Table 4.

Summary of key menopause studies in WLWH

Objective	Study Population	Findings
Natural history
To study prevalence and factors associated with early menopause in women from the DIDI Study [30]	352 HIV+ women aged≤46 years	The prevalence of early menopause (7.7%) was comparable with that reported in the Italian general population (7.1%); a higher proportion of menopause was observed in women≤40 years (5.2% vs. 1.8%) Advanced stage of HIV was the main predictor of early menopause
To describe the characteristics of postmenopausal WLWH and to investigate the factors associated with an earlier onset of menopause [89]	404 HIV+ women (69 naturally postmenopausal at time of study)	Earlier onset of menopause was associated with IDU, ethnicity and CD4 cell count <200 cells/mm
To characterize prolonged amenorrhea from ovarian failure and other causes and to estimate if HIV serostatus is a risk factor for amenorrhea in HIV+ and HIV− women [90]	1431 women (1139 HIV+ and 292 HIV−)	HIV infection is associated with amenorrhea in WLWH and may be positively associated with ovarian failure in women with amenorrhea
To study the relationship of HIV infection with the onset of natural menopause [91]	571 (53% HIV+)	HIV infection and immunosuppression were associated with an earlier age at onset of menopause (46 years vs. 47 years)
To obtain information on the prevalence of anovulation and early menopause and on pituitary-gonadal function among WLWH [95]	Stored serum samples from 52 WLWH aged 20 to 42 years who participated in selected ACTG protocols	Study demonstrated a relatively high frequency of anovulation in WLWH with trends suggesting a relationship between lower CD4 T-cell counts and anovulation 8% of the subjects had presumed early menopause – compatible with the frequency in the general population
To examine the median age of menopause, factors associated with postmenopausal status, and the prevalence of menopausal symptoms in WLWH [64]	120 HIV+ women aged 40 to 57 years	Median age of menopause was 50 years 80% prevalence of hot flashes observed in WLWH compared to 38–69% in the general population
Menopausal symptoms
To assess the effects of HIV infection and ART on change in BMD in postmenopausal women [92]	Prospective cohort study of 128 (73 HIV+, 55 HIV−) postmenopausal Hispanic and African-American women	HIV+ postmenopausal women had lower BMD, increased bone turnover, and higher rates of bone loss than HIV− women
To examine the association of HIV infection, drug use, and psychosocial stressors with type and frequency of menopausal symptoms [93]	536 women not on hormone therapy (54% HIV+)	WLWH reported more menopause symptoms than HIV− women; symptoms were less frequent in women with more advanced HIV disease Depressive symptoms and negative life events were also independently associated with symptoms
To evaluate the prevalence and factors associated with menopause symptoms in WLWH [94]	251 women (96 HIV+; 155 HIV−) aged=40 years	Menopausal symptoms were common in WLWH, particularly psychological and vasomotor symptoms HIV infection was independently associated with menopause symptoms
Treatment response
To study initial treatment responses to ART in postmenopausal WLWH [96]	267 WLWH (220 pre-menopausal and 47 post-menopausal)	No significant difference in changes in CD4 cell counts or HIV type 1 RNA levels between groups

ACTG=Adult AIDS Clinical Trials Group; IDU=intravenous drug user; BMD=bone mineral density.