A University of Washington study on menopause revealed health disparities between rural and urban women

Women living in rural communities have higher rates of menopause symptoms than their city neighbors, research from the University of Washington has found, underscoring the lack of health care access in those areas.

According to a study led by Erin Dwyer, a third-year medical student from the University of Washington, and Dr. Susan Reed, a UW Medicine OB-GYN and an expert in menopause and its treatments, women in rural areas reported more mood swings, muscle and joint pain, vaginal dryness and urinary problems.

“Understanding the menopause experience for rural women is important because improving menopausal care could potentially decrease known health disparities between rural and urban/suburban women that are observed with aging,” Reed said.

The survey, organized by the nonprofit HealthyWomen in collaboration with WebMD, gathered responses from all 50 states. It included 1,531 participants in 2019, with race and ethnicity varying by region.

The urban group had the highest diversity, with 66% identifying as white, 33% as Black and 15% as Hispanic. In the rural group, 82% identified as white, 15% as Black and 5% as Hispanic.

Reed said Dwyer chose to do the project after noticing a lack of research on how menopause affects women in rural communities.

Dwyer said that while training in Montana, she has encountered women who travel up to two hours for a 15-minute appointment.

This creates pressure for providers to deliver as much information as possible during that visit.

She added that collaborating with OB-GYNs who are passionate about discussing the benefits and risks of hormone therapy has made her more curious about understanding those differences.

“It feels like decisions need to be made there, which in contrast to a more urban environment, you can have a couple or schedule a follow-up, or it’s easier to talk about issues if they’re unsure and if you need to have a longer conversation about the potential risks or correcting misconceptions about things,” Dwyer said.

After collecting the data, Reed and Dwyer theorize that the higher reports of muscle and joint pain among women in rural areas could be due to the greater physical labor often associated with rural living. This increased strain on bones and muscles, combined with the loss of hormones such as estrogen and progesterone during menopause, may contribute to the problem.

They emphasize, however, that’s only speculation.

“We do know that women who live in rural areas have higher rates of obesity, higher rates of cardiovascular disease, higher rates of mood disorders … but we really didn’t know what aspects of menopause might be affected by a residence in a rural area,” Reed said.

Ideally, Dwyer and Reed said women should have the ability to look to their health care providers for education about menopause and therapeutic options such as menopausal hormone therapy – in which patches, pills or vaginal rings increase patients’ estrogen levels.

The study revealed that just 11% of women living in rural areas who participated in the survey are undergoing hormone therapy through the study, many fearing it’ll cause cancer or higher risks of a heart attack or a stroke, as well as because their closest provider is more than an hour away.

Dr. Kelly Anderson, a family nurse practitioner at Providence Northeast Washington Medical Group in Colville, said any studies indicating that hormone therapy causes cancer or other health issues are “poorly written and poorly distributed.”

“It’s truly individualized care, because if you have a patient who has a history of estrogen-dominant cancer, obviously, we’re not going to give them estrogen, right? I mean, that’s a no-brainer,” Anderson said. “It is not the majority of women, and the risk in general is pretty low.”

Just within the last year, Anderson said she’s seen an increase of women scheduling appointments for treatment, crediting social media discussing the importance of menopause care.

“Just this morning, I had four women I saw for menopause, and I see about 20 patients a day,” Anderson said.

“Before that, maybe a patient a couple times a week; so that’s been a huge influx over the last year.”

Anderson said in most cases, women aren’t aware there is treatment for menopause symptoms, unless they are informed by their provider.

“For some women, they want to explore hormone replacement therapy, and other women don’t want to take hormones,” Anderson said. “There’s no judgment there.”

Reed and Dwyer said this is only the beginning in understanding the importance of menopause care and seeking different treatments as needed.

They hope that the study will help improve care and decrease disparities in health outcomes between rural and urban people.

“Regardless of where people live, much depends on the providers educating our patients about menopause and offering choices,” Reed said.