Lead/Presenter: Kyle Self, San Francisco VA Medical Center
All Authors: Self KJ (SFVAMC), Gibson, CJ (SFVAMC, University of California San Francisco, School of Psychiatry), Li, Y (SFVAMC) Huang, A (University of California San Francisco, School of Psychiatry) Inslicht, S (SFVAMC, University of California San Francisco, School of Psychiatry) Maguen, S (SFVAMC, University of California San Francisco, School of Psychiatry) Byers, A (SFVAMC, University of California San Francisco, School of Psychiatry) Seal, KH (SFVAMC, University of California San Francisco, School of Psychiatry)
Nearly half of women Veterans who utilize VA services are in midlife (age 45-64). Yet, little is known about the experience or clinical management of age-related symptomatology, such as menopause, among women Veterans. Thus, we determined prevalence of menopausal symptoms and use of menopausal hormone therapy specifically between multi-racial/ethnic disparities in a national sample of midlife women Veterans.
Cross-sectional analyses of national VA medical and pharmacy records (2014-2015) were conducted to examine prevalence of documented menopausal symptoms and menopausal hormone therapy use among women Veterans aged 45-64 with > 1 clinical encounter during the observed period. Race and ethnicity were categorized in accordance with established federal standards (White, Black/African American, American Indian/Alaska Native, Asian, Multi-race, and Native Hawaiian/other Pacific Islander; Hispanic/Latina or non-Hispanic/Latina). Chi-square analyses were used to compare diagnoses and hormone therapy use by race and ethnicity.
In the full sample (n = 188,763, mean age 54.3, SD 5.4 years), 5% had documented diagnoses indicating menopausal symptoms, while 14% were prescribed menopausal hormone therapy. In targeted comparisons, white women were more likely to have documented menopausal symptoms (5.7%) than black women (4.5%, chi sq. = 119.0, p < .001), but not Asian women (5.7%, chi sq. = .01, p = .94); there were no differences in documented symptoms in non-Hispanic/Latina and Hispanic/Latina women (5.3% vs. 5.6%, chi sq. = .22, p = .23). White women were also more likely to be prescribed hormone therapy (15.4%) than black women (13.3%, chi sq. = 149.8, p < .001), and Asian women (8.5%, chi sq. = 56.7, p < .001); non-Hispanic/Latina women were more likely to be prescribed hormone therapy than Hispanic/Latina women (14.6% vs. 11.8%, chi sq. = 79.3, p < .001).
Although data from community samples consistently shows higher rates of self-reported menopausal symptoms among black and Hispanic/Latina women, these findings suggest that white women Veterans were more likely to have documented menopausal symptoms and to receive menopausal hormone therapy than women Veterans in other multi-racial/ethnic groups. These findings may signal disparities in symptom reporting, documentation, and/or treatment for minority women Veterans in the VA setting.
VA providers should discuss menopausal symptoms and management with all midlife women in their care, and adjust treatment and approaches to care accordingly to accommodate women Veterans of color.