Survey Finds Menopausal Women in Rural Areas Report More Symptoms and Barriers Attending Appointments

According to survey results published in The Menopause Society’s journal, Menopause, women living in rural areas are likely to experience a greater burden of both psychological and somatic menopause symptoms compared with women who lived in either urban or suburban areas. Despite the increased risk of symptom burden, rural women were not observed to experience more vasomotor-related symptoms.¹

Image credit: Feng Yu | stock.adobe.com

According to the authors, this study is one of the first to examine how menopause may affect women based on their place of residence, their socioeconomic status, and access to health care. Although prior research has evaluated rural health regarding cardiovascular conditions and suicide risks, little to no research has been conducted on menopausal women in these areas.²

For this study, a 2019 online survey queried US women 45 years or older who are in late menopause transition or postmenopause on menopause symptoms, resources, and treatments. Late menopause transition and postmenopause subgroups were stratified by rural, suburban, and urban residence, and age-weighted proportions for menopause symptoms and treatments were also calculated.¹

A total of 1531 women with a mean age of 50.7 years responded to the survey. Of this population, approximately 45% (n = 686) were in late menopause transition and 55% (n = 845) in postmenopause. The findings demonstrated that in muscle aches and pains as well as panic attacks were the most common among those in late menopause transition. Additionally, women in rural areas were more likely to experience these symptoms (muscle aches and pains: 65%; panic attacks: 30%) compared with women in suburban (muscle aches and pains: 49%; panic attacks: 24%) and urban (muscle aches and pains: 49%; panic attacks: 18%) areas.¹

Further, the most prevalent symptoms in postmenopause residents were mood swings, urinary incontinence, and vaginal dryness. Rural residents were more likely (mood swings: 23%; urinary incontinence: 23%; and vaginal dryness: 37%) to experience these compared with urban (mood swings: 18%; urinary incontinence: 19%; and vaginal dryness: 22%) and suburban (mood swings: 14%; urinary incontinence: 14%; and vaginal dryness: 29%) residents.¹

“I wasn’t really surprised by our findings because we know there are significant differences in other health outcomes by urban or rural residence,” Susan Reed, MD, MPH, MS, menopause expert and obstetrician-gynecologist at University of Washington Medicine, said in a news release. “We also found differences in knowledge about menopause, treatment choices and experiences, depending on where they live.”²

Interestingly, vasomotor symptom prevalence was higher among both women in late menopause transition (71%) and postmenopause (20%), but current menopause hormone therapy use was low (11% for both late menopause transition and postmenopause). These results did not differ by residence, even though there were differences observed in menopausal resources used.¹

“These differences in menopausal symptoms could relate to occupation, lower socioeconomic status, higher rates of obesity and mood disorders, and diminished access to postmenopausal genitourinary health care among predominantly white rural residing women,” the authors wrote.²

The authors note that, ideally, women should be able to use their health care professionals as sources of information regarding menopause, its symptoms, and any therapeutic options available (eg, hormone therapy, pills, vaginal rings) to increase estrogen levels, therefore, helping some symptoms. In the study, respondents noted that their health care providers did not offer hormone replacement therapy as an option.²

Further, other patients were unable to meet with their provider because of distance. For example, the survey found that if a patient had to travel an hour to visit their specialist, the likelihood of them making an appointment dropped significantly, especially when other factors (eg, childcare, work) came into play.²

“Interventions at midlife to improve menopausal care for rural women could potentially decrease health disparities between rural and urban [or] suburban women. Education on the risks and benefits of interventions, particularly menopausal hormonal therapy...should be tailored to rural women [because] our findings suggest different uses of resources on healthy aging by residence,” concluded the authors.^1,2

REFERENCES

1. Dwyer ER, Maki PM, Katz, R, Mallampalli, MP, Reed SD. Menopause symptom burden and management across rural, suburban, and urban settings in a US population. Menopause. 2024;32(1):23-30. doi:10.1097/GME.0000000000002454

2. University of Washington School of Medicine/UW Medicine. Rural women face tougher time with menopause. News release. December 31, 2024. Accessed January 8, 2025. https://www.eurekalert.org/news-releases/1069307