Race, ethnicity may affect how women experience menopause, UT research says

By Mary Ann Roser/AMERICAN-STATESMAN STAFF
Saturday, July 31, 2010

How a woman experiences menopause in the U.S. might have a lot to do with her race or ethnicity, according to a recently published University of Texas study. White, African American, Hispanic and Asian women all report different experiences with their physical symptoms as well as their attitudes toward menopause — and culture is a big reason why, said lead researcher Eun-Ok Im, a UT professor of nursing.

But other factors, including biology, education, overall health and socioeconomic status, could be influential, according to the study published in July in the Western Journal of Nursing Research, as well as other research. “More in-depth cultural studies are needed to understand the reasons for the ethnic difference in menopausal symptom experience,” the paper says.

Im’s work is based on an Internet survey of 512 women in those four ethnic/racial groups between the ages of 40 and 60. It is part of a larger five-year study funded by a $1.2 million grant from the National Institutes of Health, Im said. In general, her team found that certain menopause symptoms bother some groups greatly; others, not so much. For example, hot flashes were cited as a symptom by 67.8 percent of African American women, 64.4 percent of white women and 52.5 percent of Hispanic women. Only 26.1 percent of Asian women reported having hot flashes.

Researchers don’t know why Asian women have fewer hot flashes, said Im, who is of Korean heritage. But ingesting soy products for years before menopause and generally having less body fat could be factors, said Dr. Margery Gass, a gynecologist and executive director of the North American Menopause Society, a nonprofit that educates the public and professionals about menopause.

Asians’ body mass index “is way below everyone else’s,” said Gass, who said Im’s paper was well-done and a welcome addition to the research on ethnic differences in menopause. Weight gain was cited as a menopause symptom by 54.6 percent of black women and 50.8 percent of Hispanic women in the study. It was mentioned by 45 percent of white women and 33.3 percent of Asian women in the paper. Declining interest in sex was cited more often by Hispanic and Asian women.

Overall, white women in the study were more likely to complain of menopause symptoms. Of the 41 listed symptoms, they cited 31 the most frequently, including neck and skull aches, racing heartbeat, ankle swelling, exhaustion or fatigue, difficulty sleeping, urination at night, feeling clumsy, depression, anxiousness, difficulty concentrating and grouchiness.There also were commonalities. Women, regardless of ethnicity, reported feeling hot or cold most often, with forgetfulness being the second most common symptom, the paper said.

Im published a paper in Nursing Research this year involving the same 512 women and their attitudes about menopause. Minority women, in particular, said their culture had discouraged them from complaining.
“As African American women, we are always expected to be strong women who aren’t supposed to whine about anything,” one black woman was quoted as saying. “You just take life as it comes and do what you have to do. If you are having troubles or problems, you should just pray about it and keep going. I don’t think that my culture believes that menopausal symptoms are something that you would have to run to the doctor.”

That paper said that the women in all four groups tried to see menopause as a natural part of life and face it with optimism and humor. Im said she was surprised to see that attitude showing up in most of the white women, who had in the past tended to see menopause as a dreaded loss of youth.Some gynecologists say they see that shift in their own practices.”The mindset has changed,” said Dr. Sherry Neyman, an Austin obstetrician/gynecologist for 14 years. More white women “would like to go through a more natural menopause and not seek drugs as a first line of therapy.” She sees that in patients of other ethnic groups, too.

The study says that only those with the most serious symptoms took medication and that most of the women managed menopause in other ways: “Interestingly, many NH (non-Hispanic) Asians adopted mind control strategies such as ‘trying to be optimistic’ and ‘trying to calm down’ to manage symptoms. “Im notes that because the study was based on Internet questionnaires, women with comparatively lower levels of income and education were underrepresented.

That makes it hard to generalize the results to the population, said Gass, the menopause society chief. But, she said, “this type of research certainly gives a very good idea of what is happening and alerts clinicians to the fact that various contextual items play a role” in how women experience menopause.

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