Racial and Ethnic Differences in the Physiology and Clinical Symptoms of Menopause

Gloria Richard-Davis, MD, FACOG; Melissa Wellons, MD


Semin Reprod Med. 2013;31(5):380-386. 

In This Article

Ethnic Differences in Menopausal Symptom Experience

Symptom Differences

Transitioning into menopause is a natural part of life. All women, if they live long enough, will experience menopause. A variety of symptoms are reported frequently associated with menopause. These include hot flashes, night sweats, menstrual irregularities, vaginal dryness, depression, nervous tension, palpitations, headaches, insomnia, lack of energy, difficulty concentrating, and dizzy spells. How a woman experiences symptomatology or reports them is greatly influenced by a multitude of variables inclusive of race, ethnicity, and other psychosocial factors. Her ability to manage symptoms associated with this life transition affects her quality of life and imposes physical, psychological, and economic burdens.[22,23] Thus, strengthening women's ability to manage symptoms during the menopausal transition in culturally competent ways is imperative for the health and well-being of more than 40 million midlife women in the United States.

The menopausal transition can be categorized into several stages. In the SWAN and the Four Major Ethnic Groups (FMEG) study, the menopausal status was categorized into pre-, early peri-, late peri-, and postmenopausal.[21] [23] Both studies examined the prevalence of various symptoms by menopausal status in a multiethnic sample of women transitioning to menopause states. The study comprises two stages: a cross-sectional telephone or in-home survey conducted between November 1995 and October 1997 and a longitudinal investigation to track changes in women's physical and mental health as they age and traverse the menopausal transition. FMEG used Internet survey and qualitative online forums.[23]

The following questions were addressed in both studies:

  1. How does the structure of symptoms among mid-aged women compare across racial/ethnic groups?

  2. Is symptom reporting related to race/ethnicity or menopausal status?

  3. Does the relation between menopausal status and symptoms vary across racial/ethnic groups?

In recent years, research on menopausal symptomology has focused on identifying symptom groupings experienced by women as they progress from premenopausal to postmenopausal status. Literature reviews consistently report a relationship between culture and menopause. The sociocultural organization of one's life course in specific geographical locations profoundly affects the menopausal experience for women. Many factors are hypothesized to influence the menopause experience, such as diet, smoking, exercise, attitude, expectation, marital status, socioeconomic status, and so on.[24] [25]

However, most of these studies have been conducted among Caucasian women from western cultures. This leaves open the question of whether the findings from these studies can be extended to women of other racial/ethnic groups or cultures. Furthermore, many of the previous studies have been conducted on relatively small samples. Pham et al[26] found similar levels of psychological, vasomotor, genitourinary, and general physical symptoms in a convenience sample of 33 African American and 35 Caucasian premenopausal women, aged 44 ± 49.[26] Avis et al[27] reported from SWAN two consistent clusters of clearly menopausal symptoms emerged from the data. One was vasomotor symptoms, such as hot flashes and night sweats, and the other consisted of psychological and psychosomatic symptoms. There were racial/ethnic differences in symptom reporting as well as differences by menopausal status. Controlling for the following variables, such as age, education, health, and economic strain, Caucasian women reported significantly more psychosomatic symptoms than other racial/ethnic groups. African American women reported significantly more vasomotor symptoms. Feeling tense, depressed, irritable, headaches, and stiffness were all frequently reported symptoms ([Table 1]). In some studies, fatigue, muscle/joint pain, back/neck aches, and headaches exceeded reports of hot flashes.[27–31] In general, the Japanese and Chinese were less likely than the other groups to report any symptoms.

Im et al, from the FMEG study, also reported statistically significant ethnic differences in the total number of symptoms experienced during the menopausal transition.[23] Hispanics reported significantly larger numbers of total symptoms, physical symptoms, and psychosomatic symptoms than Asians. Caucasians reported significantly larger numbers of total symptoms, physical symptoms, psychological symptoms, and psychosomatic symptoms than Asians. African Americans reported a significantly larger number of psychosomatic symptoms than Asians. There were statistically significant ethnic differences in the frequencies of 41 individual symptoms.

Both studies reported racial and ethnic differences in symptoms experienced in menopause transition in different groups of women. The racial and ethnic differences are consistent and serve as evidence against a universal menopausal syndrome.[27] Both studies had limitations related to the selection of participants: SWAN regional selection from specific sites for each race and ethnic groups and FMEG participants were self-selected, English speaking and more educated because of Internet participation. Both study samples might not represent subethnic groups within each major ethnic group. Thus, the generalizability of the study findings is limited. Nonetheless, both support racial and ethnic differences in how women experience menopause.