Many women living with HIV experience menopause earlier than women without HIV. Their symptoms are often severe, which can cause them to stop taking anti-HIV drugs essential for controlling the virus. A common but under-treated condition is the genitourinary syndrome of menopause (GSM), which includes vaginal dryness, itching, and pain, symptoms that affect quality of life. 

Kerry Murphy, M.D., and colleagues have conducted the first clinical trial to test whether vaginal estradiol—a locally applied low-dose form of estrogen— can improve vaginal symptoms of GSM in women with HIV. In the12-week pilot study, 51 women were randomized to receive either vaginal estradiol treatment or no treatment. Their study, published online on December 8 in Clinical Infectious Diseases, found that both groups reported some improvement in symptoms over time, but women receiving vaginal estradiol experienced significantly better symptom relief. Greater symptom improvement also occurred in younger women, suggesting that earlier treatment may be especially helpful. The results suggest that topical vaginal estradiol is an effective treatment for vaginal symptoms of menopause in women with HIV and indicate that larger clinical trials would be worthwhile. 

Dr. Murphy is an associate professor of medicine and of microbiology & immunology at Einstein.