Are race, ethnicity, and menopausal status associated with GI symptoms?

Contemporary OB/GYN JournalVol 67 No 3
Volume 67
Issue 3

Being Non-Hispanic (N-H) Asian is a significant influencing factor for the number of gastrointestinal (GI) symptoms and the severity scores of GI symptoms, according to a study of 4 major racial/ethnic groups of midlife women in the United States.

Eun-Ok Im, PhD, MPH

Principal investigator Eun-Ok Im, PhD, MPH

The study in Menopause also found that premenopausal status is the strongest influencing factor for the numbers of GI symptoms among all 4 participating groups: Hispanics, N-H Whites, N-H Blacks and N-H Asians.1

In addition, premenopausal status was the strongest influencing factor for the number of GI symptoms in all participants.

Principal investigator Eun-Ok Im, PhD, MPH, a senior associate dean of research and innovation at Emory University School of Nursing in Atlanta, Georgia, was inspired to undertake the study based on her own menopausal transition with some GI symptoms.

“I suspected that menopausal transition could influence GI symptoms differently, due to cultural differences like variations in diet and defecation behaviors with hormonal changes,” Im said.

The study is a secondary analysis of data of 1,051 women from 2 internet studies on midlife women's health issues that were completed in 2013. Those studies consisted of 12 questions on sociodemographic and health/menopausal factors and the GI Index for Midlife Women.

“Asian women tended to have lower numbers of lower severity scores of GI symptoms compared with other racial/ethnic groups,” Im told Contemporary OB/GYN®. “I suspected that Asians might have more GI symptoms, considering their highly seasoned foods, such as spicy Korean foods, but was not sure about hormonal influences. For example, Asian women are less likely to experience menopausal symptoms, according to the current literature, and certain hormonal differences among various racial/ethnic groups during the menopausal transition have been reported. Yet, I think this findings need to be carefully interpreted, considering Asians’ cultural hesitance in reporting symptoms in general and menopausal symptoms in specific.”

The study concluded that postmenopausal status was the only significant risk factor influencing GI symptoms, after controlling for other variables like background characteristics and disease status.

“Postmenopausal women had the largest number and severity of GI symptoms, except among Asian women,” Im said. “My guess is that GI symptoms could increase with advancing age, as is the case with other symptoms that show a similar pattern: sleep complaints, vaginal dryness, and cognitive symptoms.”

The study’s findings need to be carefully interpreted because of several limitations of the study as a secondary analysis, according to Im. “Still, I think clinicians should consider possible racial/ethnic differences in GI symptoms experienced during the menopausal transition when they take care of racial/ethnic minority midlife women,” she said.

Clinicians also need to ponder multiple influencing factors that might differently affect GI symptoms of racial/ethnic minorities, including psychological symptoms like depression and symptom perception.

“Furthermore, clinicians ought to consider that GI symptoms in general, with the exception of Asians in our study, increase as the menopausal transition moves forward, with postmenopausal women having more severe GI symptoms,” Im said.

Cultural factors like cultural dietary patterns and practices, and defecation practices, might also influence GI symptoms during the menopausal transition.

“Of course, more studies are needed to confirm these findings on GI symptoms during the menopausal transition because little is known about it in the literature,” Im said. “Moreover, further in-depth studies are needed on the cultural factors that might differently influence racial/ethnic minority women’s GI symptoms during the menopausal transition.”

Additional studies encompassing other diverse groups are also warranted.

“Out next study aims to develop and pilot-test a web app-based information and coaching/support program that could help midlife women in their menopausal transition recognize and manage GI symptoms, after further analyzing who would be the risk groups to target,” Im said.


Im EO, Gayeong K, Choi M, et al. Gastrointestinal symptoms in four major racial/ethnic groups of midlife women: race/ethnicity and menopausal status. Menopause. Published online December 6, 2021. doi:10.1097/GME.0000000000001898

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