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Women with HIV lack support during menopause

Women with HIV are failing to get the support they need during menopause, according to a study led by University College London (UCL).

The PRIME (Positive Transitions through the Menopause) report involved almost 900 women living with HIV aged 45-60 across England, who completed questionnaires and interviews between June 2015 and April 2018. Researchers found that 47% of women with HIV do not have the information they need to manage menopause.

In a related study by the PRIME team, a survey of 88 GPs found that less than half of GPs (46%) feel confident managing menopause in women with HIV, despite the vast majority (96%) reporting they feel confident managing menopause in general.

GPs said their most common concerns were potential drug interactions between hormone treatment and HIV medication (79%), and missing an HIV-related diagnosis (51%).

Treatment advances mean that more people living with HIV are reaching their 50s and beyond.  One third of people living with HIV in the UK are female. Around 10,000 are of menopausal age, with a further 10 to 20,000 predicted to reach this age group in the next five to ten years.

Despite this, a recent report by the Terrence Higgins Trust  ‘Invisible No Longer’ highlights the lack of research on women living with HIV.  The PRIME Study is “an important step towards addressing this gap”, researchers said.

Dr Shema Tariq, study lead, clinical research fellow, and consultant HIV physician, UCL Institute for Global Health, said one of the study’s key findings was the lack of information on menopause and support available to women with HIV.

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“There are examples where women are going back and forth between their GP and HIV specialist, creating additional frustration and uncertainty during an already unsettling time.

“These findings may well apply to other groups of women managing long-term medical conditions such as those with diabetes.”

He recommended that HIV clinical services, GPs and HIV support services “be aware of the potential impact of the menopause transition on the health and well-being of women living with HIV, and ensure that services are able to support women during this time”.

Key recommendations of the report include: high-quality and accessible information about the menopause should be available to all women living with HIV attending HIV clinics, and that menopause among women with HIV should be managed within primary care, supported by close liaison with HIV specialists.

The report advised primary care staff should receive training to improve confidence and skills related to managing menopause in women with HIV. Further research on the impact of hormone replacement therapy on mental health, clinical outcomes and quality of life in women with HIV is needed, the report found.

Peer-support for women living with HIV transitioning through the menopause, a more joined up approach among commissioners of care across the HIV pathway, and a greater focus on the impact of menopause on well-being were also recommended.

The work was funded by the National Institute of Health Research (NIHR) in the form of a postdoctoral fellowship awarded to Shema Tariq.