HMN 2025: How Rural women face tougher time with menopause

Menopausal and postmenopausal women who live in rural areas reported more mood swings, muscle and joint pain, vaginal dryness and urinary problems than their urban counterparts, a study has found. study published this month in Menopause.

This is one of the first studies to examine how menopause, generally defined as the end of menstruation, might affect women based on where they live, their socioeconomic status and their access to health care. health, noted lead author Dr. Susan Reed of the UW. OB-GYN medicine and expert in menopause and its treatments.

“I wasn’t really surprised by our results,” she said, “because we know that there are significant differences in other health outcomes based on urban or rural residence.”

While many studies have focused on rural health as it relates to cardiovascular disease and suicide risk, little to no research has been conducted on postmenopausal women in rural areas, Reed suggested.

“We also found differences in menopause knowledge, treatment choices and experiences, depending on where they live,” she said.

Ideally, women should be able to turn to their healthcare providers for information about menopause and treatment options such as menopausal hormone therapy, in which patches, pills or vaginal rings increase estrogen levels patients.

Often, study respondents noted, their health care providers did not offer hormone replacement therapy as an option.

Sometimes it’s a question of distance.

Erin Dwyer, lead author of the study and a third-year medical student in Montana, said seeking help for menopause can be logistically and emotionally daunting.

If a patient has to drive more than an hour to see a specialist, their likelihood of making an appointment drops significantly, researchers found, in the face of competing priorities like work and child care.

“Some patients have to drive more than an hour for a 15-minute appointment,” said Dwyer, who designed the study.

The online survey of 1,531 respondents in 2019 showed that rural women experience a greater psychological and physical burden than their suburban and urban counterparts.

“These differences in menopausal symptoms could be linked to occupation, lower socioeconomic status, higher rates of obesity and mood disorders, and reduced access to health care. postmenopausal genitourinary health among predominantly white rural women,” the authors wrote.

Part of the disparity in care lies with the providers themselves, who may not have discussed hormone replacement therapy or menopausal symptoms with their patients, Dwyer said.

The researchers also found that many women were using alternative therapies, such as over-the-counter herbal and vitamin supplements, and that a significant number were foregoing hormone therapy or were unfamiliar with it. with the treatment option, Reed said.

Only 11% of respondents, regardless of location, reported using hormone replacement therapy, the authors noted, despite a significant number of respondents reporting currently experiencing hot flashes.

The authors proposed several theories as to why this would be the case.

“A lot of women were afraid of the risk, or that it would significantly increase the risk of developing cancer, which is not the case for those who don’t have a uterus,” Reed added. taking note of ongoing studies.

For women who have not had a hysterectomy, the risk, although low, varies depending on the hormone treatment they receive. However, the study found that this conversation did not occur between the patient and provider.

Other women, particularly those in rural areas, said they decided to “tough it out” rather than seek treatment for their symptoms, Reed said.

Whether it’s a harsh approach or fear of the potential risks of hormone therapy, the long-term effects of inaction on a woman’s health can be significant, Reed said.

“One example is women who suffer from severe hot flashes for many years. In recent studies, we see higher associations with cardiovascular disease as well as with changes in biomarkers this may suggest a higher risk of dementia,” she said.

“Mid-life interventions to improve menopause care among rural women could potentially reduce health disparities between rural and urban/suburban women. Education about the risks and benefits of interventions, particularly menopausal hormone therapy…should be tailored to rural women, as our results suggest different uses of healthy aging resources by residence,” the authors concluded.

Reed called the cross-sectional survey a starting point for answering “bigger questions” about how to improve care among underserved women’s communities.

The survey was organized by the nonprofit Health Women and WebMD. Responses came from all 50 states.