Dr. Anna Hachfeld and Dr. Susanna Weidlinger answer:

For most women, menopausal symptoms begin during the perimenopause (→ Box "Definitions"), which is the period when menstruation is still present – an aspect that both patients and doctors should keep in mind. Studies show that women with HIV tend to enter menopause earlier and that their symptoms are often stronger and more frequent than in HIV-negative women. Menopausal symptoms are very diverse and diffuse (→ Box "Typical Menopausal Symptoms"). This can sometimes make it difficult to properly categorize them. This may cause anxiety and affect medication adherence. Proper treatment of menopausal symptoms is important in improving the quality of life for affected women. Hormone replacement therapy also reduces the increased risk of osteoporosis, cardiovascular diseases, and depression associated with HIV infection – especially for women whose menopause begins before the age of 45. Since many HIV care providers have little experience in treating menopausal symptoms and many gynecologists are not familiar with HIV, it is important to address the issue proactively. Also, sharing experiences among affected women can be helpful. Networks such as the Sophia Forum or Positive Women Switzerland offer support and information.

Definitions

Menopause:
The menopause is the last natural menstruation in a woman's life. It typically occurs after the age of 45, with an average age of 52. The absence of menstruation before the age of 45 has medical significance and must be medically investigated and treated.

Perimenopause:
Perimenopause is the transitional phase from the fertile period (with regular menstruation) to menopause (with permanent cessation of menstruation). It usually occurs between the ages of 40 and 50 and lasts on average 5–10 years, with individual variation. During this time, often referred to as "the menopause years," there are significant hormonal changes:

• Initially, ovarian activity fluctuates, leading to significant variations in the two sex hormones, estrogen and progesterone, and causing irregular cycles.
• Later, ovarian function gradually declines until it ultimately ceases entirely.

Postmenopause:
Postmenopause refers to the period after menopause and the cessation of all ovarian activity. In this phase, there is an absolute deficiency of the sex hormones estrogen and progesterone.

Premature Ovarian Insufficiency (POI):
POI means that a woman's ovaries lose function before the age of 40. This leads to irregular or absent periods and a lack of sex hormones. Such a condition must be investigated and treated, as early and untreated hormonal deficiencies pose health risks.

Early Menopause:
Early menopause refers to menopause that occurs before the age of 45. This situation must also be investigated and treated, as an early and untreated deficiency in sex hormones carries health risks.

Typical Symptoms of Menopause

Possible symptoms during the menopausal phases:

• Hot flashes and sweating
• Sleep disturbances: difficulty falling asleep, difficulty staying asleep, waking up too early
• Palpitations, rapid heart rate, irregular heartbeat, tightness in the chest
• Depressive mood: hopelessness, sadness, tearfulness, lack of energy, mood swings
• Irritability: nervousness, inner tension, aggressiveness
• Anxiety: inner restlessness, panic
• Physical and mental exhaustion: overall decreased performance, memory impairment, difficulty concentrating, trouble finding words, forgetfulness
• Sexual problems: changes in sexual desire, activity, and satisfaction
• Urinary problems: discomfort while urinating, frequent urge to urinate, involuntary loss of urine
• Vaginal dryness: sensation of dryness or burning in the vagina, pain during intercourse
• Joint and muscle complaints: rheumatism-like symptoms
• Headaches
• Drier skin, thinner and more brittle hair