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

Treatment or Management Approach: "Allopathic or Naturopathic"

Although evidence for ethnic differences in menopausal symptom management was reported in previous studies, the usages of the management strategies or the influences of women's ethnic-specific attitudes on the choice of management strategies have rarely been compared among multiethnic groups in the United States. Recently, Im et al[23] reported four themes reflecting differences in menopausal symptom management among the four major ethnic groups: (a) "seeking formal or informal advice," (b) "medication as the first or final choice," (c) "symptom-specific or holistic," and (d) "avoiding or pursuing specific foods."[32]

Seeking Formal or Informal Advice

The four ethnic groups had prominent differences in their approach to seeking information on menopausal symptom management. Most white women visited their doctors for care and advice to manage their menopausal symptoms. This was believed to be largely because they thought menopausal symptoms were a serious health issue that would affect their life for a long time. White women noted they wanted more information and support from their doctors. On the contrary, many ethnic minority women sought advice from elders as their primary information source on how to manage their menopause symptoms because they had experienced menopause. Close friends were their secondary source of information. Asian women largely believed that menopause is part of the normal aging process and did not seek care.

Medication as the First or Final Choice

Clear ethnic differences were noted on the decision of medical treatment. While white women preferred to take a variety of different medications to alleviate their symptoms, ethnic minority women commonly chose not to take medications to handle their menopausal symptoms. For white women, medication was their first strategy to manage their symptoms in comparison with ethnic minority women who used medication as their last option when alternative approaches had failed.

Symptom Specific or Holistic

Stark contrasts were reported in white versus ethnic minority women's approach to treatment of specific symptoms. White women largely preferred symptom-focused management strategies or treatments for menopausal symptoms. On the contrary, ethnic minority participants favored holistic "mind-body-spirit" strategies that would help relieve menopausal symptoms by making their entire body feel better.

Avoiding or Pursuing Specific Foods

Again, differences were reported with white women avoiding certain "trigger" foods versus ethnic minority women pursuing health foods to improve their general health.

Hormone Therapy

In National Health and Nutrition Examination Survey, researchers confirmed ethnic differences in the use of hormone replacement therapy (HRT); white women were much more likely to use HRT than non-Hispanic, African American, or Mexican American women.[33]

This finding is consistent with trends noted by other investigators. In 2001, Avis et al from SWAN data reported that hormone use was highest among Caucasian women and lowest among African American and Hispanic women.[27] Multiple investigators cited similar findings indicating white women were much more likely to use HRT than non-Hispanic, African American, or Mexican American women. In addition, white women were prescribed or offered HRT more often.[22,34] This trend is interesting given the SWAN data, which reported white women having fewer vasomotor complaints when compared with African American and Hispanic women. In addition, post Women's Health Initiative (WHI), there was a significant decline in hormone prescribing across all ethnic groups.[35]

Complementary or Alternative Treatment

The use of complementary and alternative medicine (CAM) is very common. In 1999, the National Health Interview Survey data estimated approximately 40% of women in the United States used some form of CAM in the past 12 months. More than $600 million was spent on CAM for menopausal treatment.

Bair et al[36] reports data from the SWAN study, which revealed more than 80% of participants used some form of CAM. There was significant use across all ethnic groups, but differences did prevail. White and Japanese women had the highest rates of use (60%), followed by Chinese (46%), African American (40%), and Hispanic (20%) women. Overall use of CAM therapy remained relatively stable over the study period. As women progressed through menopausal transition, there were some ethnic differences noted, though not statistically different. Use of CAM among white women did not change with transition status. However, for Chinese and African American women, an increase in CAM use was observed in perimenopause and decreased once menopause occurred. This is in contrast to Japanese and Hispanic women, where use of CAM decreased during early perimenopause and increased physical activity as they progressed to late menopause. All groups decreased CAM use once menopause was reached.[36]

Historically, investigators have noted differences in use of CAM. Hirata et al reported Asian women, especially Chinese women, were more likely to use acupuncture and dong quai, a Chinese herb traditionally prescribed as a tonic for women.[37] Korean women commonly use red ginger, which reportedly improves fatigue and depression.[38,39] Asian women were more likely to use soy products.[38] Of note, however, is that a major predictor of subsequent CAM use in menopausal transition is the use of CAM before menopausal transition.[35]