Women With HIV Experience More Fatigue, Muscle Aches After Menopause

Rebecca Schnall, PhD, RN

In a recent study, researchers at the Columbia University School of Nursing determined that post-menopausal women suffer from more fatigue and muscle aches than others living with HIV, supporting the need for better care management among the growing population.

The aim of the study was to examine the influence of menopause as part of sex differences in HIV symptom burden. Two of the most common symptoms in people living with HIV are fatigue and muscle aches/joint pains, which especially invoke additional burden in women.

Although women make up less than 20% of the population with HIV, the number of those women over the age of 50 is growing. Previous studies have shown some HIV symptoms to affect women more than men, but little was known about the influence of menopause on this burden.

“Given the shifting demographics in the HIV epidemic, our findings are very salient for people living with HIV and for their health providers,” one of the co-authors Rebecca Schnall, PhD, RN, Mary Dickey Lindsay Associate Professor of Disease Prevention and Health Promotion, said in a statement. "If health care providers can better predict, identify, and manage the symptoms that are most burdensome to women living with HIV, they can improve care for these women.”

The study builds on the results of a national online survey conducted from February—August 2016 by Schnall to better understand how people living with HIV in the US experience symptoms and manage the disease.

Schnall conducted a cross-sectional study that included both a sex-based analysis of previously reported HIV symptom characteristics of 1342 respondents in an online survey (males, n= 957; females, n= 385). Participants commonly reported symptoms of fatigue, depression, muscle aches and difficulty falling asleep.

For the most troublesome symptoms assessed in the sex-based analysis, depression scores were similar (p > 0.05) but higher burden scores for fatigue (p = 0.013) and muscle aches/pains (p= 0.004) were exclusively observed in females once adjusted for covariates.

Co-authors of the more recent study, Nancy Reame, PhD, MSN, Mary Dickey Lindsay Professor Emerita of Disease Prevention and Health Promotion, and Schnall, analyzed original survey data to compare responses from women and men and then directed a subsequent overview among women who participated to assess their reproductive status.

“The study of differences in the way men and women experience HIV symptoms is an important emerging focus,” Reame said in a statement. “A number of studies have described menopause symptoms in women with HIV, but few have examined whether menopause might help explain the enhanced severity of HIV symptoms observed in women when compared to men.”

From the respondent pool of the original study, the follow-up online survey included eligible females (n= 242) and focused menstrual bleeding patterns.

Respondents to the follow-up survey (n= 222) were predominantly Black, heterosexual, nonsmokers and obese, with an HIV diagnosis of approximately 16 years and at least 1 comorbid condition.

Burden scores were higher in women reporting amenorrhea due to natural menopause or hysterectomy (n= 104) versus the menstruating group (n= 118) for muscle aches/pain (p= 0.05), fatigue (p= 0.03) and difficulty falling asleep (p= 0.04), independent of age, duration of HIV and other health conditions.

Independent of aging, symptom burden may be exacerbated after menopause, supporting a shifting paradigm for HIV care management, researchers concluded.

The paper, “In People Living With HIV (PLWH), Menopause (Natural or Surgical) Contributes to the Greater Symptom Burden in Women: Results From an Online US Survey” was published in the March 2018 online edition of Menopause.