Summary
Several studies have reported racial/ethnicity differences in the prevalence of vasomotor symptoms (VMS), sleep disturbance and VMS treatment for menopause. In order to assess the reproducibility of these differences, recently Kingsberg et al. [1] systematically reviewed observational studies which were published between 2000 and 2021 and reported on the prevalence/incidence of VMS, sleep disturbance or treatment use in menopausal women stratified by race/ethnicity. The authors screened 3,799 records extracted from PubMed and Embase and included 27 papers (19 studies). Incidence data was not found. Prevalence data varied widely, but some common patterns emerged. In all five studies comparing VMS between Black women and White, Hispanic and/or East Asian women, the prevalence was highest in Black women and lowest in East Asian women. Overall, the prevalence of sleep disturbance was compared among Black, White and East Asian women in two study populations, and was highest in White women in both papers. Sleep disturbance was more common than VMS in East Asian women. In all four studies comparing hormone therapy use between White women and Black and/or East Asian women, treatment use was more common in White women. According to the findings the authors highlight the need for individualized counseling and treatment, outreach to under-served minorities, and for future studies the use of standardized definitions and outcome measures for VMS and sleep disturbance.
Commentary
The first thing that comes to my mind when reading the title of the article by Kingsberg and collaborators [1] if in fact there really are true differences in terms of ethnicity or perhaps it is a question of education and culture? Much research has been performed in relation to ethnicity and menopausal symptoms and deterioration of female quality of life. This article focuses fundamentally on hot flashes and sleep disorders, leading to interesting conclusions.
In one study from Argentina [2], the characteristics of the studied population was evaluated in relation to the same symptoms analyzed in the commented review. The authors of the Argentinian study found that all women were dissatisfied with their sleep, and presented insomnia, especially in the first years of menopause. When assessing the quality of sleep, it was verified that almost half of the studied women required medical attention for this problem; unfortunately, this study did not focus specifically on ethnicity. Contrary to this, a Colombian study, carried out by Monterrosa-Castro et al. [3], did take ethnicity into consideration when analyzing the prevalence of sleep problems in mid-aged women during the COVID-19 pandemic. In another study [4], some differences were observed in relation to ethnicity: Caucasian women showed the highest odds and Hispanic women showed the lowest odds of frequent awakenings, although interaction effects between ethnicity and the menopausal stage were not significant, coinciding with the results of the multiethnic study of Kravitz et al. [5]. In any case, although there are studies that take ethnicity into consideration when analyzing menopausal symptoms, not all compare the severity of VMS with sleep problems, and the use of menopause hormone therapy with focus on ethnicity.
As a final comment we can say that this systematic review [1] sheds new insights of the importance of the evaluation of menopausal symptoms and the individualization of treatment.
Take home key points
- It is very important to consider counselling menopausal women regarding their treatment in an individualized manner, taking ethnicity into account.
- There is a need for the design and development of randomized controlled studies in which ethnicity is taken into consideration.
Prof. Alejandra Elizalde-Cremonte, MD, PhD
Full Professor, Chair, Department of Women and Children, Faculty of Medicine, National University of the Northeast (UNNE), Corrientes, Argentina
Past President of the Latin American Association of Gynecological Endocrinology (ALEG)
President of the Association of Gynecology and Obstetrics of Corrientes, Argentina (AGOC)
Vice-President of the Argentinean Menopause and Andropause Society (AAMA)
Board Member of the Argentinean Federation of Societies of Gynecology and Obstetrics (FASGO)
Associate Member of the International Menopause Society (IMS)
References
- Kingsberg SA, Schulze-Rath R, Mulligan C, Moeller C, Caetano C, Bitzer J. Global view of vasomotor symptoms and sleep disturbance in menopause: a systematic review. Climacteric. 2023;26(6):537-549.
https://pubmed.ncbi.nlm.nih.gov/37751852/ - Valiensi SM, Starvaggi A, Folgueira A, Izbizky G, Pilnik S, Belardo MA. Calidad de sueño, síntomas depresivos y las otras cosas de la menopausia [Sleep quality, depressive symptoms and other menopause things]. Vertex. 2020;XXX(147):1-7.
https://pubmed.ncbi.nlm.nih.gov/33890922/ - Monterrosa-Castro Á, Monterrosa-Blanco A. Prevalencia de problemas de sueño en mujeres climatéricas colombianas durante la pandemia COVID-19. Rev Colomb Obstet Ginecol. 2021;72(2):162-170.
https://pubmed.ncbi.nlm.nih.gov/34506703/ - Baker FC, de Zambotti M, Colrain IM, Bei B. Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nat Sci Sleep. 2018;10:73-95.
https://pubmed.ncbi.nlm.nih.gov/29445307/ - Kravitz HM, Zhao X, Bromberger JT, et al. Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women. Sleep. 2008;31(7):979-990.
https://pubmed.ncbi.nlm.nih.gov/18652093/
If you would like to add a comment or contribute to a discussion based on this issue, please contact Menopause Live Editor, Peter Chedraui, at peter.chedraui@cu.ucsg.edu.ec.
