Women in Rural Spain Face Greater Challenges During Perimenopause, Study Finds

Perimenopausal women in rural Spain experience more severe symptoms and a lower quality of life compared to those in urban areas, according to data published in a study earlier this year.

As women approach menopause, hormonal changes can occur, leading to a number of physical and emotional symptoms. This transitional period, known as perimenopause, can significantly affect a woman's quality of life.

The impact of these changes can vary, however, based on factors such as reproductive history, physical health and demographic characteristics, according to authors of the study published in Gynecological Endocrinology.

The study shares that women living in rural areas face unique challenges that may heighten their vulnerability during perimenopause, including different exposures to environmental factors such as endocrine disruptors.

While some studies have compared perimenopausal symptoms in urban and rural settings, results have been inconsistent and limited, particularly in Spain.

For example, while some research suggests that urban women may experience more intense symptoms, other studies report that rural women have more severe issues like vasomotor and urogenital problems.

To fill in this gap, Spanish researchers examined the prevalence of perimenopausal symptoms and Health-Related Quality of Life (HRQoL) among rural and urban women in Spain.

The study, conducted between December 2019 and April 2023, focused on perimenopausal women from eight regions in Spain.

Women aged 45 to 55 were invited to participate through letters sent to women’s associations and during routine health checkups or gynecological consultations.

To be included, participants needed to meet specific criteria related to their menstrual cycles. Those with chronic diseases, mental disorders, recent hormone treatments or significant life changes were excluded.

HRQoL was measured using the Short Version of the Cervantes Scale (C-SF) and a questionnaire specifically designed to evaluate menopause's impact on various aspects such as health, aging and relationships, was included.

Scores on the C-SF ranged from 0 to 5, with lower scores indicating better health in negative domains and worse health in positive domains.

Depressive symptoms were assessed using the Beck Depression Inventory 2 (BDI-2), which evaluates symptoms over the previous two weeks. Scores from this questionnaire were categorized to indicate different levels of depression.

The study revealed that women in rural Spain experienced more intense perimenopausal symptoms such as hot flashes and rated their HRQoL lower than women in urban areas. This was reflected in their higher scores on the C-SF (33.2 vs. 26.4).

Though, when it came to depression, there were no significant differences between the two groups.

These findings relate with similar studies in countries such as India, Turkey, Poland and Peru, according to researchers.

However, the results do contrast with data from studies in Mexico and among Spanish postmenopausal women, suggesting cultural and geographical factors may play a role.

The study's strengths include its focus on a robust, well-defined sample of perimenopausal women from rural Spain, offering insights into a population often underrepresented in research, authors expressed.

It also highlights the challenge of accessing healthcare in rural areas, where medical consultations for symptoms like hot flashes can be limited.

However, the study has limitations. As a cross-sectional study relying on self-reported data, the findings should be interpreted cautiously.

Additionally, some data were collected during the COVID-19 pandemic, which may have influenced stress levels and symptom reporting, particularly in urban areas. The study's focus on just eight communities also limits its generalizability to other regions.

Based on findings, researchers highlighted the need for targeted healthcare strategies to support perimenopausal women in rural areas.