Special Report: Addressing stigma and recognizing vulnerable populations

In the third episode of the Contemporary OB/GYN Special Report series, JoAnn V. Pinkerton, MD, and Jill Liss, MD, MSCP, FACOG, examined how cultural stigma, lack of awareness, and systemic inequities contribute to the underdiagnosis and undertreatment of vasomotor symptoms (VMS) during menopause.

Pinkerton explained that cultural perceptions of menopause strongly shape how women experience and report symptoms. “Cultural representations of menopause influence how women perceive the experience, or how they report their symptoms, or even how they conceptualize the change,” she said. In some societies, menopause is seen as a time of empowerment, while in others, it remains stigmatized or linked to aging and loss of fertility. Research shows that racial and ethnic differences also influence symptom patterns—Black women experience menopause earlier and with longer-lasting, more intense vasomotor symptoms,¹ while Asian women report fewer or milder episodes, potentially due to cultural attitudes that value aging.²

The discussion also focused on populations most at risk for inadequate treatment. Pinkerton emphasized that women entering menopause prematurely or experiencing early perimenopausal symptoms are often overlooked. “When a woman goes to their provider in their 30s and says, ‘I’m having irregular cycles, mood changes, and brain fog,’ providers don’t even think this could be the beginning of perimenopause,” she said. She also noted that Black women are less likely than White women to receive hormone therapy, despite having more severe symptoms.

Other vulnerable groups include women with comorbidities—such as cardiovascular disease, diabetes, or a history of estrogen-sensitive cancers—who may be told they cannot use hormone therapy, as well as older women who missed opportunities for treatment earlier in life. Liss agreed, adding, “There’s a whole generation of women who really missed the sweet spot to get the care that they needed, and I sympathize greatly.”

Our Experts:
JoAnn V. Pinkerton, MD, division director, Midlife Health Center, University of Virginia.

Jill Liss, MD, MSCP, FACOG, associate clinical professor of Obstetrics and Gynecology, University of Colorado School of Medicine.

Liss has no relevant disclosures to report. Relevant disclosures for Pinkerton include Bayer.

References:

1. Harlow SD, Burnett-Bowie SM, Greendale GA, et al. Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women's Health Across the Nation (SWAN). Womens Midlife Health. 2022;8(1):3. Published 2022 Feb 8. doi:10.1186/s40695-022-00073-y
2. Yu Q, Chae HD, Hsiao SM, et al. Prevalence, severity, and associated factors in women in East Asia with moderate-to-severe vasomotor symptoms associated with menopause. Menopause. 2022;29(5):553-563. Published 2022 May 1. doi:10.1097/GME.0000000000001949