Approximately 1.2 million Americans live with HIV. And about 13 percent don’t know they have the virus.

HIV symptoms aren’t always obvious — at least not right away. As much as you might like to think you’d intuitively know if you were infected with HIV, often people who are HIV-positive feel totally fine.

What does this mean? In short, an absence of some of the more typical symptoms seen in acute HIV infection, such as prolonged fevers, fatigue, or a sore throat that won’t go away, doesn’t mean you don’t have the virus. There are a lot of symptoms associated with HIV — many unique to women — that suggest it’s possible to be HIV-positive even if it doesn’t feel like how you’d expect it to.

About 2 to 4 weeks after becoming infected with HIV, some people feel like they have the flu. As the body starts responding to the virus, you might start to experience the following:

  • fever
  • muscle aches
  • swollen lymph nodes
  • fatigue
  • night sweats
  • rashes
  • sore throat

Some people with HIV also develop skin rashes or sores, including on the skin around the mouth and on the genitals. Oral, anal, or genital ulcers, especially coupled with any of the symptoms above, can be a hallmark of acute HIV infection. Or they may be a sign of another sexually transmitted infection.

Rapid weight loss, often related to flu-like symptoms, is also an early sign.

But then, after that, women might begin to experience symptoms that won’t affect men.

Here are eight female-specific signs you may have HIV:

It’s not uncommon for your menstrual cycle to change if you have HIV. Amenorrhea is when you miss a period for 3 or more months. Evidence suggests that your period might:

  • be lighter
  • be heavier
  • be irregular
  • stop altogether

You might also have worse premenstrual syndrome (PMS) symptoms due to hormonal fluctuations, including:

  • breast sensitivity
  • severe cramps
  • fatigue

Your immune system has a harder time fighting off bacteria and fungi when you have HIV. As a result, you’ve got a better chance of developing other infections if you have HIV — including a vaginal yeast infection.

Signs of a vaginal yeast infection include:

  • pain during sex
  • pain when you pee
  • burning in and around your vagina and vulva
  • thick, white vaginal discharge (it looks a little like cottage cheese)

While yeast infections are common, they occur more frequently in women who have HIV. They may also be harder to treat. If you have recurring vaginal yeast infections (four or more a year) and struggle to find relief, it may be a sign of a bigger infection in your body.

Pelvic inflammatory disease is an infection of the upper genital tract and may impact the uterus, fallopian tubes, and ovaries, leading to pain in the pelvis.

PID may be more severe in women who are HIV-positive than in women who test negative for the virus. “It may also be more difficult to treat, according to a study from 1997. The 2000 report by the American Academy of Family Physicians also found that a relationship between HIV-associated PID and bacterial vaginosis appears to exist.

Women with HIV may experience longer-lasting or more severe symptoms, including increased vaginal discharge or severe abdominal pain, or they might find that their PID is harder to treat. PID symptoms might also return more often with HIV, even after HIV treatment has begun.

PID is often associated with other STIs, such as chlamydia or gonorrhea, and if you’re diagnosed with one of these conditions, you should also get tested for HIV since it could be a factor in the severity of your PID.

Bacterial vaginosis develops when the bacteria in your vagina change, causing an imbalance of healthy and harmful bacteria. In women ages 15 to 44, it’s the most common vaginal condition.

BV is more common in women living with HIV, and it can be more difficult to treat. BV, which is actually linked to HIV transmission, is seen as one of the biggest ways a woman can contract HIV, according to a 2013 study. So although BV isn’t exactly a sign that you have HIV, it does mean you’re more likely to get it. And if you already have HIV, even if you don’t know it, you may be more likely to transmit it if you also have BV.

If you already have another sexually transmitted infection, HIV can play a role in your body’s management of other STIs.

For example, if you have genital herpes, HIV might cause more frequent and severe outbreaks. Effectively treating the herpes might also prove more difficult since women with HIV are also more likely to develop resistance to herpes medications.

The most dangerous STI for women with HIV, though, is human papillomavirus (HPV), the virus that causes genital warts and certain cancers. It’s more active in people with HIV and puts women at an increased risk of cervical cancer. Cervical cancer is considered an AIDS-defining cancer, which means that if you get it, your HIV status has progressed to AIDS.

Symptoms of cervical cancer include abnormal bleeding and pain during sex. You should schedule an appointment with your doctor immediately if you experience both of these symptoms.

Women with HIV often enter menopause younger than those without HIV. They’re also more likely to experience severe side effects, including hot flashes.

So if you’re starting to get some of those symptoms, give your doctor a call so you can find out what’s really going on.

Osteoporosis is a disease that causes bones to be weaker and break more easily, and bone loss occurs faster in women with HIV. It’s a problem you’ll likely have to deal with for a long time if you find you are HIV positive, since some HIV meds can make it worse.

If you get infected with HIV later in life (when osteoporosis becomes more common in general), you might be especially prone to breaking a bone. So if you take a fall and end up with a broken bone really easily, it could be a sign of HIV. It’s a potentially more troubling sign if you’ve gone through menopause or if you suddenly end up with a lot of broken bones.

HIV-related heart disease is one of the leading causes of death for people with HIV, and the risk of heart attack is particularly high for women.

Women don’t often experience the same symptoms during a heart attack as men either. Heart attacks can feel more like the flu for women or feel like indigestion, shortness of breath.

Your back, neck, jaw, or stomach might cause you pain. If you experience any cardiovascular issues out of the blue, don’t ignore it. Talk with your doctor about getting tested and make an appointment with a cardiologist.

If you’re experiencing any of these symptoms, it’s important to talk with your doctor. It’s possible you have HIV and don’t know it.

Not only will this help you get treatment, but it will also help you protect others from getting HIV too.

Even if you’re exhibiting symptoms that could easily be linked to something else — and have nothing to do with HIV — it’s always better to get definitive answers about your health.

Routine screening for HIV is recommended since symptoms of the virus may not be apparent. Regular STI testing is a good idea too if you’re sexually active and/or have multiple sex partners. Testing is the only way to know for sure if you have HIV or any other sexually transmitted infections.