Menopause Experience Differs by Ethnic Group


LAKE BUENA VISTA, FLA. — Menopause symptoms vary significantly by ethnic group, based on data emerging from a longitudinal study.

The acculturation of women immigrants to the United States, as well as their socioeconomic status, are two factors that might account for these differences, said Dr. Nanette F. Santoro, an endocrinologist who has coauthored multiple studies based on data from the Study of Women's Health Across the Nation (SWAN).

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 one ethnic minority group: black, Hispanic, Chinese, or Japanese. More than 10 years later, about 85% of the participants remain in the study.

“We found differences by ethnicity—very intriguing differences,” Dr. Santoro said.

For example, in one study of 11,652 women from SWAN, Dr. Santoro and her colleagues found that 126 participants (1.1%) reported onset of menopause before age 40 years, a condition known as premature ovarian failure (Human Reprod. 2003;18:199–206). This occurred in 1.4% of both black and Hispanic women, 1.0% of white women, 0.5% of Chinese women, and 0.1% of Japanese women. (See bar chart.)

These differences were deemed statistically significant.

Acculturation of immigrants is “a double-edged sword,” Dr. Santoro 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 at the same time can 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 to 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, said Dr. Santoro, director of the division of reproductive endocrinology and infertility at Albert Einstein College of Medicine, New York.

She cautioned, however, 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, the 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,” Dr. Santoro said.

Hispanic and black women were more likely to report depressive symptoms, and Chinese and Japanese women were less likely to do so, the study found.

“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,” she said.

Black women in SWAN reported the most hot flashes. Dr. Santoro 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 than were Hispanic women, who reported more embarrassment with vasomotor symptoms.

SWAN is supported by grants from the Department of Health and Human Services.


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