Black Women and Menopause: Why Symptoms Can Be Longer and More Severe

Black menopausal woman starting out the window

When women take care of their health, they become their best friend.

Are you experiencing more menopause symptoms than your white friends or colleagues? Every menopause journey is unique, but research shows that Black women can experience symptoms more intensely, like hot flashes, earlier, for a longer period of time, and are more likely (up to 3 times greater risk) to have premature or early menopause. To achieve the best possible care and health outcomes, Black women and their healthcare practitioners need to understand the differences and disparities in menopause journeys for women of color.

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    Black women’s health in the SWAN study

    The Study of Women’s Health Across the Nation (SWAN) encompasses research that began in 1994 and provides an ongoing analysis of women+ in the U.S. The study focuses on physical, biological, psychological, and social changes in midlife. And it provides valuable findings and insights about the menopause journey.

    SWAN researchers have studied the impact of menopause on these U.S. women:

    • African American
    • Hispanic
    • Japanese
    • Chinese
    • Caucasian

    The research has spanned the U.S. in cities like Boston, Chicago, Detroit, Los Angeles, Newark, Pittsburgh, and Oakland.

    The study maps differences during the menopause journey that may be seen in different races and ethnicities within a race. The differences are not the result of racial genetics (99.9% of our DNA is the same across the globe) but related to lived experiences and factors like exposure to racism/bias/discrimination as well as social determinants of health (SDOH).

    SDOH are defined by Healthy People 2030 as

    “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”
    They include factors like:
    • Access to quality education.
    • Access to quality healthcare.
    • Access to an environment and neighborhood that supports a healthy lifestyle, e.g., access to nutritious foods, physical activity opportunities, clear air, and water.
    • Socioeconomic status (SES): a measure of an individual's or group's standing in the community and refers to an individual's position in a society (which is determined by income/wealth, level of education, occupation, and social class), insufficient access to quality care, and other intersecting factors like racism.

    Menopausal woman having a hot flash

    The study indicates Black women are more likely to have:

    • Heavy menstrual bleeding1
    • Hysterectomy1
    • Longer and more severe hot flashes1
    • Experience early menopause2
    • Depressive symptoms2
    • A more difficult time sleeping2
    • Longer menopause transition (10 years or more vs 7.5 years)3

    In comparison with white study participants, the research shows Black (and Latina) women+ are more likely to experience hot flashes, and enter both perimenopause sooner, and menopause at an earlier age. 

    As a result, they are at even higher risk and for a longer period of time for conditions like cardiovascular disease (conditions like hypertension, heart disease, and stroke), diabetes, and high cholesterol compared to those from other racial/ethnic groups going through the menopause transition. 

    And the difference is sometimes significant.

    African American women have a 2- to 8-fold greater risk of premature and early menopause.

    That bring symptoms at a younger age:
    premature = age younger than 40
    early = between 40 and 45

    Earlier menopause

    With premature and early menopause, symptoms can be more severe. 

    In general, women are at increased risk for many chronic conditions due to the hormonal transition, but when the menopause journey starts earlier, that risk lasts longer.

    The conditions involve both physical and mental health and include: 

    There are a multitude of potential reasons for premature/early menopause. Some of these causes seen more often in Black women+ are:

    1. They are at greater risk of having a hysterectomy. If the ovaries and uterus are removed, menopause develops virtually overnight. And some people may still have an earlier onset even if only the uterus is removed.
    2. They are more likely to begin their periods at a younger age
    3. Several autoimmune conditions are seen more commonly in Black women.

    Additionally, life stressors may be a factor. A process called “weathering” means many Black women are older biologically than chronologically and when compared to many other racial groups. 

    smiling and positive black woman

    Why Black women age faster

    Black women and their health practitioners should be aware of the biological age difference compared to other racial groups and its implications for Black women’s health over the course of a lifetime.

    It’s not surprising Black women enter the transition earlier, given the biological age difference by midlife due to “weathering.

    The term weathering was first coined in 1992 by Dr. Arline Geronimus, a researcher who found,

    “the health of African American women may begin to deteriorate in early adulthood as a physical consequence of cumulative socioeconomic disadvantage.”

    The result? An accelerated decline in physical health outcomes and a multitude of health disparities.

    Among the cumulative socioeconomic disadvantages experienced by Black women are a longstanding history of  racism/bias/discrimination and a high prevalence of chronic stress. The impact of systemic racism is insidious and far-reaching, has often been rampant in every nook and cranny of society, and long entrenched in medicine

    Impact of stress

    Stress in and of itself can be a strong contributory risk factor for overweight/obesity due to its impact on the hormones ghrelin and leptin.

    It can lead to visceral fat (excess internal abdominal fat around the organs), which in turn, increases inflammation in the body and the risk of conditions like diabetes, hypertension, and high cholesterol, which in turn increases the risk of heart disease and premature death.

    And there is the epigenetic effect, in which the damaging effects of stress in one generation can be passed on up to 2 later generations.

    Black women often don’t get the same treatment as white women, and their concerns may be dismissed or completely ignored in what has become known as medical gaslighting.

    There may be delayed responses that can be life-threatening or even deadly, as was the case with Dr. Susan Moore, a Black doctor who died of COVID-19 and publicly reported inadequate and delayed treatment which she attributed to racial bias at the hospital where she was receiving care.

    These life stressors can contribute to the biological aging in Black women+ and change the menopause experience, starting the journey at an earlier age. 

    In general, the transition can last longer,

    10 years rather than 7.5.

    Black women’s health during menopause

    The SWAN study has also found Black women have shorter sleep duration, and lean Black women have longer-lasting and more severe hot flashes.

    Black women+ also tend to have a greater severity of other symptoms:

    However, Black women+ also tend to have a lower decline in sexual function.

    Geographical differences

    Remember, every journey is unique, and health disparities are impacted by more than just race/ethnicity. Within each broad disparity, there are sub-groups of symptoms.

    For example, in the United States, a study of more than 22 thousand menopausal women showed geographic differences in a woman’s menopause journey.

    Southern women reported menopause nearly 11 months earlier than Northeastern women and at least six months earlier than women throughout the U.S., even after controlling for race, reproductive history, smoking, socioeconomic status, physical activity, and history of cardiovascular disease.

    The cause remains unclear, although researchers are evaluating theories related to increased cardiovascular risk in the South. This research is important, as more than half of all the Black population lived in the South in 2022.

    While endless combinations of factors influence how you’ll feel during the menopause transition (family history, underlying health conditions, demographics, socioeconomics, ethnicity, lifestyle, overall health), race stands out in the U.S. as one of the broad determining factors.

    That’s why pausitive health is committed to helping women of color and across the world recognize the differences in their menopause journeys while providing actionable steps to manage symptoms.

    Even though their symptoms may be more severe, studies show Black women are less likely

    to be counseled about and prescribed hormone therapy. They're also less likely to use HRT.

    Black women and HRT

    A study presented at the 2023 annual meeting of The Menopause Society found in patients with menopausal symptoms, and a diagnosis of depression, anxiety, or bipolar disorder, white women with menopause symptoms and one of those mental health diagnoses were 40% more likely to receive a prescription for hormone therapy for menopausal symptoms than Black women with the same diagnoses and symptoms.

    Contributory factors for the overall findings may include:

    • Provider bias, which can also lead to an underestimation of the severity of symptoms
    • Disparities in who feels comfortable talking to their doctor about menopause and if a doctor asks about menopause symptoms
    • Medical gaslighting
    • A more positive outlook on the menopause journey by African American women+ which can positively impact symptoms and the ability to cope with them.
    • A more negative perception of HRT by Black women, who in focus groups said they managed symptoms with lifestyle changes because HT was “unnatural,” had too many side effects, or required “taking pills.”
    • Greater openness to lifestyle choices, non-hormonal medications, herbs, and other non-hormonal approaches, which are often effective in helping women+ manage their menopause symptoms and potentially reduce their incidence or severity.

    Addressing health disparities takes systemic change.

    If there’s ever been a time in your life to do something about it, the menopause journey is one with great potential for having an impact.

    Black women more positive about menopause

    Despite these health disparities, a study found African American women are more likely to have a positive outlook about menopause, with Chinese American and Japanese American women having the least optimistic outlook.

    African American women viewed menopause as a signal of freedom and independence and perhaps a more minor stressor compared to other societal stressors in daily life like the internecine impacts of racism.

    A woman’s mental mindset can impact her experience during the transition. It’s as much a mental and emotional journey as it is physical.

    Managing menopause as a Black woman

    Menopause is more than a gynecological event and requires a holistic solution. Consider your nutrition, physical activitysleep, and mindset – all powerful tools you can leverage to manage menopause symptoms.

    Consider consulting specialists far beyond your gynecologist for support. That may include a nutritionist, acupuncturist, herbalist, or personal trainer. Practices like mindfulnessguided imagery, and gratitude can reduce stress, increase resilience, and make it easier to handle whatever comes your way.

    And many of these options are services that are now available online. For those with health insurance coverage through their employer, some of the services may be covered under your medical plan.

    Given the impact of racism (and sexism) on mental/emotional health and well-being, and the impact of mental/emotional health on physical health and well-being, seeking professional help with a therapist or psychiatrist if/when needed is a key component of a comprehensive plan to optimizing overall well-being and longevity.

    Finally, take care of yourself as best you can as early as you can – mentally, physically, and emotionally. Menopause may be your natural life cycle right now, but the moments leading up to this stage of life can impact your menopause journey and the years to follow.

    Find a doctor who really cares, demonstrates cultural humility and sensitivity on the ongoing journey to cultural competence, and is committed to ongoing education on menopause that may be needed to close training gaps and stay up to date. And some women are more comfortable and achieve better health outcomes when their physician is of the same race/ethnicity, as has been seen with regard to maternal and neonatal health and mortality.

    Additionally, it can be helpful to search for a clinician who has specific training and expertise in the management of the menopause journey.

    Joining a support group can also be helpful. And there are many options, from those focused on menopause broadly to others dedicated specifically to Black women’s health.

    As women move through life, those who may have been hesitant in the past often become more comfortable being vocal about their needs and expectations. Voicing your concerns and shining a bright light on the disparate treatment of Black women before, during, and after menopause can be empowering and also result in much-needed change.

    Practitioners need to recognize the differences, listen to their patients, and respond to reported symptoms, especially since menopause can start at an age earlier than the average.

    Understand these are broad generalities, and every menopause journey is unique. Race and ethnicity may impact your experience, the severity of your symptoms, the quality of the care you receive, and the health inequities that may be experienced.

    There are various contributory factors, including the “isms” (e.g., racism, sexism), which impact overall health and well-being, stress levels, and how you feel during menopause.  

    Knowledge is power. Use menopause as a time of action and better health and well-being!

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