Vasomotor symptoms (VMS), or hot flashes and night sweats, are often considered a major symptom associated with menopause. However, according to a recent study, VMS shows pronounced racial/ethnic variations. Dr. Siobán D. Harlow, a reproductive epidemiologist and one of the authors of the study tells SheKnows that on average, hot flashes last about six and a half years for White women and about 10 years for Black women. “We sat that the burden for VMS is higher for Black and Hispanic women,” she says.
“From premenopause to the early perimenopause and menopause to the post-menopausal period, we see that burden at every stage of reproductive aging. They are also more likely to report hot flashes and more likely to experience frequent hot flashes.” She notes that Black women are 60% more likely to have frequent or bothersome hot flashes compared to their White counterparts. There has been a lot of research done on this topic, and women’s reproductive health since the study came out in 2022, but a lot more needs to be done, especially as it relates to women of color, who have historically not received the proper medical they deserve.
The impact of VMS
There were also symptom variations across different ethnic groups of Hispanic women, with the highest rates of VMS reported among Central American women. The study outlined the association between VMS and quality of life, particularly how VMS impacts mood, sleep, and cognitive function (it’s important to note that Black women are less likely to self-report sleep problems but more likely to have objectively measured poor sleep quality). Unsurprisingly, VMS had a negative effect on all of these life aspects. But despite their worse symptoms, depression, and sleep disturbances included, they are less likely to receive hormone therapy, as well as medical and mental health services.
Why are there racial/ethnic differences in VMS?
We don’t fully understand why there are these racial/ethnic differences in VMS. A different study from The National Library of Medicine calls out the cultural variations in how women experience, interpret, label, and report VMS to others may also play a role in observed racial/ethnic differences in VMS. However, when doing the initial study, researchers evaluated the differences in the menopause transition of Black and White women using socioeconomic characteristics, everyday discrimination, and life stressors.
“It is clear that discrimination and structural racism play an important role in health broadly but getting the full story is difficult. It’s putting each of the little pieces together and understanding the overall picture—how do we integrate and understand the difference in the experience of the menopausal transition as a whole.” Dr. Harlow states.
Progress and research have come a long way
Dr. Harlow started the cohort study in 1996, which she calls out was a time in which there was very little research on menopause at all. “What was there, only pertained to White women,” she tells SheKnows. “The belief was that they lasted two years so there had been an overall lack of data. It’s only recently, into the early 2000s, that we’re getting a better understanding of both the average and the variability in the experience of menopause and its related symptoms.”
She adds, “The research today shows life context factors that are more prevalent in Black women than White women. This includes lower education level, higher financial strain, higher stress, and increased probability of stressful life events. All of those factors increase your risk of VMS. But even when we take into account those factors, it doesn’t fully explain the disparity that we see in the probability of having hot flashes. So there’s something more to know.”
But there’s still more to learn
Although progress has been made, as Dr. Harlow notes above, there is still more to know and learn. “It’s also true that in the 90s, there was nothing for minoritized populations and Black women. There continues to be less, so it is relatively recent that we’re getting the quantitative evidence, which is important to change focus and direct attention to these issues.”
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What does the future look like for research in this field?
“There’s still a lot we do not understand about why women have hot flashes and why some women don’t,” Dr. Harlow says. “Our studies haven’t really categorized the different physiological experiences that women have or the severity.” What Dr. Harlow hopes to better understand down the road is what distinguishes a low-level hot flash from a bothersome hot flash. She adds, “We also need to understand what’s provoking the hot flashes 10 years before menopause. We need to do more work looking at other physiological factors, such as cardio-metabolic changes or differences in premenopause, hypertension, and glucose levels. Lastly, we need to improve our measurement of hot flashes and study the non-reproductive endocrine physiologic signals for the hot flash onset and severity.”
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