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HIV/AIDS Resource Center for Women
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A Conversation With L. Jeannine Bookhardt-Murray, M.D.

March 28, 2013


How can a person tell the difference between the night sweats that people living with HIV often experience and the hot flashes that are associated with menopause?

Usually when women are going through menopause, there's a complex of symptoms: the hot flashes, and then the feeling cold, and the sweats. But you put it together, based on their report and their history, and it's not just night sweats alone, frequently; with menopause, they have other symptoms along with night sweats. So it's really what we call a clinical diagnosis, based on their history. We can also check a woman's estrogen level -- which may or may not be helpful. Just because a woman has a certain level of estrogen doesn't mean it's responsible for her symptoms. So the diagnosis of menopause is usually based on symptomatology, rather than any kind of lab report. We look for it when women hit about 45 years of age; we know that's the average age.

Are Hot Flashes More Frequent and Intense for Perimenopausal Women Living With HIV? (From

Do HIV-positive women bear a heavier burden of one of the most bothersome symptoms of menopause than do HIV-negative women? A study at a recent huge HIV research conference delivers a tentative yes. There's still more to learn; Boston nurse practitioner Sara Looby, one of the study authors, explains her preliminary findings in this summary. She also shares recommendations for altering these symptoms with lifestyle changes like quitting smoking.

What have you seen as far as menopause and HIV that's different from what you might expect from a woman who's not living with HIV?

I've found that women who have very low CD4 counts, and have been maintaining low CD4 counts for a while, tend to go through menopause sooner than other women. I can't give you an exact age -- again, it's variable -- but I may find women with low CD4 counts going through menopause around the age of 40. That's the one area: Low CD4 counts seem to impact regular hormonal balance.

Other providers have reported that when the viral load is really, really high that that, too, can affect menopause. But I've not seen that firsthand. I've just seen low CD4 counts affecting menopause.

Does taking HIV meds factor into menopause at all? Can HIV meds intensify symptoms of menopause? Are any meds associated with hormonal balance issues?

No, not in any ways that I'm aware or have seen or read. But the one drug that I know can interfere with hormonal balance, that may be part of the lives of some women living with HIV, is methadone. Women who are on methadone tend to not have regular periods. So do women who are underweight. You may have a woman who has a diagnosis of AIDS and she's well underweight, and she may experience lack of periods.

What are some of the medical concerns that perimenopausal and postmenopausal women need to be aware of? Do those differ in women living with HIV? I've heard recently about bone mineral density and cardiovascular complications in menopausal women -- which, of course, are already of concern for people living with HIV.

Those are the major ones. Osteoporosis is a huge concern. There are a lot of data coming out showing that osteoporosis may be actually happening earlier in people living with HIV (men and women), anyway. So once a woman completes menopause the rates of osteoporosis may actually be going up.

There are a number of things that we need to do as far as women living with HIV and approaching menopause, like watch a woman's vitamin D level; make sure that vitamin D is replaced if the level is low; make sure that the woman is getting enough calcium, exercise and sunlight. Those are all very, very important.

Smoking impacts bone density; we know that a large number of people with HIV infection are heavy smokers. We want to try to get them off of the tobacco, because that does weaken the bones.

I imagine that smoking cessation and exercise would have an effect on cardiovascular concerns, as well. Are there any other lifestyle changes that you recommend to older women specifically who are dealing with menopause, as far as mediating some of the cardiovascular issues? Or are medications the only answer?

"There are some situations where medications are absolutely important -- like with HIV -- but for many of the diseases that we get in life, we can prevent them, or at least make a big impact on them, by lifestyle changes."

No. I'm not a lover of medications. There are some situations where medications are absolutely important -- like with HIV -- but for many of the diseases that we get in life, we can prevent them, or at least make a big impact on them, by lifestyle changes.

When I say lifestyle changes, I mean a comprehensive package. Here's what I talk to my patients about:

  • I tell them about eating flesh foods (meats) . We know that flesh foods alter the pH of the body; and the lower the pH, the higher the risk of developing cancer. So I talk to my patients about eliminating flesh foods. That's a hard one.
  • Stop smoking .
  • If possible, get off on any foods that impact the bones -- like carbonated beverages, which leech the calcium from the bones. Sodas are very, very bad for bones. So I talk to them about that.
  • Then there's the issue of getting enough rest at night -- seven to eight hours.
  • Drinking enough water -- the standard recommendation is eight glasses a day of water.
  • Getting enough sunlight and fresh air -- at least an hour of sunlight and fresh air every day, even in the winter. It's really important. Walk.
  • Exercise is extremely important, for the heart, for the bones, for the lungs, and for the brain -- just about every part of the body.

The thing I worry about is that women don't often take care of themselves. Women have traditionally taken care of everyone else. And when it comes time to taking care of ourselves, sometimes we don't even know how to do it. We need to learn how to take care of ourselves, and keep ourselves healthy.

Alternative Treatments and Keeping Healthy After Menopause
In "Menopause and HIV" (From the Well Project)

There are other therapies available to treat menopausal symptoms, and a number of ways to stay on top of your health following menopause. Check out this list of tips and suggestions from the Well Project -- and for women who choose alternative therapies, it's best to consult a skilled practitioner and let your regular health care provider know exactly what you are doing.

How do you start those conversations about self-care, specifically with older women living with HIV?

I just start out by talking to them, asking them, "How's your diet? What do you eat?" and really finding out what their goals are -- how healthy they feel now; how healthy they want to feel; and then some time frames for changes they're going to make in their lives.

I really want them to work toward goals. If it's quitting smoking, and they're ready to set a quit date, we set a quit date. If they're ready to give up carbonated beverages, we set a quit date. It's really about having goals that they work toward over time, taking baby steps. Some people can leap and make a lot of changes at once. But I don't find most people can do that.


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See Also
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