[Question #6421] HPV and Menopause, vaccine age limit

14 months ago
Doctors, I am writing this message for Dr. Hansfield.

I am 47 and close to menopause years. I used to have HPV when I was in my  30s. I went to google and it said HPV comes back when you are at menopause or perimenopause. I think I am in my perimenopausal years because my menstrual cycle is not as regular as it once was. My marriage ended recently and I am dating again. Is my HPV back? Does this internet information I found mean that all old HPV  come back at menopause or that some do? Can I get men older than age 50 to get the vaccine? The person I am seeing now is 53 years old. I am nervous.
14 months ago
soory, I mean can men older than 45 get vaccine?
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Welcome to the Forum and thanks for your question.  As we have said many times before, clients do not get o choose who will answer their questions.  Dr. Handsfield and I have worked together for nearly 40 years and while our verbal styles differ, we have never differed in the substance of our advice. 

The internet and Google have not served you well. Unfortunately, much of what is seen on the internet is incorrect, either because it is out of date, taken out of context, or just plain wrong.  Any effect that menopause has on the risk for re-activation of HPV is minor and inconsequential and should not concern you.   I suggest that, if you are concerned (and I sense you are) all that is needed is for you to periodically get a reproductive health check which includes HPV testing.  Such testing will tell you if your HPV has returned (in my opinion, this is unlikely).  Should HPV be discovered, the next steps for prevention of progression to cancer (which are unlikely to occur)  are well defined, depending on the findings. 

Regarding your partners.  Their risk for reinfection, should your past HPV reactivate, is low and their risk for problems related to an infection, should it occur is lower still.

Finally, current guidelines approve the HPV vaccine for persons up to age 45.  For persons older than this, should they desire it, while they would need to pay for the vaccine themselves, there is no medical or scientific reason that the vaccine would be contraindicated for them.  Receipt of the vaccine would be just fine. 

I hope that these comments are helpful  EWH

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14 months ago
Okay I am glad to hear that. The stuff I read seemed official, one was even from the journal of infectious diseases, but I am not too well understood on this stuff so maybe i misinterpreted.

One more question if you would not mind.
I read that the number of HPV reappearances could possibly be higher in menopausal women then what current data says because of something called "the cohort effect." I understand that to mean that women who are in their 50s now have not been as exposed to HPV as  younger women today because they didn't have as many sex partners in the past since casual sex wasn't as big then as it is now.

It implies that maybe hpv reappearance in women with menopause is higher than it seems and that this will be seen in the future as these current women get older and get into menopause. Does this change your answer or opinion at all? Just wanting to mention it to be safe and see if we are on the same page.

and you said "Regarding your partners.  Their risk for reinfection..." I am confused on why you said partner "reinfection"?
14 months ago
and I almost forgot! I was told I had a "high-risk" HPV type when I was diagnosed in my 30s. Does this matter? It ended up going dormant.
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Thanks for your follow-up.  As we age our ability to fight off or, in the case, suppress HPV infection declines somewhat but not to a great degree.  Recent data (we are still learning lots of new information regarding the natural history of HPV) suggests that the virus often persists in a suppress form even though it becomes undetectable.  For the vast majority of people, the virus remains suppressed and there is no reappearance of detectable infection, no progression, and no meaningful risk for transmission to others.  As I said above, simply following with regular reproductive health checks with your regular doctor should take care of any small risk that your past infection may reactivate. 

I am not sure of how the term "cohort effect" was used in the material you have read.  In general what is meant by the term "cohort effect" is that when a group of persons with similar characteristics are followed over time, occurrences tend to occur among individuals within the group at about the same time (for instance, if a group of women is followed from age 30 onward, within the group (cohort) as a whole menopause will occur at similar ages).  Thus with respect to HPV which is a chronic but usually not serious infection, reactivations could be occurring within the group at similar time points following infection.   (I hope this is not too convoluted, if so, please ask and I'll try again).

Sorry for the use of the term "reinfection" in my original reply, I should have said "infection".

Finally, that your past infection (now quiescent) was a so called "high risk" HPV type in no way changes my comments.  The majority of sexually active persons, irrespective of gender or numbers sex partners while have become infected by so-called high risk HPV types within a few years of the onset of sexual activity.  The term "high risk" is a bit of an overstatement since the vast majority of persons with such infections suppress their HPV infections and suffer no consequences.  The term "high risk" is a relative term that refers to the fact that some types of HPV are more likely to lead to precancerous changes than others.  Even among persons infected with those types only a very small proportion progress. 

I hope that these clarifications are helpful.  If not, please use your follow-up question for clarification.  EWH

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14 months ago
All of that makes sense to me, thank you for taking  time to answer so detailed.

I want to use my last follow-up to repeat a question i dont think was answered. One of the things I read online made the following assumption:

That women who are currently in their 50s now have not been as exposed to HPV as  younger women today because they didn't have as many sex partners in the past since casual sex wasn't as big then as it is now. It implies that maybe hpv reappearance in women with menopause is higher than it seems and that this will be seen in the future as these current women get older and get into menopause. This information was from a online paper from journal of infectious disease

Does any of that change your  opinion that hpv reappearance because of menopause is still not likely?
14 months ago
I am not sure if it makes sense. To say it another way.
This current generation of women might have a lot more hpv reappearance when they hit menopause then what current data says. Which means that maybe  and hpv reappearance during menopause will show to be likely? Since right now we don't have the right data set of women.
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

I apologize.  I replied you your follow-up question hours ago and apparently that reply is lost in the internet ether.  I'll try again.

I am unconvinced that women currently in or around their 50s are at lower risk for HPV.  Studied performed 15 years ago indicated that in the 6 months following the ONSET of sexual activity monogamous women accrued HPV rapidly with nearly 60% being positive for so-called "high risk" HPV in 6 months.  Monogamy does not change the consideration.  Further, persons who are 50 now were born after the so-called "sexual revolution" was in full swing.  Thus I'm, skeptical that women currently in their 50s are meaningfully less exposed than women of other ages.

No change in my assessment or advice.  You had HPV detected in the distant past.  It cleared and there is no evidence that it has recurred.  I would urge you to not worry and to simply follow up with periodic sexual health check ups going forward.

I hope this is helpful.  EWH

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14 months ago
Thank you Dr Hook, you have helped a lot. I appreciate you. Have a happy holidays.
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Thank you. Happy holidays to you as well.


this thread will now be closed.  EWH

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