Self-reported early-onset menopause among women living with HIV and hypertension in Botswana: a cross-sectional study

Objectives: Early-onset menopause has been increasingly observed among women living with HIV (WLWH). However, limited data exist on its prevalence and determinants in sub-Saharan Africa. This study aimed to determine the prevalence and predictors of self-reported early-onset menopause among WLWH in Botswana. Methods: This cross-sectional analysis was conducted as a substudy within the InterCARE cluster-randomized controlled trial among women with HIV and hypertension aged ≥18 years, at 14 HIV clinics in Botswana. Data were collected between January and September 2023 and included sociodemographic, clinical, reproductive history, and HIV parameters. Early-onset menopause was defined as self-reported cessation of menstruation for at least 12 months before the age of 45, unrelated to surgery or pregnancy. A generalized estimating equation model was used to identify independent predictors of early menopause. Results: The mean age (SD) of the 1,088 women enrolled was 59.1 (7.2) years, with 23.7% (n=258) having experienced early-onset menopause. The mean age (SD) at menopause overall was 47.4 (5.5) years and that for early-onset menopause was 40.3 (4.6) years. In adjusted analysis, the only predictor of early-onset menopause was HIV diagnosis before age 35 years (aRR=1.46; 95% CI: 1.06-2.01; P =0.020). CD4 count was inversely associated with the risk of early-onset menopause (aRR 0.98; 95% CI: 0.96-1.00; P =0.045). Conclusions: Early-onset menopause is relatively common among WLWH in Botswana and is associated with a younger age at HIV diagnosis. These findings highlight the need for integrated reproductive and HIV care, including screening and management of early-onset menopause to prevent menopause-related complications.