Today we'll delve into the intricate world of menopause and its diverse manifestations across different ethnic groups. The SWAN (Study of Women’s Health Across the Nation), a longitudinal study of 3,302 women throughout the United States, has provided us with invaluable insights into how menopause is not just a biological milestone but also a life event shaped by cultural and social factors (1).
The SWAN Study: Age of Menopause
The SWAN Study has been pivotal in understanding menopause. It revealed that the average age of the final menstrual period varied among ethnic groups: 50.9 years for Latinx women, 52.2 years for Black women, 52.4 years for Chinese women, 52.9 years for White women, and 53.1 years for Japanese women. However, when adjusting for socioeconomic, lifestyle, and health factors, these differences vanished, suggesting that external social factors significantly influence the timing of menopause (2).
Symptom Diversity and Ethnicity
The study also shed light on the prevalence of menopausal symptoms:
Hot Flashes and Night Sweats (Vasomotor Symptoms): A considerable percentage of women reported experiencing these symptoms, with Latinx women (49.4%) and Black women (46.5%) reporting the highest rates. The SWAN study controlled for hysterectomy status, so the experience of hot flashes in Black women was likely underrepresented due to their disproportionately high rates of hysterectomy.
Emotional Impact: Latinx women reported more embarrassment, anxiety, and depression related to hot flashes and night sweats.
Vaginal Irritation: Latinx women were more affected by vaginal irritation than any other ethnic group.
Depressive Symptoms: Latinx and Black women were more likely to report depressive symptoms, while Chinese and Japanese women were least likely.
Sleep Disturbances: Latinx and Black women reported the highest percentage of sleep disturbances.
Attitudes Towards Menopause: Interestingly, Black women reported more positive attitudes towards menopause, contrasting with the less positive attitudes reported by Chinese- and Japanese-American women. As attitudes towards menopause may have affected the participants' responses in the study, we must bear this in mind.
A 2014 study of 1,513 menopausal women looked at a wider variety of ethnicities. This study found that Native American women were most likely to report ever having vasomotor symptoms (66.7%), followed by Black (61.4%), White (58.3%), Hawaiian/Pacific Islander (45.5%), mixed-ethnicity (42.1%), Latinx (41.7), Vietnamese (40.0%), Filipino (38.9%), Japanese (35.9%), East Indian (31.3%), Chinese (29.0%), and other Asian (25.6%) women (3). It is unclear why the rates in this study were quite different from the rates in the SWAN study, but this difference can likely be explained by sampling from different areas of the country and the role of social factors.
A 2024 cross-sectional study of almost 69,000 women found that, even after controlling for socioeconomic status, there were significant differences in the experience of menopause symptoms based on ethnicity (4):
Black women were more likely to report hot flashes.
Latinx and mixed-race women were more likely to report hair and skin changes.
Indigenous women were more likely to report pain with sex.
Disparities in Menopause Management
A 2022 study analyzed data from 2014 to 2015, involving 200,901 women veterans with an average age of 54.3 years. The racial/ethnic composition was 58% White, 33% Black, 4% Latinx, and 4% other (5).
The findings revealed that:
Only 5% had documented menopause symptoms.
5% were prescribed vaginal estrogen.
5% were prescribed systemic hormone therapy.
In fully adjusted models, Black women veterans had lower odds of documented menopause symptoms compared to Latinx White women. Additionally, both Black and Latinx women were less likely to be prescribed systemic hormone therapy. Conversely, Latinx women had higher odds of being prescribed vaginal estrogen.
These findings suggest that despite evidence indicating a higher menopause symptom burden among Black women in community samples, documented menopause symptoms and hormone therapy were less common among Black compared to White women veterans. Furthermore, Latinx women veterans had lower odds of prescribed systemic menopause therapy yet higher odds of prescribed vaginal estrogen, despite no difference in documented symptoms.
This disparity may indicate significant gaps in symptom reporting, documentation, and treatment for Black and Latinx women veterans. It underscores the need for healthcare providers to be aware of these disparities and to strive for equitable care in the diagnosis and management of menopause symptoms.
The Clinician Perspective
A 2023 study explored the experiences of primary care practitioners caring for ethnically diverse women in regards to whether their patients seek help for menopausal symptoms. The clinicians in this study believe that a lack of awareness and communication barriers affect these women’s help-seeking behaviors. The study suggests that cultural expressions of symptoms can pose challenges for practitioners, and emphasizes the need for increased awareness and trustworthy information resources to help women from ethnically diverse backgrounds prepare for menopause. It also points out the necessity for clinicians to recognize and support the unique experiences of these women to improve their quality of life and potentially reduce future disease risk (6).
Beyond Biology: The Role of Social Factors
The SWAN Study’s findings emphasize that menopause is not solely a biological process but also a social one. The experience of discrimination and othering can increase vulnerability to menopausal symptoms. This highlights the need for a healthcare system that is not only medically attentive but also culturally sensitive and aware of the social determinants of health.
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Sources:
Green R, Santoro N. Menopausal symptoms and ethnicity: the Study of Women's Health Across the Nation. Womens Health (Lond). 2009 Mar;5(2):127-33. doi: 10.2217/17455057.5.2.127. PMID: 19245351; PMCID: PMC3270699.
Gold EB, Crawford SL, Avis NE, Crandall CJ, Matthews KA, Waetjen LE, Lee JS, Thurston R, Vuga M, Harlow SD. Factors related to age at natural menopause: longitudinal analyses from SWAN. Am J Epidemiol. 2013 Jul 1;178(1):70-83. doi: 10.1093/aje/kws421. Epub 2013 Jun 20. PMID: 23788671; PMCID: PMC3698989.
Reed SD, Lampe JW, Qu C, Copeland WK, Gundersen G, Fuller S, Newton KM. Premenopausal vasomotor symptoms in an ethnically diverse population. Menopause. 2014 Feb;21(2):153-8. doi: 10.1097/GME.0b013e3182952228. PMID: 23760434.
Kochersberger A, Coakley A, Millheiser L, Morris JR, Manneh C, Jackson A, Garrison JL, Hariton E. The association of race, ethnicity, and socioeconomic status on the severity of menopause symptoms: a study of 68,864 women. Menopause. 2024 Jun 1;31(6):476-483. doi: 10.1097/GME.0000000000002349. Epub 2024 Apr 23. PMID: 38652870.
Blanken, Anna MA; Gibson, Carolyn J. PhD, MPH; Li, Yongmei PhD; Huang, Alison J. MD, MAS; Byers, Amy L. PhD, MPH; Maguen, Shira PhD; Inslicht, Sabra PhD; Seal, Karen MD, MPH. Racial/ethnic disparities in the diagnosis and management of menopause symptoms among midlife women veterans. Menopause 29(7):p 877-882, July 2022. | DOI: 10.1097/GME.0000000000001978
MacLellan J, Dixon S, Bi S, Toye F, McNiven A. Perimenopause and/or menopause help-seeking among women from ethnic minorities: a qualitative study of primary care practitioners' experiences. Br J Gen Pract. 2023 Jun 29;73(732):e511-e518. doi: 10.3399/BJGP.2022.0569. PMID: 37130614; PMCID: PMC10170522.
Latest update: Jun 4, 2024
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