The influence of ethnicity on the symptoms of post-reproductive women

Romana Belešová *, Valérie Tóthová
University of South Bohemia in České Budějovice, Faculty of Health and Social Sciences, Institute of Nursing, Midwifery and Emergency Care, České Budějovice, Czech Republic

Korespondenční autor: Romana Belešová (

ISSN 1804-7181 (On-line)

Full verze:
Full version

Submitted:14. 3. 2022
Accepted: 1. 6. 2022
Published online: 30. 6. 2022


Theoretical basis: The menopause is a period in women’s lives when their ability to reproduce decreases, and as it gradually ends, women move into the so-called post-production phase. In this transitional phase, women are at risk of developing various symptoms, which are affected by more factors than only a deficiency of ovarian hormones (estrogens). Many recent international studies have shown the influence of other factors on women‘s health during this period, such as the family environment, interpersonal relationships, employment, and ethnic and cultural aspects.

Goal: The literature review is devoted to the research of published studies dealing with the influence of ethnicity and culture on the occurrence of symptoms and health of women in the post-reproductive phase of their lives.

Methods: We searched for the included studies using the method of content analysis. The scientific databases focused on women’s health, and studies published between 2017 and 2022 were found in databases such as PubMed, Scopus, ScienceDirect, and EBSCO. We used the keywords “ethnicity”, “menopause”, “symptom”, “influence”, “woman”, and the Boolean operator “AND”. The content analysis took place from January to February 2022. After checking the eligibility and relevance of studies, we included and analysed eight articles.

Results: It is clear from the literature review results that ethnic and cultural factors are involved in vasomotor, somatic, and cognitive symptoms in women with estrogen deficiency.

Conclusions: The information obtained can be helpful, and used in providing individual holistic care to women of different ethnicities in both primary care and inpatient health facilities.

Keywords: Culture; Ethnicity; Factor; Influence; Menopause; Symptom; Woman


1. Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, et al. (2005). Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20(2): 185–194. DOI: 10.1359/JBMR.041007.

2. Bell RJ (2013). Cross-cultural studies of menopause: the challenge continues. Menopause. 20(11): 1107–1108. DOI: 10.1097/GME.0b013e3182a­346a2.

3. Bergström I, Freyschuss B, Landgren BM (2005). Physical training and hor-mone replacement therapy reduce the decrease in bone mineral density in perimenopausal women: a pilot study. Osteoporos Int 16(7): 823–828. DOI: 10.1007/s00198–004–1758–3.

4. Brown DE, Sievert LL, Aki SL, Mills PS, Etrata MB, Paopao RN, James GD (2001). Effects of age, ethnicity and menopause on ambulatory blood pressure: Japanese-American and Caucasian school teachers in Hawaii. Australas Mark J 13(4): 486–493. DOI: 10.1002/ajhb.1080.

5. Cauley JA (2011). Defining ethnic and racial differences in osteoporosis and fragility fractures. Clin Orthop Relat Res 469(7): 1891–1899. DOI: 10.1007/s11999–011–1863–5.

6. Čepický P (2011). Gynekologická endokrinologie [Gynaecological endocrinology]. In: Roztočil A, et al. Moderní gynekologie [Modern gynaecology]. Praha: Grada, pp. 66–94 (Czech).

7. Chapurlat RD, Garnero P, Sornay-Rendu E, Arlot ME, Claustrat B, Delmas PD (2000). Longitudinal study of bone loss in pre-and perimeno-pausal women: evidence for bone loss in perimenopausal women. Osteoporos Int 11(6): 493–498. DOI: 10.1007/s00198­0070091.

8. Dalal MS, Agarwal M (2015). Postmenopausal syndrome. Indian J Psychiatry 57(Suppl. 2): 222–232. DOI: 10.4103/0019–5545.161483.

9. Dostál J, Turková M (2017). Perimenopauza a postmenopauza [Perimenopause and postmenopause]. In: Pilka R, et al. Gynekologie [Gynaecology]. Praha: Maxdorf, pp. 65–75 (Czech).

10. El Khoudary SR, Greendale G, Crawford SL, Avis NE, Brooks MM, Thurston RC, et al. (2019). The menopause transition and women’s health at midlife: a progress report from the Study of Women’s Health Across the Nation (SWAN). Menopause 26(10): 1213–1227. DOI: 10.1097/ GME.00000000000­01424.

11. Fait T (2013). Klimakterická medicína [Menopausal medicine]. 2nd ed. Praha: Maxdorf, 120 p. (Czech).

12. Gold EB, Colvin A, Avis N, Bromberger J, Greendale GA, Powell L, et al. (2006). Longitudinal analysis of vasomotor symptoms and race/ethnicity across the menopausal transition: Study of Women’s Health Across the Nation (SWAN). Am J Public Health 96(7): 1226–1235. DOI: 10.2105/ AJPH.2005.066936.

13. Gonçalves, JTT, Silveira MF, Campos MCC, Costa LHR (2016). Sobrepeso e obesidade e fatores associados ao climatério. Ciência & Saúde Coletiva 21(4): 1145–1156. DOI: 10.1590/1413– 81232015214.16552015.

14. Hale L, Troxel WM, Kravitz HM, Hall MH, Matthews KA (2014). Acculturation and sleep among a multiethnic sample of women: The study of Women’s Health Across the Nation (SWAN). Sleep 37(2): 309–317. DOI: 10.5665/sleep.3404.

15. Im E-O (2003). Symptoms experienced during menopausal transition: Korean women in South Korea and the United States. J Transcult Nurs 14(4): 321–328. DOI: 10.1177/104365­9603257160.

16. Im E-O, Chang SJ, Ko Y, Chee W, Stuifbergen A, Walker L (2012). A National Internet Survey on Midlife Women’s Attitudes Toward Physical Activity. Nurs Res 61(5): 342–352. DOI: 10.1097/ NNR.0b013e31825­da85a.

17. Im E-O, Ham OK, Chee E, Chee W (2015). Physical activity and depressive symptoms in four ethnic groups of midlife women. West J Nurs Res 37(6): 746–766. DOI: 10.1177/019394­5914537123.

18. Im E-O, Hu Y, Cheng C-Y, Ko Y, Chee E, Chee W (2018). Clusters of midlife women identified by cognitive symptoms. Maturitas 110: 33–40. DOI: 10.1016/j.matu­ritas.2018.01­.013.

19. Im E-O, Ko Y, Chee E, Chee W (2017). Immigration transition and sleep-related symptoms experienced during menopausal transition. Women Health 57(1): 69–87. DOI: 10.1080/036302­42.2016.1153018.

20. Im E-O, Ko Y, Lee Y, Chee E, Chee W (2020). Immigration Transition and Cognitive Symptoms During Menopausal Transition. West J Nurs Res 42(4): 269–277. DOI: 10.1177/019394­5919858366.

21. Im E-O, Lee B, Chee W, Brown A, Dormire S (2010). Menopausal Symptoms Among Four Major Ethnic Groups in the United States. Western J Nurs Res 32(4): 540–565. DOI: 10.1177/019394­5909354343.

22. Marlatt KL, Redman LM, Beyl RA, Smith SR, Champagne CM, Yi F, Lovejoy JC (2020). Racial differences in body composition and cardiometabolic risk during the menopause transition: a prospective, observational cohort study. Am J Obstet Gynecol 222(4): 365.e1–365.e18. DOI: 10.1016/j.ajog­.2019.09.051.

23. Mishra GD (2017). Menopause, A stage in the Life of Women. In: Cano C. Menopause. A Comprehensive Approach, Springer, Cham., pp. 3–7.

24. Moher D, Liberati A, Tetzlaff J, Altman DG (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med 6(7): e1000097. DOI: 10.1371/journal. pmed.1000097.

25. Munhoz L, Aoki EM, Cortes ARG, de Freitas CF, Arita ES (2018). Osteoporotic alterations in a group of different ethnicity Brazilian postmenopausal women: An observational study. Gerontology 35(2): 101–109. DOI: 10.1111/ger.12322.

26. Pien GW, Sammel MD, Freeman EW, Lin H, DeBlasis TL (2008). Predictors of sleep quality in women in the menopausal transition. Sleep 31(7): 991–999.

27. Portman DJ, Gass MLS (2014). Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause 21(10): 1063–1068. DOI: 10.1097/ GME.00000000000­00329.

28. Resmi S, Anil Bindu S, Benny PV (2020). Climacteric symptoms among women residing in a rural area of Kerala state – A cross-sectional study. Clin Epidemiology Glob Health 8(4): 1341–1344. DOI: 10.1016/j.ceg­h.2020.05.008.

29. Richards JS, Young HA, DeSagun R, Kerr GS (2005). Elderly African-American and Caucasian men are infrequently screened for osteoporosis. J Natl Med Assoc 97(5): 714–717.

30. Rönnlund M, Sundström A, Adolfsson R, Nilsson L-G (2015). Subjective memory impairment in older adults predicts future dementia independent of baseline memory performance: Evidence from the Betula prospective cohort study. Alzheimers Dement 11(11): 1385–1392. DOI: 10.1016/j. jalz.2014.11.006.

31. Roztočil A, et al. (2011). Moderní gynekologie [Modern gynaecology]. Praha: Grada, 528 p. (Czech).

32. Satoh T, Ohashi K (2005). Quality-of-life assessment in community-dwelling, middle-aged, healthy women in Japan. Climacteric 8(2): 146–153. DOI: 10.1080/136971­30500117961.

33. Sharma K, Bansal M, Chopra S, Kaur M (2016). Menopause Characterization, Menarche and Fertility among Rural Females of Shimla (Himachal Pradesh). SM J Reprod Health Infertil 1(1): 1005.

34. Sievert LL (2014). Menopause across cultures: clinical considerations. Menopause 21(4): 421–423. DOI: 10.1097/GME.00000000000­00099.

35. Simočková V (2011). Gynekologicko-pôrodnické ošetrovateľstvo [Gynaecological and obstetric nursing]. Učebnica pre fakulty ošetrovateľstva. Martin: Osveta, 216 p. (Slovak).

36. Utian WH, Woods NF (2013). Impact of hormone therapy on quality of life after menopause. Menopause 20: 1098–1105. DOI: 10.1097/GME.0b013e31829­8debe.

37. Wei GS, Coady SA, Reis JP, Carnethon MR, Coresh J, D’Agostino RB, Sr., et al. (2015). Duration and degree of weight gain and incident diabetes in younger versus middle-aged black and white adults: ARIC, CARDIA, and the Framingham Heart Study. Diabetes Care 38(11): 2042–2049. DOI: 10.2337/ dc14–2770.

38. Zhang Y, Zhao, X, Leonhart R, Nadig M, Wang J, Zhao Y, et al. (2019). A Cross-Cultural Comparison of Climacteric Symptoms, Health-Seeking Behavior, and Attitudes towards Menopause Among Mosuo Women and Han Chinese Women in Yunnan, China. Transcult Psychiatry 56(1): 1287–1301. DOI: 10.1177/136346­1518804094.

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