Roughly 6,000 women in the United States enter menopause each day, and for some it can feel like navigating uncharted waters. Menopause, which begins 12 months after a woman’s last menstrual cycle, typically occurs between the ages of 40 and 55, with the average age being 51 in the U.S. The transition usually lasts for seven years, but symptoms may not always be present, and for some, they can last longer or be more severe.
And while the process can be challenging for anyone going through it, research has shown that the length, frequency and severity of symptoms of menopause can look different across races.
In fact, a recent two-decades long study found that women of color reach menopause 8.5 months earlier than white women, and have worse symptoms like hot flashes, depression, and sleep disturbances.
What the research shows
Beginning in 1994, a landmark study of the racial discrepancies in menopause, the Study of Women’s Health Across the Nation (SWAN) followed more than 3,000 Hispanic, Japanese, Chinese, Black, and white women in seven cities for more than two decades.
What they found was Black and Hispanic women reach menopause earlier than white, Chinese, and Japanese women, and Black and Hispanic women experience menopause symptoms for 10 or more years – twice as long as white, Chinese, and Japanese women.
The most common symptom that plagued all women were hot flashes, which led to night sweats that disrupted sleep schedules and daily activities like work and exercise due to fatigue. But the study also found that Black women experienced more intense, frequent, and the longest duration of hot flashes.
Monica J.R. Williams, MD, CEO and Lead Physician of Deep Rooted Health, LLC says that there is also evidence that even though Black women are less likely to self-report sleep problems, they are more likely to have objectively measured poor sleep quality when a thorough history is taken.
But the reason for why certain symptoms are worse for some races opposed to others is not perfectly clear, and is often nuanced.
“The disparity in how Black women experience menopause is not attributed to a singular cause, but rather a multi-faceted issue,” says Dr. Williams. “It spans from instances where healthcare providers might not offer treatments to their African American patients or do so less frequently, to the presence of comorbidities that may deem them less suitable candidates for treatment. This complex situation extends to instances where Black women themselves might decline treatment due to miseducation, coupled with a historical mistrust of the medical system based on past mistreatment.”
The study also found that women of color tend to undergo surgical menopause at earlier ages, meaning they are more likely to have surgery removing their reproductive organs. This is likely due to the high rates of other gynecological disorders like fibroids in women of color.
Karla Robinson, MD and Medical Editor at GoodRx says that there is also an interesting connection that researchers are exploring between stress and the early onset and severity of menopause.
“There’s this notion of “weathering” or accelerated aging that can be seen in Black women facing high levels of stress from structural racism and other socioeconomic factors,” says Dr. Robinson. “Over time, these factors may lead to chronic inflammation that decreases overall health and may be contributing to early menopause as well. Research is ongoing to determine the factors that may be contributing to these differences.”
A larger systemic issue might be at play
Entering into menopause can come with a slew of questions and fears, but when women of color seek medical attention during this transition they are more likely than white women to encounter doctors who do not have their lived experiences.
As of 2019, when the data was last collected, only 6 percent of the physician workforce was Black, and only 36.3 percent were female, according to the Association of American Medical Colleges. And this glaring underrepresentation of women of color within the workforce reverberates throughout the healthcare system, says Dr. Williams.
“The scarcity of African American physicians also diminishes the potential for culturally sensitive and patient-centered care,” she adds. ”Contributing to unequal treatment and ultimately impeding efforts to improve health outcomes for Black women when compared to their white counterparts.”
Women of color might also feel that their concerns or pain are not taken seriously by their physician, which can lead to mismanaged or unmanaged menopause symptoms. This has been shown to increase the risk of long-term chronic diseases, and can cause worsening mental health symptoms that can affect their overall quality of life.
“When a Black woman enters a hospital, her concerns may be dismissed, her pain underestimated, and her voice marginalized,” says Dr. Williams. “These biases are products of a system that has perpetuated stereotypes and implicit biases, eroding trust between Black patients and healthcare providers. This trust gap translates into delayed or inadequate care, resulting in preventable complications that spiral into tragic outcomes.”
And this bias is also notably evident in maternal care, with women of color impacted in much greater numbers.
Pregnancy-related mortality rates among Black and American Indian and Alaska Native (AIAN) women are over two times higher, compared to the rate for white women. Black, AIAN, and Native Hawaiian and Other Pacific Islander (NHOPI) women also have higher rates of pre-term births, low birthweight births, or births for which they received late or no prenatal care compared to white women.
This disparity is a result of structural racism, medical mistreatment, and a general lack of healthcare access and proper prenatal care, says Dr. Robinson. The differences in health insurance coverage, access to quality care and basic education all play a role in driving worse maternal and infant health outcomes for people of color.
“The lack of health equity in our society is a longstanding issue that exists along racial, socioeconomic, and gender lines,” says Dr. Robinson. “Additionally, our healthcare system is difficult to navigate. If you add this to a lack of exposure and access to the healthcare system, this can make it hard for some Black women to advocate for themselves. And this can also impact the care they receive.”
What this means for women of color
While it’s clear that women of color who receive inadequate menopausal care have worse health outcomes, there is promising work happening. With in-depth research like SWAN study, increasing numbers of women entering the medical field, and a growing list of startups that offer virtual and hybrid care for menopause symptoms, doctors are excited for what the future of menopausal care may hold.
“My hope is that as we continue to bring these issues to the forefront, we will see a culture shift and the health equity issues of Black women, and women as a whole, will decrease” says Dr. Robinson.
But for women of color navigating menopause who are concerned about receiving adequate care, Dr. Williams recommends several proactive steps.
She says to first and foremost, advocate for yourself confidently within the healthcare system. This includes communicating your symptoms, concerns, and expectations clearly to your healthcare provider.
“Seeking a provider who values cultural competence and demonstrates an understanding of diverse experiences can significantly enhance your care,” says Dr. Williams. “Additionally, consider seeking a second opinion if you feel your concerns are not being addressed adequately.”
She also recommends empowering yourself with knowledge by researching menopause and its impact on women of color, which can enable you to have informed discussions with your healthcare provider. And lastly, engage in support networks, both online and offline, where you can connect with other women of color facing similar experiences, exchange advice, and share insights.
“I would add that although the research demonstrates that Black women suffer disproportionately from the effects of uncontrolled menopausal symptoms, they have no less of a desire than their counterparts to have relief and quality of life,” says Dr. Williams.