The Impact of Race, Ethnicity, and Socioeconomic Status on the Severity of Menopause Symptoms: A Study of 68,864 Women

Objective To evaluate how race, ethnicity, and socioeconomic status (SES) affect the severity of menopause symptoms in a large, diverse sample of women. Methods For this cross-sectional study conducted between March 24, 2019, and January 13, 2023, a total of 68,864 women were enrolled from the Evernow online telehealth platform. Participants underwent a clinical intake survey, which encompassed demographic information, detailed medical questionnaires, and a modified Menopause Rating Scale (MRS). The modified scale was adapted for ease of use online and is available in the supplementary material along with the full intake. Symptom severity was evaluated using a multivariate binomial generalized linear model, accounting for factors such as race, ethnicity, age, BMI, smoking status, bilateral oophorectomy status, and SES. Odds ratios and confidence intervals were calculated based on the linear regression coefficients. Results Of the participants, 67,867 (98.6%) were included in the analysis after excluding outliers and those with unknown oophorectomy status. The majority of respondents identified as White (77.4%), followed by Hispanic (9.0%), Black (6.7%), two or more races/ethnicities (4.4%), Asian (1.2%), Indigenous/First Nations (0.8%), Middle Eastern (0.3%), and South Asian (0.2%). Notably, individuals identifying as Black, Hispanic, Indigenous/First Nations, Middle Eastern, or with two or more races/ethnicities reported higher levels of symptom severity compared to their White counterparts. Conversely, Asian and South Asian participants reported lower symptom severity. Even after incorporating SES into the linear model, racial and ethnic groups with lower SES (Black, Hispanic, Indigenous, and multiple ethnicities) exhibited slight shifts in odds ratios, while maintaining high statistical significance. Conclusions Our study suggests that the relationship between race and ethnicity and the severity of menopause symptoms is not solely explained by differences in SES but is itself an independent factor. Understanding and addressing social, cultural, and economic factors is crucial to reduce disparities in menopausal symptoms.