Menopause differs among ethnic groups

Menopause symptoms vary significantly by ethnic group, based on data emerging from a longitudinal study.

Acculturation of women immigrants to the United States and socioeconomic status are two of the factors that might accoun for these differences, and endocrinologist who has coauthored multiple studies based on the Study of Women’s Health Across the Nation (SWAN) data.

The study included women from seven sites: Boston; Newark; N.J.; Pittsburgh; Detroit; Chicago; Oakland, Calif.; and Los Angeles. Each site recruited white women and women from each ethnic minority group; black, Hispanic, Chinese, or Japanese. More than 10 years later, about 85 percent of the participants remain in the study. “We found differences by ethnicity — very intriguing differences.”

For example, in one study of 11,652 women from SWAN, found that 126 participants (1.1 percent) reported onset of menopause before age 40 years, also known as premature ovarian failure. This occurred in 1.0 percent of white women, 1.4 each of black and Hispanic women, 0.5 percent of Chinese women, and 0.1 percent of Japanese women. These differences were statistically significant.

Acculturation of immigrants is “a double-edged sword,” said at the annual meeting of the North American Menopause Society. It can improve socioeconomic status, access to health care, and attainment of higher education, but also worsen health through a less-nutritious diet.

In contrast to other minorities, Hispanic women in SWAN and similar studies tend to improve little or even worsen in terms of health once they are assimilated, she said. Watch for the “Hispanic paradox”: Health outcomes are worse among this population with increased acculturation, despite better socioeconomic status, because of factors such as higher rates of teen pregnancy and cigarette smoking, a director of the division of reproductive endocrinology and infertility, Albert Einstein College of Medicine, New York said.

She cautioned that the Hispanic population is heterogeneous and cannot be addressed as a single entity. The Hispanic SWAN participants came from many different countries and cultures and displayed some internal differences. For example, women from Puerto Rico were more vulnerable to acculturation and reported more menopause-related sleep problems and depressive symptoms than did other Hispanics.

Meanwhile, acculturation of Japanese women was associated with fewer menopausal symptoms than were seen in Hispanics. Similarly, Chinese participants reported fewer symptoms compared with white, black, and Hispanic women in SWAN.

“There are clear-cut differences in symptom reporting by ethnicity.”

Hispanic and black women were more likely to report depressive symptoms, and Chinese and Japanese women were less likely to do so. “This is confounded, possibly, by lower socioeconomic status in the African American and Hispanic groups and a higher socioeconomic status in Chinese and especially Japanese women.”

Black women in SWAN reported the most hot flashes proposed that increased adiposity among these women might provide more insulation and make them less heat tolerant. Black women, however, were less bothered by hot flashes, compared with Hispanic women, who reported more embarrassment with vasomotor symptoms.