Chicago—How women experience hormone replacement therapy for symptoms of menopause appears to vary significantly by race, according to a new study.

The report in Menopause suggested that white women—the most likely users of the therapy—also appear to accrue the most benefit and report quality-of-life (QoL) improvement.

The results were from the Study of Women’s Health Across the Nation (SWAN), a longitudinal, epidemiologic study seeking to understand how the physical and social changes experienced by women in mid-life and older affect their health and well-being as they age. One factor is experiences during menopause, such as hot flashes, night sweats, vulvovaginal discomfort, and urinary issues.

The University of Chicago (UChicago)–led researchers examined data compiled from surveys of women about menopause symptoms and treatment options, including hormone therapy (HT), complementary alternative medicine treatments, and no treatment at all.

While white women on HT often said they experienced better QoL when compared with white women who did not use any treatments, black and Hispanic women reported the lowest rates of HT use. In fact, black and Chinese women who used HT actually reported reduced QoL compared with those who used no treatments, according to the study.

“The results really highlight the differences in preferences between women of different races,” stated lead author Monica Christmas, MD, associate professor of obstetrics and gynecology, director of the Center for Women’s Integrated Health, and director of the Menopause Program at UChicago Medicine. “In particular, we saw that most of the non-white women in our study really preferred integrative complementary alternative medicine or things like lifestyle modifications over prescription therapy for managing their symptoms.”

While embarking on the research, the study team hypothesized that—among midlife women with vasomotor and/or genitourinary symptoms of menopause—HT compared with complementary alternative medicine (CAM) would be associated with a higher QoL, and race/ethnicity would modify associations of HT and CAM with QoL.

To test that, the researchers conducted cross-sectional and longitudinal analyses of the QoL in the SWAN participants using HT, CAM, or both. More than 2,500 women completed a CAM use questionnaire and QoL assessments at baseline, and additionally every 1 to 2 years from 2002 to 2013.

During 7.8 (standard deviation [SD], 2.9) years of follow-up, 732 women (29%) reported HT of 2.4 (SD, 1.7) years, and 798 women (32%) reported CAM use of 2.1 (SD, 1.4) years.

“Overall, neither HT nor CAM was associated with QoL,” the authors noted. “However, the treatment-by-race/ethnicity interaction was significant for self-reported QoL (P = .034 at baseline, P = .044 longitudinal). Among white women, self-reported QoL was higher in HT-only users than in those who used neither (P = .030; d = 0.11; 95% CI, 0.01-0.21). In contrast, black women using HT only had lower self-reported QoL compared with black women using neither (P = .027; d = –0.21; 95% CI, -0.40 to -0.02).”

The researchers found that comparisons between treatment types within each racial/ethnic group put the spotlight on significant differences in self-reported QoL. “Clinicians should be aware of racial/ethnic differences in treatment preferences when counseling patients on treatment options for menopausal symptoms to provide optimal care,” the researchers advised.

The authors suggested that patterns in how physicians tend to prescribe HT might have an effect on outcomes, as well as cultural differences in preferences.

“Some studies have shown black women are given hormone therapy prescriptions for managing their menopause symptoms at a lower frequency than white women,” Dr. Christmas stated. “Some of that may also be due to medical comorbidities, putting those patients at higher risk for complications or side effects with hormone therapy, but some of it may also be related to unconscious racial biases, where physicians don’t think that black women’s symptoms are as serious or uncomfortable.”

The study noted that more culturally sensitive care for women experiencing menopause could make a difference.

“Clinicians need to recognize that culturally sensitive care is imperative to overall success in treating patients,” stated Dr. Christmas. “It was very surprising to find that black women reported lower quality of life in response to hormone therapy. Black women tend to experience more frequent and severe menopause symptoms for a longer duration than white women, so my instinct as a physician would be to encourage a black patient reporting hot flashes and discomfort to consider hormone therapy—but these results indicate that more education around the short and long-term benefits of hormone therapy is needed.”

Dr. Christmas added that women need better information about HT compared with complementary and alternative approaches, explaining, “Hormone therapy has been found to be the most effective treatment in treating vasomotor and genitourinary symptoms associated with menopause. In addition, to counseling around proven benefits of hormone therapy, counseling on complementary alternative approaches is warranted as well. There is a misconception that because something is herbal it is good for you. Many patients are surprised to learn that many of the common herbal treatments advertised to treat menopausal symptoms were not better than a placebo and can be associated with adverse side effects. We really need more research to determine what is underlying these differences in treatment uptake, so that we can help patients navigate the menopause transition and best treat symptoms to optimize quality of life and overall health.”

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