‘A patient came to see me for a second opinion regarding HRT. She had seen a doctor regarding her menopausal symptoms and was told that she did not need HRT because she was black’.
…Myth or Truth?
The experience of the perimenopause and menopause by women of ethnic minority groups is complex involving an interplay of a number of different factors. These include differences in hormonal changes around this time, personal attitudes and perceptions (shaped by culture, race and ethnicity), psychological factors, as well as socioeconomic factors. It is important to mention that there is limited research evidence available in this group of women in the UK and so most has been obtained from overseas studies.
There are differences in biological and hormonal changes in women of different races and ethnicities which means that they are likely to experience the perimenopause and menopause differently. For example, Chinese and Japanese women experience longer menstrual cycles than Caucasian women during menopause, whilst Afro-Caribbean and Hispanic women ovulate less in the last year before the final menstrual period compared to women of other races.
In women of Afro-Caribbean origin
- The mean age of natural menopause is 49.6 years
- Women experience a longer peri-menopause
- They have the highest prevalence and longest duration of hot flushes and night sweats and they are also more likely to be severe
- They are more likely to experience shorter sleep duration, more frequent sleep awakenings and less efficient sleep
- Weight gain and mental health issues may be prominent
- They display a smaller decline in sexual function and report a greater importance of sex
In South-east Asian women (e.g., China, Japan)
- Women may not complain of severe hot flushes and night sweats
- Chinese and Japanese women may report a lower importance of sex and suffer more from low libido and sexual pain
- They may suffer more from forgetfulness, joint and muscle pains
In South Asian women (e.g., India, Pakistan, Bangladesh, Sri Lanka, etc)
- The average age of menopause in Indian women (living in India) is 46.7 years
- The mean age of menopause for Pakistani women is 47.16 years
- Indian women may complain more of genital and bladder symptoms
- There is a higher incidence of risk factors for heart disease during the perimenopause, such as insulin resistance, diabetes or pre-diabetes, high blood pressure, high cholesterol, and central obesity
An important consideration is that gender and racial discrimination, socioeconomic factors can lead to chronic stress and have long term health implications that may cause women to have more severe menopausal symptoms and a longer perimenopause.
The answer….It’s a Myth!
Reference: Menopause in Ethnic Minority Women; British Menopause Society; June 2023