HIV and menopause: current evidence, gaps, and future directions for integrated care

To synthesize current evidence on menopause in women living with HIV, highlighting the biological, psychosocial, and structural determinants of health, and to identify research and implementation gaps to inform integrated models of care.

With increasing life expectancy, more women with HIV are transitioning through menopause. Data from international cohorts suggest that menopause may occur approximately three years earlier in women with HIV than in HIV-negative peers. Symptom burden - including vasomotor, psychological, and sexual health disturbances - appears greater and is compounded by stigma, multimorbidity, and socioeconomic disadvantage. Evidence on the safety of menopausal hormone therapy, drug-drug interactions with antiretroviral therapy, and long-term cardiometabolic and bone outcomes remains sparse, particularly in low-income and middle-income countries (LMICs). Intersectional inequities affecting racially minoritized and migrant women are increasingly recognized but under-researched.

Menopause in women with HIV remains an under-prioritized aspect of care despite its significant clinical and psychosocial implications. Future efforts should focus on longitudinal and interventional studies, integration of menopause assessment within HIV services, and culturally sensitive, multidisciplinary care models that address inequities across global settings.