Study title: Understanding the impact of menopause on the health of African women, particularly those living with HIV (The Menopause Study)

Lead Researcher(s)

Celia Gregson, Rashida Ferrand

Funder(s)

University of Bristol, Global Challenges Research Fund

Partner(s)

Biomedical Research and Training Institute, Ministry of Health and Child Care Zimbabwe, University of Bristol, University of The Witwatersrand

Background

The scale-up of antiretroviral treatment has dramatically improved survival, such that increasing numbers of women with chronic HIV are now reaching the menopause across Africa. However, little is known of the menopausal experiences of African women, including those living with HIV. Research has seldom focussed on African woman at this stage of life. Menopause is a period of change, including rapid skeletal changes which increase fracture risk. Understanding mechanisms of bone loss in the context of HIV infection is intended to help inform interventions and guidelines.

Study aim(s)

To understand the views of women living in Southern Africa, concerning menopause and ageing, particularly of muscles and bones, and the barriers and facilitators to accessing medical treatments.

To co-produce contextually relevant resources—booklets and poster—about menopause with women in Zimbabwe and South Africa

To quantify declines in bone strength, bone architecture and muscle strength associated with menopausal transition in Southern African women and determine how these differ between those with and without HIV infection.

To identify risk factors for menopause-related losses in bone strength and architecture in women living in Southern Africa, including antiretroviral regimes amongst those who are living with HIV.

Study design

This was a mixed-methods study which investigated whether HIV infection and its treatments worsened menopausal bone loss and whether good viral suppression, achieved through antiretroviral treatment (ART), attenuated this effect. The study examined whether certain ARTs, such as tenofovir, had more detrimental effects on bone mass and architecture, and whether HIV infection was associated with earlier menopause. The study also aimed to understand women’s opinions about menopause, their experiences of menopause, associated health, and to identify unmet needs, such as gaps in knowledge, understanding, and/or health care provision. Understanding both patterns of bone loss and women’s opinions about menopause in the context of HIV infection will help inform future interventions and guidelines.

The study comprised three work packages:

Work Package 1: Qualitative Study in Harare and Soweto

We interviewed women at different stages of menopause to understand country-specific contexts and women’s priorities during this life stage.

Work Package 2: Longitudinal Analysis

We analyzed data already collected from 450 women followed up over a 4-year period in Soweto, Johannesburg. This analysis determined changes in bone density through the menopausal transition and how these changes were influenced by HIV infection.

Work Package 3: Cross-sectional Study

We collected new data from 380 pre-, peri-, and post-menopausal women living in Harare. Each participant completed detailed questionnaires and underwent musculoskeletal evaluation using DXA and pQCT to measure bone and muscle mass, as well as assessments of muscle function and physical performance.

Study dates

2019 - 2023