MENSTRUAL FUNCTION IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED WOMEN WITHOUT ACQUIRED-IMMUNODEFICIENCY-SYNDROME

To assess whether HIV infection is associated with menstrual abnormali ties in HIV-infected women without AIDS, we evaluated 248 premenopausa l HIV-infected women without AIDS and 82 HIV-negative women. Detailed medical, drug use, and menstrual histories (using menstrual calendars) were obtained. Complete physical and pelvic examinations and CD4 coun ts were performed. HIV-infected women were more likely to experience i ntervals > 6 weeks without menstrual bleeding [8 vs. 0%, odds ratio (O R) = 10.8, 95% confidence interval (CI) 1.8-1,000) and amenorrhea > 3 months (5 vs. 0%, OR = 7.1, 95% CI 1.1-1,000) (after adjustment for dr ug use, age, and race). Premenstrual breast swelling (p = 0.01), tende rness (p = 0.01), and dysmenorrhea (p = 0.04) were less common in HIV- infected women. There were no differences in intermenstrual bleeding o r irregular menstrual cycles. Among HIV-infected women, only a past hi story of substance abuse was significantly associated with menstrual i rregularities in a logistic regression model adjusting for age, curren t and past drug use, alcohol use, cigarette smoking, CD4 count, and ca tegory B conditions [1993 Centers for Disease Control (CDC) classifica tion system]. The increase in amenorrhea (> 3 months) and in menstrual cycle intervals > 6 weeks and the lower rates of premenstrual breast symptoms in HIV-positive women suggest the possibility of disturbances in menstrual function that do not appear to be attributable to clinic ally apparent secondary complications of HIV. Changes in menstrual fun ction were also significantly associated with a past history of, but n ot current, substance abuse, suggesting the possibility that socioecon omic factors rather than biologic effects of drugs may be responsible.