Follicle-stimulating hormone in postmenopausal women living with HIV: a prevalence study.

Shema Tariq,Iain Reeves,Frank A Post,Nicola E Mackie,Robert F Miller,Fiona Burns,Melanie Rosenvinge,Andrew Ustianowski,Caroline A Sabin,Abigail Severn,Julie Fox,Hajra Okhai,Ann Sullivan,Yvonne Gilleece,Richard Gilson

doi:10.1111/hiv.13205

Abstract

ObjectivesWe examined follicle‐stimulating hormone (FSH) levels in women living with HIV aged > 45 reporting ≥ 12 months’ amenorrhoea, and investigated correlation with menopausal symptoms.MethodsA cross‐sectional substudy of 85 women from the Positive Transitions through the Menopause (PRIME) Study who reported irregular periods at entry into the PRIME Study and ≥ 12 months’ amenorrhoea at recruitment into this substudy. Serum FSH was supplemented with clinical data and menopausal symptom assessment. Serum FSH > 30 mIU/mL was defined as consistent with postmenopausal status. Associations between FSH and menopausal symptom severity were assessed using Pearson's correlation and the Kruskal–Wallis test.ResultsMedian age was 53 years [interquartile range (IQR): 51–55]; all were on antiretroviral therapy, three‐quarters (n = 65) had a CD4 T‐cell count > 500 cells/μL and 91.8% (n = 78) had an HIV viral load (VL) < 50 copies/mL. Median FSH was 65.9 mIU/mL (IQR: 49.1–78.6). Only four women (4.7%) had FSH ≤ 30 mIU/mL; none reported smoking or drug use, all had CD4 T‐cell count ≥ 200 cells/μL, and one had viral load (VL) ≥ 50 copies/mL. Median body mass index (BMI) was elevated compared with women with FSH > 30 mIU/mL (40.8 vs. 30.5 kg/m2).Over a quarter (28.2%) reported severe menopausal symptoms, with no correlation between FSH and severity of menopausal symptoms (p = 0.21), or hot flushes (p = 0.37).ConclusionsFour women in this small substudy had low FSH despite being amenorrhoeic; all had BMI ≥ 35 kg/m2. We found that 95% of women with HIV aged > 45 years reporting ≥ 12 months’ amenorrhoea had elevated FSH, suggesting that menopausal status can be ascertained from menstrual history alone in this group.

Highlights

Improvements in survival due to antiretroviral therapy (ART) have resulted in successfully treated individuals with HIV having a near normal life expectancy [1,2], with a consequent shift in the age distribution of people living with HIV
| 3 was to examine follicle-stimulating hormone (FSH) levels in women living with HIV aged > 45 years reporting ≥ 12 months’ amenorrhoea, and to investigate correlations with menopausal symptom severity, and hot flush severity
This suggests that ovarian decline due to menopause is the most likely cause of secondary amenorrhoea in women living with HIV aged > 45 years, and that FSH testing is not necessary for confirmation

Summary

Introduction

Improvements in survival due to antiretroviral therapy (ART) have resulted in successfully treated individuals with HIV having a near normal life expectancy [1,2], with a consequent shift in the age distribution of people living with HIV. Menopause is a normal life transition but one that can be associated with a range of symptoms and longer-term health consequences. In the early stages of menopause, FSH levels rise in response to the depletion of ovarian follicles and the consequent fall in levels of Inhibin B [4]. Mean FSH levels increase significantly across the menopause transition, from 7.0 mIU/mL in the reproductive stage to 45.7 mIU/ mL in postmenopausal women, meaning that FSH can provide useful biological confirmation of postmenopausal status [5]. Given the likelihood of menopause being the cause of secondary amenorrhoea in women aged > 45 years, and the fluctuation in FSH levels, laboratory testing for biological markers of ovarian activity is not routinely recommended in amenorrhoeic women in this age group

Objectives

Methods

Results

Conclusion