One thing we know for certain about peri/menopause is that the experience varies widely from woman to woman. But research also shows that race and ethnicity are major factors in when peri/menopause begins and what symptoms we experience. It also shows that women are offered different care for their symptoms based on their race and ethnicity — a double-standard that needs to end now. Early Signs of Perimenopause in Black Women Perimenopause can begin earlier than many expect, especially for Black women, sometimes starting in the late 30s or early 40s. Because awareness around this phase is still limited, early symptoms are often misunderstood or dismissed as stress or lifestyle-related changes , including what some describe as weird perimenopause symptoms such as unexpected fatigue, body changes, or digestive discomfort like perimenopause bloating. Recognizing these signs early can help in managing symptoms more effectively. Changes in Menstrual Cycle One of the first noticeable signs is a shift in menstrual patterns. Periods may become irregular, heavier, lighter, or more spaced out than usual. These changes happen due to fluctuating hormone levels that affect ovulation and cycle regularity. Hot Flashes and Night Sweats These are among the most common early symptoms. They may begin years before menopause and can disrupt daily routines and sleep. They are caused by sudden changes in body temperature regulation linked to declining estrogen levels. Sleep Disturbances and Fatigue Many women experience difficulty falling asleep or staying asleep, often leading to ongoing fatigue and low energy levels. Hormonal shifts can interfere with sleep cycles, making restful sleep harder to maintain. Mood and Cognitive Changes Irritability, anxiety, low mood, and brain fog can appear without a clear reason. These changes are often linked to fluctuating hormone levels, especially estrogen. These symptoms occur because hormonal changes can directly impact brain chemistry and emotional regulation. Some women may also experience perimenopause nausea or even symptoms similar to perimenopause morning sickness, which can feel unexpected during this phase. Understanding that these symptoms may be connected to hormonal changes is an important first step. It helps reduce confusion and encourages timely support. Understanding the SWAN Study and Its Impact Much of what we know about these disparities comes from the largest ongoing study of women and menopause, The Study of Women's Health Across the Nation (also known as SWAN), which began in 1994 with a mission to define this major health milestone for women. This observational study enrolled a diverse group of 3,302 participants, all between 42 and 52 years old (1,550 Caucasian, 935 African American, 286 Hispanic, 250 Chinese and 281 Japanese), in order to gain an unprecedented insight into the physical, biological, psychological and social changes that occur during this transitional period. Before this initiative, most menopause research had been primarily focused on white women. Thanks to SWAN, researchers were able to learn that Black women have a very different menopause experience, both in terms of symptoms and in terms of how structural racism played a role in the care they were able to access. Key Findings on Menopause in Black Women Among the SWAN findings: Black women reach menopause about 8.5 months earlier than white women, and experiences hot flashes, depression, disturbed sleep and other symptoms more often than white women. The study also found that structural racism — discrimination that prevents people of color from accessing goods, services and opportunities at the same rate as their white peers — is a major contributor to the health disparities between Black and white women in midlife. Black women are less likely to receive hormone therapy, mental health services, or medical help in general during menopause. Expert Insights on Perimenopause in Black Women We asked Dr. Maggie Ney, a licensed board-certified naturopathic doctor and co-director of the Women's Clinic at Akasha, about what Black women need to know about peri/menopause symptoms and treatment. Peri/menopause is a subject that is rarely addressed in our society, period, and in Black communities, it's almost never discussed. What advice do you have for Black women experiencing menopause? Differences in Symptoms and Care The SWAN study revealed important disparities in menopause care and experience among Black women. Compared with white women, Black women often enter perimenopause and menopause earlier, experience more frequent and severe symptoms, and have symptoms that persist longer. Hot flashes and night sweats are particularly more intense, but higher rates of sleep disturbance and depressive symptoms have also been reported. Despite this increased symptom burden, Black women are less likely to be offered appropriate menopause care and treatment, and their concerns are more likely to be dismissed or minimized. These disparities are especially concerning given that many OB-GYNs report limited formal training in menopause and perimenopause management. Awareness is essential. Recognizing that symptoms such as sleep disruption, mood changes, hot flashes, and fatigue may be hormonally related can help women seek appropriate care, ask informed questions, and advocate for evidence-based treatment options. According to a 2022 SWAN study, Black women are three times more likely to experience premenopausal symptoms. Do you have any advice on how to navigate these conversations with physicians when our symptoms are being dismissed? Navigating Conversations with Doctors One of the biggest challenges is that menopausal and perimenopausal symptoms are still frequently overlooked or minimized, particularly in Black women. That’s why awareness and self-advocacy are so important. Once you recognize that symptoms such as sleep disruption, anxiety, mood changes, hot flashes, or brain fog—especially when they become more pronounced in your 30s and 40s—may be hormonally driven, you can confidently bring this into conversation with your physician. I often coach my patients on how to approach these discussions in a clear and collaborative way. You might say something like, “I’m aware that Black women can experience menopause symptoms earlier and more intensely. Could hormones or perimenopause be contributing to what I’m experiencing?” A good physician should be willing to listen, explore the possibility, and discuss options with you. And if your concerns are repeatedly dismissed or minimized, it’s okay to seek a second opinion or find a provider with more experience in menopause care. Every woman deserves to feel heard, supported, and appropriately treated. What causes racial differences in the menopausal experience? Though I was taught in medical school that Black women go through menopause earlier, that Black women have more fibroids, that Black women die in childbirth more often, that Black women have more incidences of high blood pressure, and that Black women have more heart disease, I was never taught why. Research has strongly suggested that this situation has to do with the environment and systemic racism. What tips or recommendations would you give to women who are starting to feel some symptoms of perimenopause and want to view it as more of a positive change, rather than something negative that happens to us? Changing the Perspective on Perimenopause When we understand what’s happening in our bodies during perimenopause and menopause, we can become proactive instead of fearful. Awareness changes the conversation. It helps women recognize that these symptoms are not “just aging” or something they simply must endure, and it opens the door to meaningful support and treatment. Perimenopause and menopause can actually be a powerful transition — a time when many women reconnect with themselves, pursue passions, and step more fully into what lights them up. But to do that, we have to feel well. That’s why finding the right resources and individualized care is so important. For some women, that may include lifestyle changes, targeted supplements, nutrition, and stress support. For others, hormone therapy can be life-changing and can significantly improve symptoms, quality of life, sleep, mood, and long-term health. The goal is not just to “get through” menopause, but to feel vibrant, supported, and empowered through this next phase of life. What is some key info to know about Black women's experience with menopause? In the US, the median age for reaching menopause is 51. The research in SWAN shows that Black women reach menopause at 49, two years earlier than the national median age. Black women are also three times more likely to experience premature menopause — that’s menopause before age 40. It's important to know these stats because if you're coming in with menopause symptoms like depression and sleep issues, even hot flashes, in your thirties, your physician may not be trained in peri/menopause and it will not be on their radar. It's up to us really to bring it up and be our own advocates. The SWAN Study's Findings Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women’s Health Across the Nation (SWAN) 46% of Black women, compared to 37% of white women, reported experiencing vasomotor symptoms. 27% of Black women reported clinically significant depressive symptoms, compared to 22% of white women. Black women are 50% more likely to report hot flashes. Black women are more likely to experience depression, though less likely to report sleep problems. Black women are also more likely to have untreated hypertension due to menopause. Black women 22% more likely to report physical limitations due to menopause than white women. FAQs When does perimenopause typically start in Black women? Perimenopause may begin earlier in Black women, often in the late 30s to early 40s, with symptoms developing years before periods completely stop. What makes menopause symptoms different for Black women? The differences are likely multifactorial and may include hormonal changes, chronic stress exposure, social determinants of health, and disparities in access to healthcare and treatment. What are the early warning signs of perimenopause to watch for? Common early symptoms include irregular periods, sleep disturbances, hot flashes, mood changes, anxiety, brain fog, fatigue, and changes in concentration or energy levels. Symptoms can develop gradually and may fluctuate over time. Why is menopause often underdiagnosed in Black women? Menopause symptoms are frequently underrecognized due to lack of awareness, limited menopause education among healthcare providers, and symptoms being attributed to stress, aging, or other medical conditions. How can Black women prepare for or manage perimenopause effectively? Tracking symptoms, prioritizing sleep, nutrition, movement, and stress management, and working with a knowledgeable healthcare practitioner can make a significant difference. Treatment may include lifestyle interventions, supplements, or hormone therapy. The most important thing is knowing that you do not have to suffer in silence, and that effective support and treatment options are available. *The information found in this blog shall not be considered medical advice and is being provided for information purposes only. It is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider should you have any questions or concerns. Blog Updated on: June 1, 2026
