Menopause Pride: The LGBTQIA+ Experience And Where to Find Inclusive Doctors

Menopause health disparities

The menopause journey increases a woman’s risk for several conditions, including cardiovascular disease, weight gain, and mental health concerns. 

As an LGBTQIA+ person, this risk can go up, and sometimes that happens disproportionately, which makes it a health disparity.

Let’s talk about these disparities for an LGBTQIA+ person.

1. Increased cardiovascular disease (CVD) risk

If a person is assigned female at birth and maintains that status, the typical estrogen level profile is protective up to the onset of menopause with regard to conditions like heart disease, osteoporosis, and potentially dementia (studies are mixed, and there is controversy in the medical community).

As estrogen levels plummet and eventually level out at a much lower baseline during the post-menopause, the risk of cardiovascular disease (hypertension, heart disease, and stroke) increases, along with the risk of elevated LDL (“bad” cholesterol) and triglycerides and decreased HDL (“good” cholesterol).

And some LGBTQIA+ individuals may enter menopause with higher baseline levels of risks for CVD. For example, in transgender women, hormone therapy may be a risk factor as well. As one study found, transgender women taking estrogen had higher rates of stroke (and blood clots) than their cisgender counterparts.

Researchers have also linked increased risks of CVD to chronically elevated cortisol levels (the “stress hormone”) triggered by discrimination. Some research indicates exposure to anti-LGBTQIA+ discrimination can increase mental and physical health risks for a variety of conditions. Additionally, the community is disproportionately exposed to psychological and social stressors throughout their lives.

Another cause for a greater likelihood of CVD may be certain lifestyle-related risks. Data from the Women’s Health Initiative shows that lesbian women, for example, demonstrated a higher incidence of risk factors like smoking, obesity, and alcohol consumption, with smoking and obesity being the most common risk factors for heart disease in this group.

LGBTQIA+ people are also less likely to access healthcare services that could be preventive, with reported causes being past negative experiences when seeking care, as well as difficulty in finding welcoming, culturally-sensitive healthcare practitioners with the training and experience to address what can be unique needs of some individuals in the community.

2. Weight gain

While weight gain is a common symptom for heterosexual women during the menopause journey, lesbian and bisexual women are more likely to enter the menopause journey being overweight or obese, and the trend continues as they get older.

3. Mental health

The hormonal changes that occur in many people during the menopause journey can increase the risk of mental health conditions like depression and anxiety as well as emotional distress related to stress. If these conditions are preexisting, a new episode may be triggered, or a current episode may exacerbate.

As noted below, some LGTQIA+ individuals on the menopausal journey may already have a higher baseline rate of the conditions for which menopause increases the risk.

The LGBTQIA+ community has a higher prevalence of mental health conditions compared to the general population:

• LGB adults are more than twice as likely as heterosexuals to experience a mental health condition.
• Transgender people are almost four times as likely to do so.
• More than 25% of bisexual females and approximately 15% of lesbians reported having had a major depressive episode (MDE) between 2021 and 2022, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). And bisexual females were six times more likely to have attempted suicide within the same timeframe than cis heterosexual women.
• The rate of anxiety is also higher, with the 2022 CDC Household Pulse Survey showing 32% of LGBTQIA+ adults aged 45-65 have anxiety compared with 26.2% of non-LGBTQIA+.