No two women experience menopause the same way—not even biological relatives— and there are no guarantees of when, how long, or how intense menopause will be for any given person.
However, there is a difficult truth: Black and brown women generally experience a more difficult, lengthy and early perimenopausal journey than their white or Asian counterparts. In fact, Asian American women suffer the least. (And women in Asian countries suffer less than women in the western world.)
Results from the Study of Women’s Health Across the Nation (SWAN) indicated that women of color are more likely to experience perimenopause earlier and face higher risks because of it.
Multiple reviews have been done on this work, and the dataset continues to have new insights.
Perimenopause for women of color: Yes, it's harder
As we mentioned before, the majority of what is known today about how aging women experience menopause is sourced from a mass study of women through SWAN, which has been ongoing since the late 90s. This study, which included women from a variety of backgrounds, has focused on the wide range of changes that can be experienced from the point of starting perimenopause onwards. Studying a diverse group of women has helped researchers make observations into how women’s hormones change based on their ethnicity, income level, and more.
Take the average age for showing signs of menopause. The SWAN study found that Black women tended to show what the medical establishment deems as perimenopause symptoms around the age of 49—nearly a year before their white counterparts. Latina women participating in the study also experienced signs earlier than white women.
In addition, Black and brown women are not only experiencing perimenopause earlier, they’re also feeling premenopause symptoms more intensely than white or Asian women typically do, and for a longer period of time.
As a whole, white women go through perimenopause and then menopause for about 6.5 years before becoming post-menopausal. Latina women have been found to extend that time period to almost 9 years, with Black women reporting the longest times at around 10 years. That’s close to a decade of bad sleep, sore breasts, hot flashes and more. Simply put, women of color are spending more time living with their fluctuating hormones than white women are.
Longer, tougher, earlier perimenopausal symptoms: Why?
There are a number of reasons—and subsequent reviews put a new lens on it. Some of the things that researchers believe are linked to perimenopause:
- Financial security and income
- Pre-existing conditions such as high blood pressure or diabetes
- Allostatic (ongoing) stress
- Childhood trauma
- Body Mass Index (BMI)
- Age of the first period and first pregnancy
- History of medical & mental health care may be factor
Many of these are known as social determinants of health - when you have more resources, stability and education, you are generally healthier.
To put it plainly, is systemic racism and inequity part of this large disparity? When it comes to economic equity and health access, the data says yes.
Resources = health
When data sets were adjusted to look at women of similar socioeconomic and social status regardless of race, the racial differences were not a factor.
In other words, fewer resources you have, the harder perimenopause is likely will be.
Black, brown and indigenous women tend to check more of the boxes leading to perimenopausal symptoms because of their systemic and socioeconomic circumstances and a whole host of other factors. These include disparities in healthcare, opportunity and the workforce. With more difficult circumstances come more allostatic stress, which also exacerbates perimenopausal symptoms.
When data sets were adjusted to remove race as the determining factor and to look at an equal playing field of socioeconomic status, the racial differences were not a factor.
Meaning it's likely situational and systemic challenges, not genetic or inherently racial differences, that create this divide.
Racial Disparities in Women’s Healthcare
In addition to having to deal with difficulties for longer, early-onset perimenopause can potentially drive other health issues like osteoporosis, heart disease, and other deadly conditions like ovarian cancer. This makes early awareness and monitoring essential.
Celebrity Gabrielle Union recently opened up about her experience with perimenopause on “The View.” She described how her fluctuating hormones caused her to gain weight, lose hair, and even struggle with thoughts of suicide. It was only after discussing her symptoms with her therapist that she realized something bigger could be at play with her health.
For women of color who are more likely to experience health issues related to perimenopause, taking early steps can mean the difference between a long healthy life and the alternative. And herein lies the rub: For women of color, simply sharing symptoms is not enough. Women of color need someone to believe their symptoms and believe their experiences.
Medical gaslighting is far too common for women in general, but it rings especially true for Black women and other women of color. Being told that an issue is in a person’s head and dismissing them can stop women from seeking medical care, which can lead to a delay in treatment or neglect of it altogether.
Take this alarming statistic: Black women in the United States are over three times more likely to die in pregnancy or postpartum than white women due to conditions like pregnancy-related cardiomyopathy or blood pressure disorders. Past studies also showed that Black women were offered or prescribed Hormone Replacement Therapy less often than white women, despite symptoms.
There's also an ugly history with people of color and the medical establishment. This can make women less likely to seek medical care. This goes back to being subjected to medical research without information or consent, all the way to a racial disparity in pain medications.
Simply put, the American healthcare system has a massive issue with healthcare equity, and the people who suffer most are women of color.
Dealing with it
It's not surprising that Black women are less likely to speak to a doctor about perimenopause than white women. In addition to the issues already covered, there are fewer providers of color or culturally aware practitioners in both medical and mental health specialties.
So what do women do? Talk to friends and family. While greater community connection within communities of color is a positive, there are indications that friends and family may counsel each other to just get through it.
Interestingly, another study found that even though women of color experience more symptoms than others, they report suffering less. They are less likely to report that the symptoms are interfering with their lives. This may be a continuation of the "strong woman" expectation society puts on women of color, it may be greater community support or a number of other factors for all of us to learn about and, perhaps, learn from.
What perimenopausal women of color can do
All of this news can feel particularly discouraging, but not particularly surprising if you have been living it.
When it comes to taking actual, tangible actions to protect reproductive (and, by proxy, mental) health, there are a few things that women of color can do to protect themselves from perimenopause. First and foremost is to find healthcare providers who listen and acknowledge the racial disparities in healthcare. Other steps that can be taken include:
- Find a gynecologist who specializes in treating perimenopause and can help manage the worst of the fluctuations. While this is an undertaking for any woman, the North American Menopause Society certified database is a place to start.
- Take simple steps to help mitigate stress, including time in nature, walking, journaling or breath work.
- Seek mental health support to help process grief, stress and trauma. This is another area where more providers of color are sorely needed, and cultural barriers have been a factor. Finding providers within the community can be difficult, there are more online therapists providing group and virtual support and may be an option.
- Work with natural supplements. Some plant materials have been found to soothe symptoms like hot flashes, stress and challenging periods and PMS.
- Supporting others in your community to seek help and referring trusted providers to normalize care, including mental health services.
Every woman truly is different, so Wile has created regimens to mix and match, meeting your needs, not assuming we are all the same. Our product quiz is a place to start and evaluate if our products may be part of your toolkit.
What white (and all) women can do
Let's acknowledge even privileged women haven't exactly been heard by the medical establishment—perimenopause, HRT and women's health in genera are woefully under-researched and under-trained.
However, it is up to us to agitate for change. Here are some ideas that any woman with privilege—including the advantages of time and other resources—can undertake.
- Share and refer great health care providers widely with your networks. Leave positive, detailed reviews online to lessen the labor finding them.
- Pressure your healthcare systems to include more transparency and higher quality of care and diversity of staff for perimenopausal women, from GPs and internists, mental health to OB/GYNs and empowered nurse practitioners.
- Expand your social networks and world views to be more diverse.
- Vote with your dollars by doing business with more local, black- and brown-owned businesses and community organizations that support communities of color. Black women are the largest and fastest-growing cohort of new business owners in the U.S.
- Urge change. Understand that we vote for the health of our entire communities when we vote in elections. Local elections—often skipped—can have the biggest impact of all.
- Talk about and normalize conversations around perimenopausal health.
- If you are an employer or manager, support those on your team with flexibility where you can.
We're all in this together and these actions will benefit many of us, including those who come after us.
Avis, Nancy E, et al. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition, 2015 April JAMA Intern
Crowley, James. “Hollywood Life.” Hollywood Life, September 14, 2021. https://hollywoodlife.com/2021/09/14/gabrielle-union-suicidal-thoughts-perimenopause/.
Fraser, Sarah. “The Toxic Power Dynamics of Gaslighting in Medicine.” Canadian Family Physician 67, no. 5 (May 1, 2021): 367–68. https://doi.org/10.46747/cfp.6705367.
Harlow, Siobán D, et al, Disparities in Reproductive Aging and Midlife Health Between Black and White Women: The Study of Women's Health Across the Nation, 2022 Feb 8, Women's Midlife Health
Levine, Beth. “Racial and Ethnic Disparities in Menopause.” EverydayHealth.com, January 13, 2022. https://www.everydayhealth.com/menopause/what-experts-want-bipoc-women-to-know-about-menopause/.
Weng, HH, et al. Racial Differences in Physician Recommendations of Hormone Replacement Therapy, 2001 Dec, Preventative Medicine
Williams, Makeba MA, NCMP, FACOG, et al, A review of African American women's experiences in menopause. 2022 November Menopause
This article is intended for informational purposes and is not intended to replace a one-on-one medical consultation with a professional. Wile, Inc researches and shares information and advice from our own research and advisors. We encourage every woman to research, ask questions and speak to a trusted health care professional to make her own best decisions.