Race matters when prescribing hormone therapy for menopausal women

Michael Jackson may have sung "it don't matter if you're black or white," but when it comes to prescribing hormone therapy, it appears that race may definitely matter. That is according to a new study, presented at the 2023 Annual Meeting of The Menopause Society in Philadelphia September 27–30, that found even though Black patients have more menopause symptoms, they receive less treatment.

Women experience menopause differently with no two women having the exact same symptoms. Prior research has confirmed that menopause symptoms can vary by race, with Black women being known to have more severe hot flashes and other hallmark menopause symptoms than White women. The menopause transition can also be affected by psychiatric conditions which tend to worsen moods and severe hot flashes during the menopause transition.

A new study based on data gathered from nearly 66,000 midlife women (of which a high percentage were Black) sought to determine if there are racial disparities in the prescription of hormone therapy for menopausal Black women compared to White women with and without a psychiatric diagnosis.

Even though a large percentage of study participants were Black, there was a surprisingly low rate of documented menopause symptoms (11%) compared to prior reports of up to 80%. The researchers theorized that this low rate may be related to a lack of patient reporting, physician inquiry, or physician documentation of menopause symptoms.

"I had noticed for years that Black women were very quick to deny menopause symptoms unless specifically asked if they had X, Y, or Z symptoms and even less likely to admit that symptoms were interfering with daily life. This study really solidified what I had observed in clinical practice and that is that many Black women downplay and normalize menopause symptoms even when their quality of life is impacted," says Dr. Sally MacPhedran, co-author of the study and an associate professor in the Department of Reproductive Biology at Case Western Reserve University School of Medicine.

The data additionally confirmed that women with psychiatric conditions were more likely to have menopause symptoms than those without such a condition. Similarly, women with menopause symptoms were more likely to have a psychiatric condition than women without menopause symptoms. These results support prior reports that menopause symptoms and psychiatric conditions may independently exacerbate each other.

Additional data gathering showed that a higher percentage of women with both menopause symptoms and psychiatric conditions were prescribed hormone therapy compared to women with menopause symptoms who did not have psychiatric conditions. This could indirectly reflect a higher severity of menopause symptoms among psychiatric patients.

"Menopause education alone can help women feel like they are not going crazy due to the changes they are experiencing in their bodies or dismissing what they are experiencing because they think it is just another depressive or manic episode. This study is an example of the importance of psychology and gynecology working together to educate and treat peri- and postmenopausal women," adds Dr. Danette Conklin, lead author and assistant professor of psychiatry and reproductive biology at Case Western Reserve University School of Medicine.

Specifically, regarding the objective of the study, researchers found that overall, hormone therapy is being prescribed at low rates to menopausal patients across all patient groups. However, Black women with psychiatric conditions receive hormone therapy significantly less than their White counterparts. In fact, White women with psychiatric conditions and menopause symptoms were 40% more likely to receive a prescription for hormone therapy than Black women.

"This study reinforces that health care professionals must ask patients about their specific menopause symptoms so they can discuss the options that could help them improve their quality of life," says Dr. Stephanie Faubion, medical director for The Menopause Society. "Black women should have the same access as White women to the available treatment options."