Faculty member Rebecca Schnall and Nancy Reame smiling at the camera.

New Study: Menopause Contributes to a Greater Impact From Fatigue and Muscle Aches in Women Living With HIV

March 12, 2018

As the aging HIV population expands, so does the number of women with HIV who are going through menopause. Researchers at Columbia Nursing collaborated to examine the impact of menopause on women’s experience of HIV symptoms. Beyond being a study that could support better care management for this patient population, their work is associated with Columbia Nursing’s distinguished alumna and volunteer leader, Mary Dickey Lindsay ’45, who endowed the professorship held by both authors.


The study, which was published online in March in the journal Menopause, was co-authored by Rebecca Schnall, PhD, Mary Dickey Lindsay Associate Professor of Disease Prevention and Health Promotion, and Nancy Reame, PhD, Mary Dickey Lindsay Professor Emerita of Disease Prevention and Health Promotion.


Following advancements in treatment during recent decades, HIV has largely become a chronic condition. This means a greater percentage of people with HIV are living longer; nearly half of the 1.1 million Americans with an HIV diagnosis are age 50 or older. Although women make up less than 20 percent of people with HIV, the number of those women over the age of 50 is growing. Additionally, while previous studies have shown that some HIV symptoms affect women more than men, little was known about the influence of menopause on this added burden.


“The study of differences in the way men and women experience HIV symptoms is an important emerging focus,” said Reame. “A number of studies have described menopause symptoms in women with HIV, but few have examined whether menopause might help explain the enhanced severity of HIV symptoms observed in women when compared to men.”


According to Schnall, the inspiration for the study came from a call for grant applications from the National Institute of Health’s (NIH) Office of Research on Women’s Health, which offered funding for adding sex/gender comparisons to existing projects. Schnall had just conducted an NIH-funded national online survey (February to August 2016) to better understand how people living with HIV in the United States today experience symptoms and manage their disease. Recognizing the opportunity, she reached out to Reame.


“I was excited by the potential to study sex/gender differences in the experience of HIV symptoms, particularly given the gap in existing research,” said Schnall.


Reame welcomed the collaboration.


“As a women’s health researcher with a longtime focus on menopause, I’ve been intrigued by how female reproductive aging affects the way women experience chronic health conditions such as diabetes, cardiovascular disease, and HIV,” said Reame. “Dr. Schnall’s research provided a natural opportunity for us to combine our respective areas of expertise and take a closer look at how reproductive status, and menopause in particular, plays a role in women’s experience of HIV symptoms.”  


In Schnall’s original online survey, people living with HIV reported fatigue, depression, muscle aches, and difficulty falling asleep as their most common symptoms. Schnall and Reame analyzed the data to compare responses from women and men. They then conducted a follow-up survey among the women who participated to assess their reproductive status.


Their findings showed that post-menopausal women suffered a greater impact from fatigue and muscle aches—regardless of their age, the duration of their HIV infection, and the existence of other health conditions.


“Given the shifting demographics in the HIV epidemic, our findings are very salient for people living with HIV and their health care providers,” said Schnall. “If health care providers can better predict, identify, and manage the symptoms that are most burdensome to women living with HIV, they can improve care for these women.”


As their titles indicate, Schnall and Reame share the distinction of having received an endowed chair established by Mary Dickey Lindsay, who graduated from Columbia Nursing in 1945. Lindsay has had a lifelong devotion to improving health and health care in New York City and beyond, and to helping generations of Columbia students prepare for careers in nursing. 


Reame was named the recipient of the chair when it was first bestowed in 2005 and Schnall succeeded her in 2016. They are both honored to share this association.


“As a nurse, we do so much more than healing,” said Schnall. “Although 1945 seems like a long time ago, Mary was ahead of her time and has paved a path on which I have started to build my work. She focused her life on making communities strong, attending underserved communities, and building the Columbia University School of Nursing.”


Reame added, “Mary has been an inspirational leader in women’s health advocacy and reproductive rights, especially for the most vulnerable, not only for the city of New York but globally. Serving as the primary and senior authors on this women’s health manuscript couldn’t be a more fitting tribute to Mary’s work.”


The paper, titled “In People Living with HIV (PLWH), Menopause (Natural or Surgical) Contributes to the Greater Symptom Burden in Women: Results from an Online US Survey,” was published in the March 2018 online edition of Menopause. Other study contributors from Columbia Nursing are Haomiao Jia, PhD, associate professor of biostatistics, and Melissa Gradilla, MPH, research coordinator; and Susan Olender, MD, assistant professor of medicine, Columbia University Vagelos College of Physicians and Surgeons. Research reported in this publication was supported by the National Institute of Nursing Research and the Office of the Director of the National Institutes of Health.


A full version of the study can be found here.