MenoLabs News | Thu, Apr 06, 2023

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.

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.

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.

 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?

What the SWAN study revealed is that Black women go through menopause and perimenopause earlier than white women, and have more significant menopausal symptoms that last longer: Black women have more significant menopausal symptoms such as hot flashes and night sweats, in particular, but also depression and sleep disorders. And they are also not being offered the same care as white women. Their symptoms are more often dismissed and they're not given treatment options.  We also know that about 80% of OB-GYNS report not having the training in menopause and perimenopause, so until that happens, women need to be their own advocates. It starts with really just being aware that these symptoms can be related to hormonal changes and to menopause.

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? 

Symptoms are often not recognized or are dismissed, so what I recommend is, if we are aware and knowledgeable that these symptoms could be related to hormones, we just have to bring it up to our doctors. I do a lot of coaching with my patients on how to best speak to their doctor, and what I recommend is saying something along the lines of, “I'm aware that Black women have more significant menopausal symptoms than white women, and that these symptoms can start earlier. Do you think that this could be going on with me?” If your doctor is dismissive, then, then really it is time to look for another doctor.

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? 

When we are aware of what is going on with our bodies, that’s when we can be proactive. It takes away some of the fear around what's happening, and once the fear is gone, we can take action to feel better. Peri/menopause is really the time in our lives when we can pursue our passion, pursue what drives us, what lights us up. But in order to do this, we have to feel good, so finding the right resources is really important.

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

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.

Resources

Visit the North American Menopause Society (NAMS) website “Find a Menopause Practitioner” feature to find a menopause clinician who is right for you

To listen to the full conversation and more in depth discussion about everything from Heart Health to HRT, click here