Ovarian Aging and Hormone Replacement Therapy Hormonal Levels, Symptoms, and Attitudes of African-American and White Women

Abstract

OBJECTIVES:To characterize reproductive hormone levels, symptoms, and attitudes related to menopause among healthy, menstruating white and African-American women aged 44 to 49 years. DESIGN: Pilot study; cross-sectional survey. SETTING:Community-based convenience sample of women in the Philadelphia metropolitan area. PARTICIPANTS:Thirty-three African-American and 35 white women. MEASUREMENTS:The survey instrument collected demographic data, medical and reproductive history, health practices and behaviors. It included previously validated function, depression, and quality-of-life instruments, and a Menopause Attitude Scale that included two factors, attitudes toward the menopause and attitudes toward medical therapy. Anthropometric measurements were taken at enrollment, and reproductive hormones and daily symptom logs were followed over two menstrual cycles. MAIN RESULTS:The two groups were comparable in mean age (African-American 46.2 years, white 46.9 years). Serum levels of estradiol, follicle-stimulating hormone, dihydroepiandrosterone-sulfate, and progesterone were comparable. Symptoms were similar in type and frequency. However, the African-American women had significantly more positive attitudes toward menopause, were more likely to rely on family for information about menopause, and were less likely to have been recommended hormone replacement therapy by their physicians. A majority of women in each group expressed satisfaction with the care they had received. he decline of ovarian function among women in their thirties and forties has been implicated in the development of physiologic changes that are widely observed a decade later, including body mass and composition, osteoporosis, cardiovascular disease, and psychological distress. Existing data regarding normal reproductive aging derive primarily from white, reproductive-age women with infertility, 1 postmenopausal women, 2 or small clinical samples of women seeking medical treatment. 3,4 It is not known whether the pattern of hormonal changes are similar in African-American and white women. African-American women have higher rates of obesity, cardiovascular disease, and stroke, 5,6 but lower rates of osteoporosis and vertebral or hip fractures. 7,8 Several studies have shown that menopausal symptoms vary across cultural groups 9,10 and socioeconomic strata 9,11,12 and can be linked to differing societal attitudes toward women's changing roles during and after menopause. [13][14][15][16][17][18][19][20] The overall prevalence of affective disorders is slightly less in African-American women than white women, 21 and postmenopausal African-American women are less frequently diagnosed with depression. 22 Similarly, attitudes toward hormone replacement therapy (HRT) might vary among cultural groups. Most recent investigations of HRT use have involved primarily white women. [23][24][25][26][27][28][29][30][31] The aims of this preliminary study were to assess the physiologic and clinical characteristics of healthy premenopausal African-American and white wo...

Ethnicity and Vasomotor Symptoms in Postmenopausal Women

“…Study findings that include women in all phases of menopause are conflicting. 8,9,13,[41][42][43] Two large surveys of multiethnic, perimenopausal and postmenopausal women found similar differences in menopausal symptoms by race. A cross-sectional survey of nearly 15,000 multiethnic women, ages 40-55 years, found that African American women were significantly more likely to report vasomotor symptoms than white women and that women in the perimenopausal and postmenopausal periods were more likely to note vasomotor symptoms than those who were premenopausal.…”

“…White women were also more than twice as likely to note that their provider inquired about their symptoms compared with African American women (51.4% vs. 21.2%). 43 Our study had a relatively small sample size and included postmenopausal women of moderately high socioeconomic status who volunteered to participate in a randomized clinical trial to evaluate the effect of soy intake on lipid levels as well as menopausal symptoms. Thus, generalizability is limited.…”

Health advantage for black women: patterns in pre-menstrual dysphoric disorder

“…Moreover, culture is associated with attitudes toward menopausal symptoms and perceptions of impairment. Blacks generally espouse more positive attitudes toward menopause than whites (Standing & Glazer, 1992; Pham et al . 1997), and do not see their symptoms as impairing or disruptive to their functioning (Im et al .…”

The menopausal experience-confounding factors

“…4,6,7 For example, a study of white and African American women reported that African American women had a more positive perception of menopausal changes where cessation of menses brought relief from worrying about the burden of pregnancy. 4,8 Conversely, white women perceived menopause to be a medical problem for which they should seek medical treatment. 4 Clearly, multiple psychosocial, physical, and cultural factors can be powerful determinants of how women perceive and experience the menopausal transition.…”