Table 3.

Summary of study objectives and key findings

Author (Year)	Objective	Key Findings
Sex Hormones, Menstrual Cycle Patterns
Crawford (2009) [78]	Examine changes in dehydroepiandrosterone sulfate (DHEAS) with chronological and ovarian aging	- Latinas had lower level of DHEAS (μg/ml) at baseline (107.0 [63.7–146.6]) than other racial/ethnic groups, but no significant annual decline (1.34%; p = 0.47).
		- Compared to other racial/ethnic groups, Latinas had the lowest testosterone (ng/dl) at baseline (37.5 [26.8 –51.8]) and the highest concentration of estradiol (pg/ml) at baseline of 69.1 (28.2–98.0).
Lasley (2002) [20]	Evaluate the relationship of race/ethnicity to circulating DHEAS, testosterone, and estradiol to stages of the menopause transition.	- Testosterone was positively correlated with DHEAS across ethnicities. The magnitude of this correlation was strongest in Latinas even after adjustment for age, menopause status, and BMI (r=0.43, p<0.0001).
Randolph (2003) [17]	Evaluate serum reproductive hormone concentrations by race/ethnicity	- Adjusted mean FSH levels were higher for Latinas (25.9 IU/L) than non-Latina White or Asian women.
		- Adjusted mean testosterone levels were lower for Latinas (45 ug/dl) than non-Latina White women or Asian women.
Randolph (2004) [79]	Assess patterns of change in serum estradiol and follicle stimulating hormone (FSH) concentrations across age by race/ethnicity	- Estradiol and FSH concentrations did not differ between Latinas and non-Latina White women.
Menopausal Symptoms and Mental Health
Avis (2001) [80]	Identify menopausal symptomatology congruence across various ethnic groups in the United States.	- Identified two factors of menopausal symptoms in midlife women: psychological/psychosomatic and vasomotor symptoms.
		- Compared to non-Latina White women, Latinas report less psychosomatic and VMS.
Avis (2003) [81]	Examine the association between health-related quality (HRQL) of life and early perimenopause and race/ethnicity.	- OR (95% CI) of Latinas scoring at or below the 25th percentile for each subscale: (1) Role-Physical: 1.58 (1.20, 2.09); (2) Bodily pain: 3.87 (2.95, 5.08); (3) Vitality: 1.81 (1.38, 2.37); (4) Role-Emo: 0.81 (0.61, 1.08); (5) Social Function: 2.87 (2.19, 3.78).
		- Latinas were more likely than NHW women to have impaired functioning on all HRQL subscales except the role–emotional domain.
Avis (2015) [22]	1) Determine total duration of frequent vasomotor symptoms (VMS) during the menopause transition; 2) Quantify how long frequent VMS persist post-FMP; 3) Identify risk factors for longer VMS and longer post-FMP VMS persistence.	- Frequent VMS duration was 6.5 years for NHW women, but 8.4 years among Latinas.
		- Post-FMP VMS duration was 4.9 years for Latinas and 5.4 years for NHW.
		- There were no differences between Latinas and NHW after adjusting for age, education, financial strain, study site, menopause status, health status.
Bromberger (2001) [82]	Examine the association between psychologic distress and natural menopause in a community sample of multiethnic women.	- OR (95% CI) of psychologic distress in Latinas compared to NHW: 0.64 (0.54, 0.76); rates were similar whether they were educated in the United States or elsewhere or completed the interview in English or Spanish (22.4% vs 26.7%).
Bromberger (2010) [45]	1) Evaluate the relationship between sex hormones and high depressive symptoms; 2) assess whether hormone levels or their change might explain the association of menopausal status with depressive symptoms.	- OR (95% CI) of CES-D score 16+ for Latinas compared to NHW: 2.69 (1.32–5.48).
		- Additional factors related to CES-D score of 16+: lower education (<high school), smoking, any VMS, upsetting life events
Gaston (2019) [38]	1) Examine the relationship between sleep characteristics and prevalent metabolic syndrome; and 2) Determine whether these relationships vary by menopause status and race/ethnicity	- Latinas had higher prevalence of inconsistent sleep patterns, sleep debt, frequent napping, and insomnia symptoms compared to NHW women.
		- NHW women and Latinas who reported concurrent short sleep duration and insomnia had higher prevalence of metabolic syndrome.
		- Notably, associations between poor sleep and abdominal obesity were often strongest for Hispanics/Latinas among postmenopausal women.
		- Metabolic syndrome prevalence among Latinas during pre and postmenopause was 8.7% and 21%, respectively.
		- Short sleep duration was reported at 33% premenopausal and 41% postmenopausal among Hispanic/Latina women.
Gibson (2011) [31]	To examine the directional relationship between negative affect and VMS.	- OR (95% CI) of next-day negative affect for previous-day VMS: 1.27 (1.03, 1.58)
		- OR (95% CI) of VMS within 24-hours of negative affect: 1.72 (1.39, 2.13)
		- Association of next day VMS or negative affect did not differ for Latinas.
Gold (2000) [30]	Investigate the relation of sociodemographic and lifestyle factors to menopausal symptoms.	- Latinas reported urine leakage, vaginal dryness, heart pounding or racing, and forgetfulness more frequently than did NHW women.
Gold (2006) [23]	To assess whether VMS over the menopause transition differ by race/ethnicity.	- Prevalence of any VMS was highest during early to late perimenopause: 70% for Latinas and NHW women
		- Unlike other groups, menopausal status was not associated with frequency of VMS among Latinas
		- Baseline depressive symptoms were related to greater odds of frequent VMS for Latinas (OR [95% CI]: 2.25 [1.13, 4.48]).
		- Current smoking was associated with greater odds of frequent VMS among Latinas (OR [95% CI]: 3.09 [1.53, 6.25]).
Green (2010) [60]	Evaluate if menopausal symptoms differ among Latinas, based upon country of origin and degree of acculturation in SWAN.	- Central American women were more likely to report VMS (72.4%) than Dominicans (45.2%), Cubans (34.1%), South Americans (50.9%), or Puerto Ricans (51.8%).
		- Puerto Ricans and Dominicans reported more trouble sleeping (66.1 and 64.3%, respectively) than other Latino groups (36%−52%).
		- Acculturation did not appear to impact menopausal symptoms.
Hale (2014) [37]	Examine the prevalence of self-reported sleep complaints among US-born Hispanic/Latina, Chinese, and Japanese immigrant women compared to their first-generation immigrant ethnic counterparts and consider the role of acculturation in sleep behaviors among these groups	- US-born Hispanic/Latina, Chinese, and Japanese immigrants were more likely to report sleep complaints than their first-generation ethnic counterparts.
Im (2009) [35]	The objective of the study is to have Hispanic, midlife women feel empowered to describe menopausal symptoms in their own terms.	- Four themes arose: (a) “Cambio de vida (change of life),” (b) “being silent about menopause,” (c) “trying to be optimistic,” and (d) “getting support.”
		Many participants reported how supportive their family members were during this transition. They stated that “in their culture, people believe that women in the menopausal transition need to relax more than usual”.
		Women reported that having family support relieved stress and gave them an opportunity to manage their menopausal symptoms.
Im (2017) [39]	Explored the associations of immigration to sleep-related symptoms among midlife women.	- Among Latinas, longer time in the U.S and higher acculturation were related to greater sleep-related symptoms (e.g., difficulty falling asleep).
Im (2018) [54]	Explore racial/ethnic differences in the Cognitive Symptom Index for Midlife Women and determine other multifaceted influences on symptoms.	- The most frequently reported symptoms across the racial/ethnic groups were worrying (54.1%), sleep problems (52.6), and hot flashes (44.8%).
		- Among Latinas, higher acculturation, unemployment, and postmenopausal status were significantly associated with higher total numbers of symptoms.
		- Latinas were less likely than NHW women to report mental exhaustion (OR = 0.51, 95% CI [0.35, 0.75]) or concentration problems (OR = 0.48, 95% CI [0.32, 0.71]).
Kravitz (2003) [7]	Compare age-adjusted and ethnic differences in prevalence of sleep difficulty at various stages of the menopausal transition	- NHW (40.3%) and Latinas (38.0%) reported the highest rates of sleep difficulty.
		- Age-adjusted prevalence of difficulty sleeping ranged from 30.4% in pre- to 50% in naturally postmenopausal Latinas.
Kravitz (2008) [40]	Evaluate the relationship between difficulty sleeping, progression through the menopausal transition, and racial/ethnic difference.	- A larger proportion of Latinas reported trouble falling asleep (14.4%) compared to other racial/ethnic groups.
		- In adjusted model, Latinas were less likely to report waking up several times and early morning awakening.
		- Among women without VMS, Latinas were less likely to report early morning awakening (OR = 0.37, P = 0.002)
Lanza di Scalea (2012) [46]	Examined associations among role occupancy, role stress, and role reward and mental health among women undergoing menopausal transition	- There were racial/ethnic differences in the proportion of women engaged in each type of role, with Latinas having the highest proportion of mothers (92.9%).
		- Latinas with high stress across roles had lower odds of low social functioning compared NHW women with high stress (OR [95%CI]: 0.67 [0.45,0.96]).
		- For mothers, high reward reduced the effect of high stress on depression and social functioning.
Reece (2006) [83]	Investigate perimenopausal self-efficacy beliefs in a sample of Caribbean Latinas and non-Latina White women.	- Latinas scored lower than NHW women in the cognition/decision-making behaviors subscale of the Perimenopausal Health Self-Efficacy Survey.
		- Total perceived self-efficacy was positively associated with perceived functional health.
		- Stress and control over health were related to perceived functional health.
Reed (2013) [84]	Evaluate the association of self-reported vasomotor symptom (VMS) frequency with race/ethnicity among a diverse midlife US population and explore menopause symptom differences by dietary soy isoflavone (genistein + daidzein) consumption.	- Compared with NHW women, Latinas were less likely to report hot flashes (79% vs. 84%) or night sweats ever (67% vs76%).
		- No observed difference in the proportion of Latinas vs. NHW women reporting at least moderate hot flash or night sweat bother.
Schnatz (2006) [44]	The objective of this study was to assess differences in menopausal symptoms between postmenopausal Latinas and non-Latina White women.	- Compared to NHW women, Latinas reported greater mood changes (76% vs. 54%), a decrease in energy (56% vs. 36%), palpitations (54% vs. 26%), breast tenderness (39% vs. 28%), memory loss (34% vs. 22%), and lower rates of vaginal dryness (34% vs. 44%).
		- Differences in mood changes, energy, palpitations, and memory loss remained after adjusting for sociodemographic factors.
Sexual Health
Schnatz (2010) [25]	Identify the prevalence of female sexual dysfunction in a sample comprising of mostly Latinas and women of low socioeconomic status.	- Prevalence of depression was 80.9% vs. 52.8% and that of anxiety was 76.6% vs. 45.7% among women with versus without a decrease in sexual desire.
		- The prevalence of depression was 83.3% vs. 55.9% and that of anxiety was 76.7% vs. 52.9% among women who reported dyspareunia versus those who did not.
		- Problems sleeping was the only variable associated with a statistically higher likelihood of sexual dysfunction (OR [95%CI]: 5.6 [1.2, 25.3]).
		- No significant differences were seen when comparing sex dysfunction between Latinas and non-Latina women.
Cardiovascular and Cardiometabolic Health
Allshouse (2018) [75]	Investigate whether faith was associated with a difference in time to incident metabolic syndrome among midlife women.	- Latinas had the highest incidence rate of metabolic syndrome of any racial/ethnic group.
		- Among women with low levels of faith, Latinas had a faster progression to metabolic syndrome than did non-Latina women.
		- Latinas were more likely than non-Latina women to report that faith brought them strength and comfort in times of adversity.
Derby (2006) [69]	Identify the proportion of midlife women who are candidates for preventive interventions according to national screening guidelines for hypertension and cholesterol.	- The prevalence of pre-hypertension was highest among Latinas (61%) and hypertension was highest among Latinas and African-American women (17%).
		- Latinas had the lowest HDL-C (48.3 mg/dL, 11). Blood pressure and body mass index were highest for African-American women and Latinas.
		- Among women treated for hypertension, the proportion at or below blood pressure goal was lowest for African-American (54%) and Latina women (28%).
Im (2015) [85]	Explore racial/ethnic differences in midlife women’s cardiovascular symptoms and to determine the factors related to these symptoms in each racial/ethnic group.	- Hispanics were more likely to report suffocating (12.7%) and joint swelling (16.7%; OR=5.23, 95% Confidence Interval [CI] =1.92–14.23)
		- Hispanics were less likely to report night sweats (OR=0.37, 95% CI=0.16–0.87) than NH Whites.
		- Among Latinas, the total number and severity of cardiovascular symptoms increased during the menopause transition.
		- Among Latinas, financial strain and higher body mass index were positively associated with the total number of cardiovascular symptoms, while marital status (married/partnered) and employment were negatively associated.
Jackson (2017) [71]	Describe antihypertensive medication use over time among midlife women.	- On average, Latinas have higher mean blood pressure (systolic/diastolic = 130/83 mmHg) than NHW (123/77 mmHg), Chinese (125/79 mmHg), and Japanese women (121/79 mmHg).
		- Latinas were more likely on an ACE/ARB antihypertensive medication [OR=2.03, (1.36–3.02)] or CCB antihypertensive medication [OR=1.81, (1.13–2.89)].
El Khoudary (2016) [19]	Assess associations between trajectories of estradiol and FSH over the menopause transition and subclinical measures of atherosclerosis after menopause.	- Four distinct trajectories of estradiol were identified: (a) low estradiol before and after the FMP; (b) medium estradiol before FMP but stable and high estradiol after FMP; (c) high rise of estradiol before FMP followed by early decline at FMP; (d) high rise of estradiol before FMP followed by late decline after FMP. Latinas were more likely to belong to the high rise-late decline estradiol group.
		- Three distinct trajectories of FSH were identified: (a) low rise before/after FMP; (b) medium rise before/after FMP; (c) high rise before/after FMP. Latinas were more likely to belong to the low rise FSH group than to the other trajectory groups.
		- Three distinct trajectories of FSH were identified: (a) low rise before/after FMP; (b) medium rise before/after FMP; (c) high rise before/after FMP.
		- High rise-late decline estradiol group and low FSH group had a more adverse CVD risk profile.
		- Women with the high estradiol-late decline trajectory had a lower odds of carotid plaque.
Sutton-Tyrrell (2005) [86]	Evaluate relationship among sex hormone–binding globulin (SHBG) and cardiovascular risk factors in premenopausal and perimenopausal women.	- Spearman correlation of risk factors among Hispanics between BMI and testosterone was 0.15 (p<0.05) and SHBG, FAI is 0.27 and 0.30, respectively (p<0.001).
		- Sex hormone binding globulin and free androgen index are correlated with hemostatic factors, particularly among Latinas.
Thurston (2015) [21]	Evaluated temporal patterns of VMS assessed over 13 years in relation to carotid intima-media thickness among midlife women.	- Latinas were more likely to have a consistently high probability of VMS.
		- Women with consistently high VMS and early-onset VMS also had a more adverse CVD risk factor profile.
		- Women with consistently high VMS or early-onset VMS had higher carotid intima-media thickness than women with consistently low VMS.
Torrens (2004) [87]	To assess differences in insulin sensitivity and B-cell function between nondiabetic premenopausal or early perimenopausal among five racial/ethnic groups	- There were no differences in homeostatic model assessment between Latinas and NHW women.
		- On average, Latinas had lower income, were less educated, had higher perceived stress, less physical activity, and a worse CVD risk factor profile than NHW women.
		- Fasting insulin levels were highest in African Americans and Latinas.
Ward (2019) [26]	To characterize and identify factors longitudinally related to constellations of cardiometabolic risk components in a multi-ethnic sample of midlife women.	- Hispanic women (HR = 1.61; 95% CI: 1.07, 2.43) and black women (HR = 1.25; 95% CI: 1.00, 1.57) had higher estimated risks of incident metabolic syndrome.
		- Hispanic women had the highest proportion of women with five components at baseline (6%).
		- Constellation pattern of obesity/hypertension/low high-density lipoprotein had the highest proportion of Hispanic women (11%).