title: The impact of education, cultural background, and lifestyle on symptoms of the menopausal transition: the Women's Health at Midlife Study.
abstract: OBJECTIVE
  This study aimed to examine differences in symptom clusters among women in midlife from different cultural origins and to identify sociodemographic, lifestyle, and health characteristics that could account for the differences between the cultural groups in symptom reporting.
  
  
  METHODS
  Israeli women aged 45-64 were randomly selected according to age and population strata of three groups: long-term Jewish residents (LTR), Jewish immigrants from the former Soviet Union, and Arab women (mostly Israeli-born). Interviews were conducted with 540 LTR, 151 immigrants, and 123 Arab women. The survey instrument included the occurrence and rating of how bothersome to everyday function were 16 symptoms. Three outcome variables included hot flashes and two scales for mental and somatic symptoms extracted from exploratory factor analysis.
  
  
  RESULTS
  Multivariate logistic regressions showed that immigrants and Arab women (compared to LTR) had a significantly lower risk of reporting hot flashes and mental and somatic symptoms. Menopausal status was related only to hot flashes. Low education and depression were associated with the three symptom scales, whereas nonhealthy lifestyle was related only to somatic symptoms.
  
  
  CONCLUSIONS
  Our main finding is that cultural group is an independent predictor of each of the three menopausal symptom scales. A possible explanation for the lower reporting of symptoms among Arab and immigrant groups is that they differ from the LTR in level of acculturation and attitudes toward menopause. These findings support the proposition of a cultural factor in menopausal symptomatology that needs to be addressed by clinicians caring for women at midlife.
authors.affiliation: Women and Children's Health Research Unit, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. liatl@gertner.health.gov.il
authors.forename: Liat
authors.initials: L
authors.lastname: Lerner-Geva
authors.forename: Valentina
authors.initials: V
authors.lastname: Boyko
authors.forename: Tzvia
authors.initials: T
authors.lastname: Blumstein
authors.forename: Yael
authors.initials: Y
authors.lastname: Benyamini
mesh_terms: D018912:Arabs / Q000208:ethnology; D003466:Cultural Characteristics; D004522:Educational Status; D054242:Emigrants and Immigrants; D005260:Female; D006304:Health Status; D006801:Humans; D007557:Israel; D008019:Life Style; D008875:Middle Aged; D047648:Perimenopause / Q000208:ethnology / Q000502:physiology*; D014586:USSR / Q000208:ethnology