Experience of hormone replacement therapy in postmenopausal women living with HIV

Abstract

Objective: To assess the uptake of hormone replacement therapy in women living with HIV (WLHIV) in particular acceptability, response to treatment and compliance. Study design: Retrospective review of menopausal women attending a HIV medical gynaecology clinic in a tertiary referral London Hospital between 1 January 2011 and 31 December 2016. Main outcome measures: Patient demographics, presenting symptoms, uptake of hormone replacement therapy, type of hormone replacement therapy used and bone density assessment findings at presentation. Results: Seventy-three HIV patients were evaluated. Of them 64 (87%) were of black ethnicity and 9 (13%) were of white ethnicity. The commonest presenting complaints were vasomotor symptoms (40/73, (55%)) followed by low mood/irritability (20/73, (27%)). When offered hormone replacement therapy, this was accepted by 28/53 (52%) in WLHIV. The commonest regimen prescribed was transdermal oestradiol/micronised progesterone. A total of 22/24 (91%) women of black ethnicity reported good symptom control if they had started hormone replacement therapy, with 4/24 (17%) subsequently discontinuing it; 3/4 (75%) of white women reported good symptom control with hormone replacement therapy, with no one discontinuing it. The commonest reason for discontinuation was irregular bleeding. Of WLHIV who had a bone density assessment, 15/25 (60%) had osteopenia while 2/25 (8%) had osteoporosis. Conclusion: Our data show that only around 50% WLHIV accepted hormone replacement therapy when offered and a high proportion of these women discontinued it. Further research is needed to explore the reason leading to low uptake and high rates of stopping hormone replacement therapy. In addition, there is a need to increase awareness of the benefits of hormone replacement therapy in WLHIV both in the context of preventing osteoporosis and menopausal symptom management.

Brief Report: Undertreated Midlife Symptoms for Women Living With HIV Linked to Lack of Menopause Discussions With Care Providers

“…27,31 Similarly, in a previous study of mostly ACB women living with HIV who were offered MHT, up to half did not accept it. 15 We observed lower unadjusted rates of MHT use and lower rates of care provider–led menopause discussions in ACB women. When menopause discussions were adjusted for, ACB descent was no longer associated with MHT use.…”

“…13 However, the use of MHT in women living with HIV has been poorly described, and its evaluation is limited to a handful of small studies. 4,7,14–16 These studies suggest that MHT uptake is low in this group but fail to investigate reasons for its infrequent use.…”

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

“…Despite this, a minority of women had received pharmacotherapy for their symptoms and reasons for these low treatment rates remain unexplored. 48 Furthermore, our findings draw to question whether nonpharmacologic strategies, particularly those that facilitate resilience, may also augment care by addressing underlying psychosocial/behavioural influences on symptom experience.…”

“I do the she and her”: A qualitative exploration of HIV care providers’ considerations of trans women in gender-specific HIV care

“… 59 Thus, one crucial component of gender-affirming HIV care is to avoid assumptions about what women may need, or not need, based on their gender identity. In another example, post-menopausal cis women living with HIV and cis women with various health conditions may also take estrogen-based hormone therapies, 60 and have similar concerns about drug-drug interactions between such therapies and ART. 61 …”