Community and Clinical Research Division, First On-Call Initiative, Kharkiv Oblast, Ukraine.
Department of Internal Medicine, Asokoro District Hospital, Abuja, Nigeria.
Reprod Health. 2024 Nov 3;21(1):156. doi: 10.1186/s12978-024-01892-0.
Menstrual irregularities significantly distress women living with HIV (WLHIV), impacting their reproductive health and quality of life. Although the underlying mechanism remains inconclusive, studies have outlined possible contributory factors. This narrative review explores the burden of menstrual irregularities and associated hormonal dysregulation among women living with HIV in Nigeria. It synthesises data from studies to present an overview of the prevalence, patterns, potential etiology, and impacts of menstrual irregularities among WLHIV.
A literature search across electronic databases such as PubMed, Google Scholar, and Web of Science was conducted, and information was extracted and synthesized to delineate the burden of menstrual irregularities in WLHIV. Eligibility criteria included original studies assessing the prevalence, aetiology, and impact of menstrual abnormalities among WLHIV in Nigeria. A narrative data synthesis approach utilized common themes and key concept extraction, including identifying patterns in the literature to present specific trends such as prevalence, patterns, etiology, and determinants. Menstrual irregularities were found to be prevalent among Nigerian WLHIV, varying from 29 to 76% across different regions, exceeding reports of similar studies in developed nations. Similarly, menstrual disorders including amenorrhea, oligomenorrhea, and polymenorrhea, were attributed to factors like HIV acquisition, antiretroviral therapy, low body mass index, and hormonal imbalances. Low CD4 count and high viral load with associated complications have been identified as major contributing factors. Distortion of the hypogonadal-pituitary-ovarian axis by viral-induced pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), and interferon-gamma (IFN-γ) may disrupt the hormonal balance necessary for regular menstrual cycles. Fluctuating levels of follicle-stimulating hormone (FSH), luteinising hormone (LH), estradiol, and prolactin have been reported among WLHIV. Although adherence to antiretroviral therapy has offered immense relief, its direct therapeutic effects on menstrual irregularities are inconclusive..
This study highlights the burden of menstrual disorders among WLHIV. It underscores the interplay between clinical, therapeutic, and client-associated factors as determinants of these abnormalities. Exploring associated complications like secondary infertility, reduced bone mineral density, and resultant osteoporosis, mirrors the significant impact of menstrual and hormonal irregularities on the reproductive health and quality of life of WLHIV.
月经不规律会给感染 HIV 的女性（WLHIV）带来极大困扰，影响她们的生殖健康和生活质量。尽管其潜在机制尚不清楚，但已有研究概述了可能的促成因素。本综述探讨了尼日利亚 WLHIV 中月经不规律和相关激素失调的负担。本文综合了研究数据，概述了 WLHIV 中月经不规律的流行率、模式、潜在病因和影响。
通过对 PubMed、Google Scholar 和 Web of Science 等电子数据库进行文献检索，提取并综合信息，以阐明 WLHIV 中月经不规律的负担。纳入标准为评估尼日利亚 WLHIV 中月经异常的流行率、病因和影响的原始研究。采用叙述性数据综合方法，利用常见主题和关键概念提取，包括识别文献中的模式，以呈现特定趋势，如流行率、模式、病因和决定因素。研究发现，尼日利亚 WLHIV 中月经不规律的发生率很高，不同地区的发生率在 29%至 76%之间，高于发达国家类似研究的报告。同样，包括闭经、稀发月经和月经过多在内的月经紊乱归因于 HIV 感染、抗逆转录病毒治疗、低体重指数和激素失衡等因素。低 CD4 计数和高病毒载量以及相关并发症被认为是主要的促成因素。病毒诱导的促炎细胞因子，如肿瘤坏死因子-α（TNF-α）、白细胞介素-1（IL-1）、白细胞介素-6（IL-6）和干扰素-γ（IFN-γ）可能破坏正常月经周期所需的激素平衡，从而干扰性腺轴。研究报告称，在 WLHIV 中，卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇和催乳素水平波动。尽管抗逆转录病毒治疗提供了巨大的缓解，但它对月经不规律的直接治疗效果尚不清楚。
本研究强调了 WLHIV 中月经失调的负担。它强调了临床、治疗和患者相关因素作为这些异常的决定因素之间的相互作用。探讨与继发性不孕、骨密度降低和由此导致的骨质疏松症等相关并发症相关的问题，反映了月经和激素失调对 WLHIV 生殖健康和生活质量的重大影响。
