They report higher levels of vaginal dryness, urinary problems and anxiety compared with women who live in urban settings.
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“We found differences in knowledge about menopause, treatment choices and experiences, depending on where they live,” said Dr. Susan Reed.Menopausal and postmenopausal women who live in rural areas reported more mood swings, muscle and joint pain, vaginal dryness and urinary problems than did their urban counterparts, according to a study published this month in Menopause, The Journal of The American Menopause Society.
This is one of the first studies to look at how menopause, generally defined as when menstrual periods cease, might affect women based on their place of residence, their socioeconomic status and access to healthcare, noted senior author Dr. Susan Reed, a UW Medicine OB-GYN and an expert in menopause and its treatments.
“I wasn’t really surprised by our findings,” she said, “because we know there are significant differences in other health outcomes by urban or rural residence.
While many studies have focused on rural health regarding cardiovascular conditions and suicide risks, little to no research has been done on women going through menopause in rural areas, Reed suggested.
“We also found differences in knowledge about menopause, treatment choices and experiences, depending on where they live,” she said.
Ideally, women should be able to look to their healthcare providers for education about menopause and therapeutic options such as menopausal hormone therapy, in which patches, pills or vaginal rings increase patients’ estrogen levels.
Often, the study respondents noted, their healthcare providers did not offer hormone replacement therapy as an option.
Sometimes it’s a matter of distance.
Erin Dwyer, the study’s lead author and a third-year medical student training in Montana, said that seeking help for menopause can be daunting logistically and emotionally.
If a patient must drive more than one hour to see a specialist, their likelihood of even making an appointment drops dramatically, the researchers found, in the face of competing priorities like work and childcare.
“Some patients have to drive more than an hour for a 15-minute appointment,’ said Dwyer, who conceived the study.
The online survey of 1,531 respondents in 2019 showed that rural women experience greater psychological and physical burdens than their suburban and urban counterparts.
“These differences in menopausal symptoms could relate to occupation, lower socioeconomic status, higher rates of obesity and mood disorders, and diminished access to postmenopausal genitourinary health care among predominantly white rural residing women,” the authors wrote.
Some of the disparity in care rests with the providers themselves, who might not have discussed hormone replacement therapy or menopause symptoms with their patients, Dwyer said.
The researchers also found that many women used alternative therapies, such over-the- counter herbal and vitamin supplements, and that a significant number forgoes hormone therapy or were unfamiliar with the treatment option, Reed said.
The authors offered several theories as to why this would be the case.
“Many of the women were afraid of the risk, or that somehow it would greatly increase the risk of getting cancer, which is not true for those without a uterus,” Reed added, noting current studies.
For women who have not had hysterectomies the risk, while small, varies depending on the hormone treatment they receive. However, the study found that this conversation did not occur between patient and provider.
Other women, especially those in rural areas, reported that they decided to “tough it out” rather than seek treatments for their symptoms, Reed said.
Whether it be the tough-it-out approach or fear of 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 experience severe hot flashes over many years. In recent studies we see higher associations with cardiovascular disease as well as changes in biomarkers that may suggest a higher risk for dementia,” she said.
“Interventions at midlife to improve menopausal care for rural women could potentially decrease health disparities between rural and urban/suburban women. Education on the risks and benefits of interventions, particularly menopausal hormonal therapy ... should be tailored to rural women as our findings suggest different uses of resources on healthy aging by residence,” the authors concluded.
Reed called the cross-sectional survey a starting point to address “bigger questions” about how to improve care with underserved communities of women.
The survey was organized by the nonprofit Health Women and WebMD. Responses came from all 50 states.
For details about UW Medicine, please visit http://uwmedicine.org/about.
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