An OB-GYN Talks About Health Equity and Menopause

Menopause is a nearly universal experience for middle-aged women. And most women will experience some physical, mental, and emotional changes in the years before and after the end of their menstrual cycles.

Although vasomotor symptoms, such as night sweats and hot flashes, are common in most women, their duration and severity vary by race and ethnicity. Cultural norms can also have a significant effect on how women experience menopause.

Read: Menopause symptoms are far from universal >>

“I had a Latina patient who was struggling to process what she was going through physically in terms of her hot flashes and night sweats, but she also felt like there was no one she could communicate what she was feeling emotionally to,” she said. Makeba L. Williams, MD, professor in the department of obstetrics and gynecology at Washington University School of Medicine in St. Louis. “She said her people were there for her when she had her babies, but no one talked to her about what to expect during menopause. She was almost afraid to tell her mother that she was thinking about hormone therapy because that was countercultural to her.”

As with other health conditions, racial, ethnic, and cultural disparities can make a difference in menopause care. We spoke with Williams about the connections between racial disparities in menopause and what women can do to ensure they receive care that meets their personal and cultural needs.

This interview has been lightly edited for clarity and length.

Healthy Women: What data is there on racial differences in menopausal symptoms?

Makeba L. Williams: In it SWAN study on women’s health., we found that African American women report having more hot flashes and night sweats. They get them more frequently and also for a longer duration — on average 10 years. That’s almost nine years for Hispanic women, 6.5 years for non-Hispanic white women, and even fewer years for Asian women.

Healthy Women: Do we know the reasons for these racial differences?

Makeba L. Williams: We don’t know what exactly drives them. But if we think about women’s health in the midlife transition in a holistic way, vasomotor symptoms like hot flashes and night sweats can be markers of cardiovascular disease. When we analyze who is most affected by cardiovascular diseases, we return to african american women. This connection leads to more overall disparities in the health of African American women.

Healthy Women: Living in neighborhoods with higher concentrations of air pollution and less green spaces may be associated with an earlier age at menopause. What could be the correlation between those factors?

Makeba L. Williams: We are still trying to understand how the environment affects the menopausal transition. Is there a direct relationship? Or is it one that is affected by other factors, where exposure to air pollution and less access to green spaces cause other conditions that lead to an earlier age at menopause? It is an area that needs to be explored, but we know that socioeconomic disadvantage, stress, caregiving responsibilities, and chronic exposure to racism and discrimination are associated with worsening symptoms. We see a lot of those factors in African Americans who have these disproportionate levels of menopausal symptoms.

Healthy Women: What other connections did the SWAN study uncover?

Makeba L. Williams: We saw high cigarette and tobacco use among African American women and less physical activity. Hot flashes and longer night sweats were associated with stress, lower educational level, anxiety, financial strain, low social support, obesity, smoking, and lack of a partner. There is still much we don’t know, as large numbers of women of color have been excluded from menopause research. We need to be more inclusive in our recruitment of diverse research populations to better understand what is driving these disparities.

See: HealthyWomen Congress Report: Women in Clinical Trials >>

Healthy Women: Can cultural frames of menopause affect women’s physical, mental, and emotional symptoms?

Makeba L. Williams: Culture can make a difference in what women reveal to others, what they talk about, and what is normative. White women could be more likely to seek treatment, while some women of color may feel like they have too many other things troubling them and don’t seek treatment. In the grand scheme of things, the thought might be, “Do I have time to worry about a hot flash or night sweat?” Or a small weight gain in my abdomen even though I’m exercising? We can also think about differences in body shapes, what bodies are celebrated in different communities, and how weight is distributed, meaning that weight gain might not be considered problematic in some non-white cultures. While 80% of menopausal women You will experience hot flashes and night sweats, the level of discomfort can be very different and what those symptoms represent can mean different things depending on cultures.

Healthy Women: In many Western nations, menopause is often described as a negative experience. Does that differ outside of Western contexts?

Makeba L. Williams: A common theme in the literature is that many Minority women perceive this transition as positive.. They have an accepting stance and laugh at their symptoms because they generally feel like they have all these other positive benefits of being in middle age and menopause. Many will feel liberated for the first time in their lives because they do not have some of the challenges associated with the reproductive period, such as pregnancy or bleeding. If you are African American and disproportionately affected by fibroids, when your period stops, you suddenly don’t worry about having to remember a second pair of clothes or alter your daily activities because you don’t know when your period might appear. Additionally, in many cultures, reaching a certain age and point of maturity comes with respect. There is a feeling that you have reached this vaunted stage in life.

Healthy Women: What is the best way to prepare for menopause, regardless of your cultural background?

Makeba L. Williams: Every woman deserves to have the best menopausal care. It might look like asking your healthcare provider for guidance about menopause in general. That might seem like defending and saying, “I know there are differences from person to person and how they experience menopause. Tell me more.” I hate to see women continue to suffer in silence because their mothers or aunts did it, and because their own health care provider won’t bring it up. I want patients to be free to seek information and then decide what to do. better for them.

This resource was created with the support of Astellas.

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