Abstract
ObjectivesTo measure the prevalence and correlates of abnormal menstruation among women living with HIV (WLWH) in Canada.MethodsWe used cross-sectional questionnaire data from the community-based Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), which enrolled WLWH aged ≥16 from British Columbia (BC), Ontario, and Quebec. For this analysis, we excluded women >45 years, who had primary amenorrhea, were pregnant, on hormonal contraception, or who reported history of endometrial cancer, last menstrual period >12 months ago, or premature ovarian failure. The primary outcome was abnormal menstruation (Yes vs No) based on responses to five questions about menstrual regularity, frequency, volume, duration, and intermenstrual bleeding in the six months prior to interview. An exploratory multivariable logistic regression analysis examined independent correlates of abnormal menstruation.ResultsOf 1422 women enrolled, 521 (37%) met eligibility criteria. Overall, 55.9% (95% CI:52%-60%) reported abnormal menstruation. In adjusted analyses, abnormal menstruation was associated with having a biologic sister/mother who entered menopause before age 40 (AOR 5.01, 95%CI 1.39–18.03), Hepatitis B co-infection (AOR 6.97, 95%CI 1.52–31.88), current smoking (AOR 1.69, 95%CI 1.55–3.41); and currently taking antiretroviral therapy (ART) (AOR 2.36, 95%CI 1.25–4.45) compared to being ART-naïve. Women in BC had higher adjusted odds of abnormal menstruation (AOR 2.95, 95%CI 1.61–5.39), relative to women in Ontario and Quebec.ConclusionsOver half of WLWH in this analysis had abnormal menstruation. Correlates of abnormal menstruation include genetic, socio-behavioural factors (province of residence, smoking), Hepatitis B co-infection, and current ART use.
Highlights
The prevalence of abnormal menstruation is thought to be higher among women living with HIV (WLWH)[1,2,3,4,5,6], but has not been assessed in nearly two decades
Abnormal menstruation was associated with having a biologic sister/mother who entered menopause before age 40 (AOR 5.01, 95%CI 1.39–18.03), Hepatitis B co-infection (AOR 6.97, 95%CI 1.52–31.88), current smoking (AOR 1.69, 95%CI 1.55–3.41); and currently taking antiretroviral therapy (ART) (AOR 2.36, 95%CI 1.25–4.45) compared to being ART-naïve
Abnormal menstruation among women living with HIV in Canada
Summary
The prevalence of abnormal menstruation is thought to be higher among women living with HIV (WLWH)[1,2,3,4,5,6], but has not been assessed in nearly two decades. Abnormal menstruation encompasses several variations in the menstrual cycle, including non-menopause related amenorrhea, abnormal cycle frequency, heavy or prolonged menstrual bleeding, and irregular and intermenstrual bleeding[7]. Abnormal menstruation is clinically important health outcome, as it is associated with anemia, decreased rates of fertility and reduction in quality of life. The experience of abnormal menstruation contributes to reduced quality of life for women, with impacts on physical health, psychological wellness and participation in work and social lives [13,14]
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