Menopause and Ethnicity
As if you didn’t already know, your menopausal journey can be largely different from that of any other woman. Among the factors that can influence the types, frequencies, and severities of your menopausal symptoms, did you know that your ethnic background can play a large part?
Certain menopausal symptoms appear to be experienced more (or less) among women of different ethnicities. Understanding these differences can offer a liberating new perspective as you manage your symptoms. It can also help encourage culturally competent conversations between you and your healthcare team and result in more personalized advice. Even if you are not yet experiencing symptoms, it’s a good idea to make lifestyle changes now to head off the symptoms that may be most impactful based on your ethnicity. The investment in your health today will pay off down the road.
How Symptoms Vary Among Ethnicities
The Study of Women’s Health Across the Nation (SWAN) is a large, multi-site longitudinal, epidemiological study designed to examine the health of women during the midlife years. It began in 1994 and is still running today. The SWAN study is particularly important because previous research was limited mainly to Caucasian women of northwestern European descent.
The SWAN research initiative surveyed menopausal symptoms of more than 16,000 women of various ethnic backgrounds between the ages of 40 and 55 years. Women were asked about seven symptoms: hot flashes and night sweats, difficulty sleeping, forgetfulness, urine leakage, vaginal dryness, joint stiffness and soreness, and increased heart rate.
The SWAN research has found that:
Japanese and Chinese women reported less severity of all symptoms except for forgetfulness.
Hot flashes, night sweats, forgetfulness, and vaginal dryness were most frequently reported by African American women.
Vaginal dryness, urine leakage, forgetfulness, and increased heart rate were more likely to be reported by Hispanic women.
Increased age was positively associated with quality of life for white and black women, though not for Chinese, Hispanic or Japanese women.
In a separate research study, the median total duration of hot flashes was 7.4 years. Of note, women who were premenopausal or in early perimenopause when they first reported frequent hot flashes had the longest total duration of hot flashes – more than 11.8 years. Compared to other racial/ethnic groups, African American women had the longest duration of hot flashes, with about half experiencing hot flashes for more than 10 years. Hispanic had the second longest duration followed by Caucasian, Chinese, and Japanese women. For African American women, particularly those women who are slender, symptoms tended to start earlier and last longer than for other racial/ethnic groups.
A 2009 cross-sectional correlational study among 158 midlife women found that the most frequently reported symptoms during the transition into menopause differed by ethnicity as well.
Although the total number of early menopause symptoms didn’t differ significantly between ethnicities, the frequencies of feeling hot or cold, feeling tense or jumpy, hot flashes, frequent urination, and feeling grouchy did. As in the SWAN study, Asian women experienced the fewest symptoms, while African American women experienced the most. Brazilian women experienced more vasomotor symptoms (hot flashes and night sweats) than Western, Mexican, and Mayan women.
Age of Onset
Eighty-five percent of women reach menopause naturally between ages 45 and 55, which is diagnosed when you have gone 12 consecutive months without a period. When it comes to age of menopause onset, this seems to differ slightly between ethnicities as well. The average age of onset is 51 years old.
A 2008 study published in the American Journal of Epidemiology found that African American and Caucasian women experienced a similar age of onset, while Latinas and Native Hawaiians experienced earlier onset than Caucasian women. Japanese women experienced menopause later than Caucasian women.
Other research shows that African American women are more likely to undergo hysterectomy and begin surgical menopause, while early (age 40-44) or premature (before age 40) menopause is more likely among Hispanic women. However, another study of premature menopause found that African American and Hispanic women are more likely to undergo premature menopause.
The age at which you reach menopause is important because it’s believed that estrogen is protective for many parts of our body and health, including the heart, brain, and bones. The longer you have estrogen circulating in your body, the better off you are health-wise in the long-term.
Individualities within Ethnic Groups
The SWAN researchers concluded that menopausal symptoms are often generalized among ethnicities which, as you can imagine, isn’t always helpful.
For example, symptoms experienced by Hispanic women tend to vary greatly based on country of origin (e.g., Central and South American, Cuban, Puerto Rican, and Dominican).
Certain factors can vary within ethnic groups and influence individual symptoms, such as:
Body mass index (BMI) – your weight in relation to your height. A higher BMI is associated with worse hot flashes during the menopause transition but fewer hot flashes after menopause!
Age at first full-term pregnancy
Years of oral contraceptive use
Smoking status—smoking is the most significant environmental influence known for accelerating the age at menopause—it’s never too late to quit to improve your ovarian function and overall health
Age of first period
Income—women of higher income and educational status tend to have menopause later but not necessarily to have fewer symptoms
Religion—religious faith, or spirituality, appears to be a protection against worse menopausal symptoms
Country of birth
Stage of menopause—the late menopause transition—the time between 60 days without period up to one year without periods (after one year, a woman is defined as being postmenopausal)—is the time when symptoms are typically worse
Hysterectomy status—women with removal of the uterus and ovaries have worse and more prolonged menopausal symptoms
Understanding potential ethnic differences that can contribute to your unique menopause journey offers an important perspective for both you and your healthcare providers. You will be better prepared for when and how symptoms occur, risk factors for premature or early menopause, and when you might reach menopause. All good topics for you to talk to your healthcare provider about at your next women’s health checkup.
For more information on factors that can influence your menopause symptoms, and personalized support through your unique journey, join us at Lisa Health!
Dr. Nanette Santoro is a leading clinician and researcher in Reproductive Endocrinology. She is currently Professor and E Stewart Taylor Chair of Obstetrics & Gynecology at the University of Colorado School of Medicine. She also directed the Division of Reproductive Endocrinology at 2 medical schools: New Jersey Medical School and the Albert Einstein College of Medicine. She is the author of over 120 scientific publications and two books. Dr. Santoro’s major research interests include the reproductive endocrinology of premature, peri-, and postmenopause, infertility, and the physiology of gonadotropin-releasing hormone secretion. She has been involved with numerous large-scale industry- and government-supported clinical trials, including the Study of Women’s Health Across the Nation (SWAN), the Kronos Early Estrogen Prevention Study (KEEPS), and the Reproductive Physiology of Ovarian Failure, and is a co-editor of the Textbook of Perimenopausal Gynecology. Dr. Santoro received her medical degree at Albany Medical College and completed her residency at Beth Israel Medical Center and fellowship at Massachusetts General Hospital, Harvard Medical School.