Factors affecting reproductive hormones in HIV-infected, substance-using middle-aged women.
OBJECTIVE
To determine whether reproductive hormone levels are affected by human immunodeficiency virus (HIV) and drug use.


METHODS
HIV-infected and uninfected women (N=429), median age 45, were interviewed on menstrual frequency, demographic and psychosocial characteristics, and drug use behaviors. Serum was obtained on cycle days 1 to 5 in women reporting regular menses. Premenopausal-, early menopausal, and late menopausal transition and postmenopausal stages were assigned based on menstrual history. Serum was assayed for follicle-stimulating hormone (FSH), estradiol (E2), luteinizing hormone (LH), prolactin, thyroid-stimulating hormone, and inhibin B. Body mass index, HIV serostatus, and CD4+ counts were measured. Factors associated with hormone concentrations were assessed using uni- and multivariable analyses. Hormone concentrations were compared within menstrual status categories using nonparametric comparisons of means.


RESULTS
In this cross-sectional analysis, LH and FSH increased, and E2 and inhibin B were significantly lower in women of older age and more advanced menopausal status. Increased body mass index was strongly associated with decreased LH. Opiate use was significantly associated with lower inhibin B and E2 and increased prolactin. Poorer self-rated health was statistically significantly associated with lower LH and FSH, but increased education was associated with higher LH and FSH. Among HIV-seropositive women, opiate users had detectably lower FSH and LH than nonusers, and use of highly active antiretroviral therapy was significantly related to higher LH, FSH, and E2, whereas cocaine use was associated with lower E2.


CONCLUSIONS
Age and menopausal status are strongly related to reproductive hormones. Body mass index and use of opiates, cocaine, and highly active antiretroviral therapy as well as educational attainment and perceived health can significantly modify reproductive hormones during the menopausal transition and need to be considered when interpreting hormone levels in middle-aged women.
Santoro
Nanette
N
Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY 10461, USA. glicktoro@aol.com
Lo
Yungtai
Y
Moskaleva
Galina
G
Arnsten
Julia H
JH
Floris-Moore
Michelle
M
Howard
Andrea A
AA
Adel
Goli
G
Zeitlian
Gohar
G
Schoenbaum
Ellie E
EE
D015897:Comorbidity; D004958:Estradiol / Q000097:blood*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D012739:Gonadal Steroid Hormones / Q000097:blood*; D015658:HIV Infections / Q000097:blood* / Q000453:epidemiology; D006801:Humans; D013287:Illicit Drugs; D007265:Inhibins / Q000097:blood; D007986:Luteinizing Hormone / Q000097:blood; D008593:Menopause; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D011388:Prolactin / Q000097:blood; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000097:blood* / Q000453:epidemiology; D013972:Thyrotropin / Q000097:blood
D012739:Gonadal Steroid Hormones; D013287:Illicit Drugs; C422364:inhibin B; D004958:Estradiol; D007265:Inhibins; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D013972:Thyrotropin