Can Ethnic Background and Lifestyle Affect Menopause?

From the WebMD Archives

Sept. 6, 2000 -- A new study suggests that midlife women are not all in the same boat when it comes to those common and often annoying side effects of menopause. In fact, it may be that symptoms of midlife changes, including hot flashes, night sweats, and forgetfulness, are more or less likely depending on a woman's lifestyle and ethnic background.

In addition, researchers found that the intensity of those symptoms is likely to vary from the early stages, or perimenopause, that time of hormonal change before and after menstruation stops, to the later phases, known as postmenopause. Results of the study appear in the September issue of the AmericanJournal of Epidemiology.

The number of women going through menopause in the U.S. is expected to double by the year 2025. Until now, many women's health providers believed that all women have similar body processes and similar midlife symptoms.

Not so, according to study author Ellen B. Gold, PhD, an epidemiologist and professor of epidemiology and preventive medicine at the University of California, Davis Medical Center in Sacramento. Gold and her team found, for instance, that women who stopped smoking and were physically active reported lower frequency of symptoms.

And "for women facing midlife, the findings mean that most women will experience the greatest symptoms during the perimenopause but that these will decline somewhat postmenopausally, although perhaps not to premenopausal levels," Gold tells WebMD.

The results came out of the first phase of the Study of Women's Health Across the Nation, known as SWAN. In surveys distributed to more than 16,000 women in seven areas of the U.S., women of five ethnic groups were asked about several symptoms such as hot flashes or night sweats, leakage of urine, vaginal dryness, joint stiffness/soreness, heart pounding or racing, forgetfulness, irritability, tension, and difficulty sleeping. African-American, Japanese, Chinese, Hispanic, and Caucasian women were represented in the study.

As for the variation of symptoms based on race and ethnicity, researchers found that all symptoms except forgetfulness were less frequently reported in Japanese and Chinese women when compared to white women. African-American women were more likely to experience hot flashes or night sweats and vaginal dryness when compared to white women, but they were less likely to report urine leakage or sleep problems.

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On the other hand, Hispanic women were more likely to report urine leakage, vaginal dryness, heart pounding, and forgetfulness when compared to white women.

Although symptoms were reported more frequently among women as they aged, Gold writes: "The prevalence of most symptoms varied more by menstrual status than by age." They were also reported more frequently in women who smoked, had financial problems, or engaged in less exercise.

Gold says the results carry important preventive implications and add further reasons for all women to make positive lifestyle changes.

"This study found that women who exercise more and smoke less have fewer symptoms, and that's an important difference," Sherry S. Sherman, PhD, tells WebMD. "We're delighted about the progress that is being made in women's health." Sherman is director of clinical endocrinology and osteoporosis research at the National Institute on Aging in Bethesda, Md., and is the project director of SWAN. She says the study is helping to broaden the understanding of symptoms of menopause among different women.

"Before SWAN, most of the information was obtained from white women of northwestern European descent and was very, very limited," Sherman tells WebMD. "This population-based study helps us understand just what are the real symptoms of menopause and which are aging symptoms, and how symptoms differ by ethnicity."

But Rogerio A. Lobo, MD, says the conclusion that different ethnic groups have different symptoms is not a new finding at all. "There are about six or seven papers from around the world all showing the same thing," he tells WebMD. "The only thing that is new is that these were all U.S. women." Lobo is chairman of the department of obstetrics and gynecology at Columbia University in New York and also directs its Center for Menopause.

Lobo says he does not think the study will have much impact on the clinical treatment of menopause. "Basically, the prescription for medications like hormone replacement is driven by [symptoms]," he says. "If a woman comes in and tells me she's symptomatic ... she may be a candidate for various treatments."

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