HIV may impact the menstrual cycle, leading to various menstrual abnormalities.[1] At the same time, the menstrual cycle may change the likelihood of transmitting or acquiring HIV.[2,3]

Does HIV affect menstruatIon?

People living with HIV who menstruate may experience abnormalities in their menstrual cycles and periods, this can include:[1,4]

  • The absence of menstruation for one to three months or longer.
  • Irregular periods, which vary in frequency and duration, as well as heavier or lighter bleeding.

These menstrual abnormalities can lead to various complications, including anaemia, infertility, and a reduced quality of life. They can negatively impact both physical health and mental well-being, often limiting social participation.[5]

Some studies suggest that HIV can also lead to early menopause, while others find no connection between the two.[6] What is clear, however, is that early menopause is linked to a higher risk of diabetes, osteoporosis, and heart disease.[1] These risks help in understanding the unique health challenges that women living with HIV may face as they grow older.[6]

Fortunately, research shows that menstrual abnormalities are less common in women on antiretroviral therapy (ART) who have a higher CD4 cell count and lower viral load. In contrast, women not receiving ART or those with poor adherence, lower CD4 counts, and higher viral loads are more likely to experience menstrual irregularities.[4]

Is a mIssed perIod a sIgn of HIV?

A single missed period is not generally considered an early sign of HIV. The early symptoms of HIV are similar for all genders and include fever, fatigue, muscle pain, swollen lymph nodes, and headaches.[7]

Many other factors can cause missed or irregular periods in both women living with HIV and women not living with HIV. These include:[8-11]

  • Pregnancy
  • Menopause
  • Stress
  • Too much exercise
  • Body Reproductive system disorders such as uterine fibroids, polycystic ovary syndrome (PCOS), and pelvic inflammatory disease (PID).

Other additional factors that may cause menstrual abnormalities include, low or high body weight, recreational drug use, and some types of birth control.[1,8]

That said, research does show that women living with HIV are at a significantly higher risk of experiencing missed periods lasting three or more months compared to women without HIV.[12]

The exact reasons for menstrual abnormalities in women living with HIV remain unclear.[4,12] However, HIV acquisition affects the immune system, which can change the levels of key hormones that regulate your menstrual cycle.[4]

Furthermore, HIV increases the risk of developing an opportunistic infection (OI) which are infections that occur more frequently or are more severe in individuals with weakened immune systems.[4,13] An example of an OI would be tuberculosis.[4,14] Conditions caused by OIs may also impact menstrual cycles in people living with HIV.[4,15]

Studies also show that some HIV medications can cause menstrual abnormalities.[4] Speak with your doctor about switching your HIV treatment if you are concerned about its side effects.

If you experience multiple missed periods or irregular periods, discuss it with your healthcare provider to help determine the underlying cause.

Can HIV be transmItted In menstrual blood

HIV can be transmitted through menstrual blood if an individual has a detectable viral load. However, the menstrual blood of someone who is on effective ART, and has an undetectable viral load, cannot transmit the virus.[16] This is known as Undetectable=Untransmittable (U=U).

If menstrual blood comes in contact with unbroken skin, HIV cannot be transmitted. However, HIV in menstrual blood can be transmitted if blood comes into contact with a deep open wound or cut. Transmission can also occur if blood contacts mucous membranes, i.e. parts of the body with wet, absorbent skin. These include the eyes, mouth, vagina, head of penis, and inside the anus.[16]

Does menstruation increase the likelihood of transmitting HIV to sexual partners?

For HIV-positive people who menstruate, the amount of HIV in vaginal fluids fluctuates during the menstrual cycle, with research suggesting that there is an increased potential likelihood of sexual HIV transmission during periods.[2]

HIV transmission during menstruation only occurs when there is a detectable viral load; individuals with an undetectable viral load cannot sexually transmit HIV, regardless of whether they are menstruating or not.[16,17] Importantly, there can be a delay of several months between when blood achieves an undetectable viral load and when vaginal fluid also becomes undetectable.[2]

To prevent HIV transmission, it is necessary to use physical barriers, such as condoms and dental dams, during sexual activity. Additionally, pre-exposure prophylaxis (PrEP) is important in preventing HIV transmission.[16]

Is there a higher likelihood of getting HIV while menstruating?

Menstruation itself may not increase the chances of getting HIV. However, research suggests that hormonal fluctuations throughout the menstrual cycle can temporarily reduce immunity, increasing susceptibility to HIV during certain phases of the menstrual cycle.[3]

While more research is needed to pinpoint the specific phases where transmission is more likely, it remains crucial to consistently practice HIV prevention measures throughout your menstrual cycle.[3]

Additionally, there are biological factors that make women more likely to contract HIV through heterosexual sexual activity compared to men. These include:[18]

  • The vagina’s larger surface area compared to the penis, which increases potential exposure to the virus.
  • HIV-infected semen that can remain in contact with the vaginal tract for longer periods, further raising the likelihood of transmission.
  • Having a yeast infection, bacterial vaginosis or an untreated STI in the vaginal area can elevate the chances of acquiring HIV.

Can hormonal contraceptIves be used to suppress menstruatIon?

Yes, hormonal contraceptives such as birth control pills or certain intrauterine devices (IUDs) can effectively regulate or suppress the menstrual cycle in women living with HIV.[1,8]

It’s important to know that some hormonal contraceptives may interact with some HIV medications, potentially reducing the effectiveness of the contraceptives.[19] Therefore, consulting with your doctor is essential to choosing the most appropriate method.

In addition to hormonal contraceptives, other effective methods for regulating your menstrual cycle include hormone replacement therapy and staying adherent to ART.
These, alongside your doctor's treatment recommendations, can address the specific underlying causes of menstrual abnormalities.[1,4]

Abbreviations:

ART, antiretroviral therapy; HPV, human papillomavirus; IUD, intrauterine device; OI, opportunistic infection; PCOS, polycystic ovary syndrome; PID, pelvic inflammatory disease; PrEP, pre-exposure prophylaxis; STI, sexually transmitted infection.

References:

  1. Valiaveettil C, Loutfy M, Kennedy VL, et al. High prevalence of abnormal menstruation among women living with HIV in Canada. Dionne-Odom J, ed. PLOS ONE. 2019;14(12):e0226992. doi:https://doi.org/10.1371/journal.pone.0226992
  2. Politch JA, Marathe J, Anderson DJ. Characteristics and Quantities of HIV Host Cells in Human Genital Tract Secretions. Journal of Infectious Diseases. 2014;210(suppl 3):S609-S615. doi:https://doi.org/10.1093/infdis/jiu390 
  3. Boily-Larouche G, Lajoie J, Dufault B, et al. Characterization of the Genital Mucosa Immune Profile to Distinguish Phases of the Menstrual Cycle: Implications for HIV Susceptibility. The Journal of Infectious Diseases. 2018;219(6):856-866. doi:https://doi.org/10.1093/infdis/jiy585
  4. Bonaventure MU, Adejumoke HA, Daniel FM, et al. The burden of menstrual irregularities among women living with HIV in Nigeria: a comprehensive review. Reproductive Health. 2024;21(1). doi:https://doi.org/10.1186/s12978-024-01892-0
  5. Lam C, Anderson B, Lopes V, et al. Assessing Abnormal Uterine Bleeding: Are Physicians Taking a Meaningful Clinical History? Journal of Women’s Health. 2017;26(7):762-767. doi:https://doi.org/10.1089/jwh.2016.6155
  6. Tariq S, Anderson J, Burns F, et al. The menopause transition in women living with HIV: current evidence and future avenues of research. Journal of Virus Eradication. 2016;2(2):114-116. doi:https://doi.org/10.1016/s2055-6640(20)30476-3
  7. PubMed. Justiz Vaillant AA, Gulick PG. HIV and AIDS Syndrome. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534860/ [Accessed: November 2024]
  8. NHS. Missed or late periods. Available from: https://www.nhs.uk/conditions/missed-or-late-periods/ [Accessed: November 2024]
  9. NHS. Irregular periods. nhs.uk. Available from: https://www.nhs.uk/conditions/irregular-periods/ [Accessed: November 2024]
  10. Eunice Kennedy Shriver National Institute of Child Health and Human Development - NICHD. Menstruation and Menstrual Problems. Available from: https://www.nichd.nih.gov/health/topics/factsheets/menstruation [Accessed: November 2024]
  11. NHS. Overview - Pelvic inflammatory disease. Available from: https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/ [Accessed: November 2024]
  12. King EM, Albert AY, Murray MCM. HIV and amenorrhea. AIDS. 2019;33(3):483-491. doi:https://doi.org/10.1097/qad.0000000000002084
  13. NIH. What is an Opportunistic Infection? Available from: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/what-opportunistic-infection [Accessed: November 2024]
  14. Ghebre RG, Grover S, Xu MJ, et al. Cervical cancer control in HIV-infected women: Past, present and future. Gynecologic Oncology Reports. 2017;21:101-108. doi:https://doi.org/10.1016/j.gore.2017.07.009 
  15. NHS. Cervical cancer - Symptoms. Available from: https://www.nhs.uk/conditions/cervical-cancer/symptoms/ [Accessed: November 2024]
  16. Terrence Higgins Trust. How HIV is transmitted. Available from:https://www.tht.org.uk/hiv/about-hiv/how-hiv-transmitted [Accessed: November 2024]
  17. AIDSMAP. Pebody R. Estimated HIV Risk per Exposure. Available from:https://www.aidsmap.com/about-hiv/estimated-hiv-risk-exposure [Accessed: November 2024]
  18. womenshealth.gov. Women and HIV. Available from:https://www.womenshealth.gov/hiv-and-aids/women-and-hiv [Accessed: November 2024]
  19. Krishna GR, Haddad LB. Interactions Between Hormonal Contraception and Anti-Retroviral Therapy: an Updated Review. Current Obstetrics and Gynecology Reports. 2020;9(3):98-104. doi:https://doi.org/10.1007/s13669-020-00289-7 

NP-GBL-HVX-COCO-250014 September 2025

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