Race, ethnicity impact gastrointestinal symptoms during menopausal transition
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Race and ethnicity as well as menopausal status are significant factors that affect the number and severity of the gastrointestinal symptoms that midlife women experience, according to a study published in Menopause.
The researchers conducted the secondary analysis on data from a pair of internet-based studies on health issues among four major racial and ethnic groups of midlife women.
“As I was going through my own menopausal transition, I began to experience some gastrointestinal symptoms such as acid reflux that I didn’t have previously,” study author Eun-Ok Im, PhD, MPH, RN, CNS, FAAN, senior associate dean of research and innovation and the Edith Folsom Honeycutt Endowed Chair at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta, told Healio.
“I suspected there might be some linkages of menopausal transition to gastrointestinal symptoms and possibly racial/ethnic differences in gastrointestinal symptoms during the menopausal transition due to different diet and defecation practices, for example,” Im said.
The 1,051-woman cohort included 315 non-Hispanic white women (30%), 249 non-Hispanic Black women (24%), 255 Hispanic women (about 24%) and 232 Asian women (22%) between age 40 and 60 years (mean age, 48.96 years; standard deviation [SD], 5.68 years).
Also, more than 28% were premenopausal, 32% were perimenopausal and about 40% were postmenopausal. About 95% said they did not have any diagnosed gastrointestinal diseases, and more than 73% said their general health was good.
The researchers assessed the women to see if they experienced any of the nine gastrointestinal symptoms listed in the Midlife Women’s Symptoms Index and how severe those symptoms may have been. The mean total number of gastrointestinal symptoms per participant was 1.98 out of nine (SD, 1.79).
The most frequently reported symptoms included weight gain (44.3%), bloating (32.1%) and weight loss (26.9%). However, the total number of symptoms were significantly different among the four racial and ethnic groups (F = 13.05; P < .001). Asians had significantly lower mean total numbers of symptoms (1.37 ± 1.44 out of nine).
“I thought Asian American women might experience more gastrointestinal symptoms because of their spicy and salty diet, such as soy sources, but they were less likely to experience gastrointestinal symptoms in this study, which was different from my expectation,” Im said.
“However, since Asian women, reportedly, are less likely to report their symptoms and rarely express their symptoms and pain to others, this finding might need to be carefully interpreted,” Im said. “Also, more studies are warranted to confirm this finding while considering other factors because many factors might not be included in this study due to inherent limitations of a secondary analysis.”
The researchers also found significant differences in the frequencies of nausea/vomiting, diarrhea, constipation, weight loss, weight gain, bloating and heartburn between the racial and ethnic groups. However, they found no racial or ethnic differences in the frequencies of stomach pain or loss of appetite.
While the mean total severity score for symptoms among all participants was 5.67 out of 36 (SD, 6.01), there were significant differences in the mean total severity scores by racial and ethnic group (F = 13.44; P < .001).
Asian women had significantly lower total severity scores (3.68 ± 4.48 out of 45) and white women had higher total severity scores (6.63 ± 6.72 out of 45) compared with the other groups (all pairs, P < .001). There also were significant differences between the groups in their severity scores for nausea and vomiting, diarrhea, constipation, loss of appetite, weight loss, weight gain and bloating.
White women had higher severity scores for nausea and vomiting (0.78 ± 1.47), diarrhea (0.84 ± 1.5), constipation (0.63 ± 1.35) and loss of appetite (0.38 ± 0.1) compared with the other groups. Hispanic women were more likely to have higher severity scores for constipation (0.65 ± 1.44), weight gain (1.57 ± 1.66) and bloating (1.28 ± 1.67). Black women were more likely to report higher severity scores for weight loss (0.71 ± 1.08).
The total number and severity scores of symptoms were significantly different across the premenopausal, perimenopausal and postmenopausal stages for all symptoms except for weight loss (all, P < .001). Also, the total number and severity scores increased through the menopausal transition in Hispanic, white and Black women, though these scores peaked in the perimenopausal period and decreased in the postmenopausal period for Asian women.
Premenopausal status was the strongest factor influencing the total number of symptoms and total severity scores of symptoms in all participants when all covariates were controlled.
“When controlling for covariates, only menopausal status was significantly related to the total numbers and total severity scores of GI symptoms in all racial/ethnic groups, and the total numbers and total severity scores of GI symptoms were the highest in the postmenopausal period except in Asian women,” said Im.
This finding may be because the prevalence and severity of GI symptoms may increase as aging process progresses, although Asian women showed a different pattern of GI symptoms, Im said.
“This finding might need to be interpreted in the same line of thought related to the specific symptoms that reportedly increase during the post-menopausal period, such as sleep complaints, vaginal dryness and cognitive symptoms,” Im said.
The researchers concluded that race and ethnicity and menopausal status were significant factors influencing the total number and severity scores of gastrointestinal symptoms among midlife women, though they added that more in-depth studies are needed on specific types of symptoms, racial and ethnic differences and cultural influences with more diverse groups of participants.
“Although further studies are needed, doctors need to be aware of possible racial/ethnic differences in GI symptoms that are experienced during menopausal transition and need to consider multiple influencing factors that might cause racial/ethnic differences in GI symptoms, such as psychological symptoms including depression and symptom perception,” Im said.
Doctors also need to be aware that GI symptoms in general, except Asians in this study tend to increase as aging progresses throughout the menopausal transition, Im continued.
“Finally, doctors may need to consider possible influences of cultural factors such as cultural dietary patterns and practices and defecation practices on GI symptoms during the menopausal transition, although these need to be proved through further studies,” Im said.
“My research team is thinking of developing and pilot-testing a technology-based intervention that assists middle-aged women in menopausal transition to effectively manage GI symptoms after identifying risk groups among them through further analyses,” Im said.
Reference:
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I was surprised to see such statistically significant differences in the Asian women group compared with the other racial groups reported. This study further supports past observations that the menopausal transition, likely through hormonal changes, can trigger or influence GI symptoms.
I see many women in clinic who experience new or worse symptoms of functional bowel disease, including symptoms of bloating, abdominal pain or bowel habit changes, that seem to correlate with timing of the menopausal transition. I have not noticed the ethnic differences in GI symptoms, but that is harder to assess at a clinic level.
Women frequently don't realize that their new or worsening GI symptoms may be related to their menopausal transition and hormonal changes. So, they often get the basic workup, which may include labs, imaging and endoscopy. But when all those things are unrevealing, women are often told that nothing is wrong with them and that their providers don’t know what is causing their symptoms. This can leave women feeling confused and worried that something more serious is being missed. Sometimes, this can lead to worse GI symptoms through the brain-gut interaction.
It’s important to educate patients on how their GI symptoms may be related to the menopausal transition and that related hormonal changes can alter GI motility and visceral sensitivity, which can then lead to GI symptoms. This can help the patient understand the cause of her symptoms, and this reassurance can be therapeutic in and of itself. Then patients can potentially avoid more unnecessary testing or procedures and move on to therapies that can treat their symptoms.
There are many questions in this area for which we still don’t have clear answers. For example, how long do the GI symptoms last? What is the natural progression of GI symptoms related to the menopausal transition? Will the symptoms gradually improve or resolve with time? Does hormonal therapy or other therapies help with treating these GI symptoms? Research to further clarify these questions would be helpful in guiding clinical care.
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