). HIV and amenorrhea: a meta-analysis. Aids, 33(3), 483-491.