Jihan Myers
Yes, all women go through menopause, but how the experience affects each woman can look wildly different. For Black women, the journey through menopause is often more intense, longer lasting, and less understood by the medical community. Studies show that Black women enter menopause earlier, endure more severe symptoms, and may have less access to effective treatments like hormone replacement therapy (HRT). Read on to learn more about the unique challenges Black women face during menopause and practical strategies for managing symptoms and advocating for better care, which begins with teaming up with a knowledgeable healthcare professional, like a Midi clinician, who understands that each woman’s menopause experience is unique.
How Menopause Affects Black Women Differently
When most women think about menopause, they anticipate hot flashes, mood swings, and maybe some changes in weight. The reality is menopausal symptoms are often more severe for Black women. Though menopause is actually just a moment in time—when you’ve gone 12 straight months without a period—in the five to 10 years leading up to that point, known as perimenopause, bothersome symptoms can begin.
And how each woman experiences perimenopause is highly variable. While some women glide through with minor discomfort that lingers for only a few months (how lucky!), others endure years of relentless symptoms for nearly a decade or more that affect their physical and mental wellbeing.
Research from the study “Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women’s Health Across the Nation (SWAN),” published in 2022, looked at how menopause affects women across races. Read on to find out what they found for Black women.
Earlier Onset of Menopause Among Black Women
Black women, on average, reach menopause earlier—by an average of 8.5 months—than white women, with some entering perimenopause as early as their late 30s or early 40s. While menopause timing may be influenced by genetics, researchers believe that chronic stress, socioeconomic factors, and healthcare disparities also play a role.
Black women are also twice as likely as white women to undergo a total hysterectomy (removal of ovaries and uterus). This procedure kicks off what is called “surgical menopause,” that can also accelerate the timeline for experiencing menopause symptoms for Black women.
Longer and More Severe Symptoms
On average, menopause symptoms can last anywhere from four to 10 years for most women, but Black women tend to fall toward the longer end of the spectrum. This prolonged journey often includes:
- More frequent and intense hot flashes
- Higher rates of depression and anxiety
- Increased difficulty with sleep and night sweats
Earlier onset and worsening symptoms can also increase the risk of cardiovascular health problems, says cardiologist Jayne Morgan, MD, who serves on Midi’s medical advisory board and is the Vice President of Medical Affairs at Hello Heart, specializing in women’s health and cardiovascular research. “Going into menopause earlier means that your estrogen levels start to decrease that much sooner, and estrogen is a cardioprotectant agent, binding directly to receptors on the heart,” she explains. “We also know from research that the higher your number of hot flashes, the greater your risk of narrowing of your arteries and the greater your risk of stroke.”
Higher Levels of Stress and Other Societal Factors
Black women often deal with chronic stress from systemic racism, workplace bias, and economic disparities, which can exacerbate menopause symptoms. The “weathering hypothesis” suggests that the cumulative stress of navigating life as a Black woman can lead to accelerated aging and hormonal changes, making menopause arrive earlier and hit harder.
Dr. Morgan agrees: “The weathering effect is the result of high effort coping at all times in your life—what it takes to navigate the world in the United States as a black woman being born here, having to grow up here, understanding how people perceive you, and always working against stereotypes. That chronic load of stress also increases inflammatory processes that accelerate heart disease and also are probably contributory to earlier menopause.”
Access to Care and Menopause Symptoms Among Black Women
The Hormone Replacement Therapy (HRT) Care Gap
Despite the effectiveness of hormone replacement therapy (HRT) in managing severe menopause symptoms, Black women are less likely to be prescribed hormone replacement therapy for menopause symptoms than white women, shows research. Unconscious racial bias plays a role here too, as does lack of access to providers.
As we know, this can have a serious ripple effect as HRT can be protective against the risk of cardiovascular conditions, including heart disease and stroke. In fact, a 2021 study in the Journal of the American Heart Association found that when vasomotor symptoms (hot flashes and night sweats) went untreated with HRT, it increased the risk for cardiovascular events later in life.
At Midi, we understand the different factors that women of different racial groups are up against. All of our clinical protocols consider race and culture, ensuring every patient gets the personalized care they deserve.
Why Black Women Face More Severe Menopause Symptoms
The SWAN study authors said that while we don’t know exactly why Black women tend to fare worse during menopause and in the years leading up to it, they emphasized the “role of social disadvantage, which we argue is likely related in part to structural racism, as an important driver of many of these disparities.”
That said, there’s still a lot women can do to be proactive and advocate for themselves so that they get the care they deserve.
Managing Menopause Symptoms with Hormone Therapy and Other Treatments
Regardless of race, there are things you can do to mitigate the symptoms of menopause. When you work with a healthcare provider, like a Midi clinician, who understands your unique experience, you can find relief.
Hormone Replacement Therapy (HRT)
The name is a bit misleading—you’re not replacing any hormones in your body as much as you’re supplementing them as they decline. Hormone replacement therapy (HRT), sometimes referred to as menopause hormone therapy, is the most effective treatment for managing menopause symptoms that result from the rapidly fluctuating changes in estrogen and progesterone.
HRT takes many forms, including a patch, pill, cream or gel, and has been shown to be the most effective treatment for things like hot flashes and vaginal dryness. While not every woman is a candidate for HRT, most can safely take it, according to the Menopause Society, which is the leading organization in understanding and researching the health of mid-life women. If hormone therapy is not presented to you as an option, don’t be afraid to ask. Discussing HRT with your doctor or a Midi clinician can help you make the right decision for you, your symptoms, and your approach to health.
Other Treatment Options
Beyond HRT, there are a host of other hormonal, non-hormonal, and lifestyle solutions you can try to mitigate your symptoms, including:
- Hormonal birth control can relieve perimenopause symptoms including menstrual irregularity, heavy menstrual bleeding, menstrual pain, and vasomotor symptoms. And let’s not forget that it prevents pregnancy, which is a real possibility when you’re still getting your period.
- Certain non-hormonal prescription medications, like antidepressants, have been shown to greatly improve hot flashes.
- Wellness therapies have also been shown to make a significant difference in perimenopausal symptoms. For instance, a study in the Journal of The North American Menopause Society states that cognitive behavioral therapy (CBT) can be used to improve hot flashes, depression, and other menopausal symptoms.
- Botanicals and dietary supplements such as black cohosh, soy, calcium, and vitamin E may bring relief for specific symptoms.
And don’t discount lifestyle adjustments. Getting enough physical activity, sleep, and eating a well-balanced diet can all help reduce certain menopause symptoms. Studies have shown carrying extra weight, too much alcohol, and lack of exercise are all associated with more severe symptoms.
Dr. Morgan also recommends keeping a close eye on your blood pressure. “Blood pressure is an incredible risk factor for heart disease,” she adds. “If your blood pressure is increasing because your arteries are stiffening and your estrogen levels are dropping, you may have your blood pressure going up and feel normal because high blood pressure is oftentimes asymptomatic. That's why it's called a silent killer.” Using an at-home blood pressure cuff can help you track your readings and spot increases more readily.
Another tip that may help circumvent medical gaslighting and potential biases to your care: When you’re getting in-person tests done, always ask for a blood pressure reading and an EKG, which looks at heart function, advises Dr. Morgan. “We want to make certain that those two things are done because those are the two things that the medical community cannot ignore,” she adds. “Physicians can't ignore you if your blood pressure is high—they have to treat it. If your EKG is abnormal, there has to be follow up for that. Men often get EKGs as part of their physical exams. Women don't.”
Bottom line: Even if you feel like the odds are stacked against you, there’s a lot you can do to take control of your perimenopause and menopause experience and your overall health. You don’t have to struggle through years of discomfort. Teaming up with the right healthcare professional, like a Midi clinician, who honors your unique experience can be a gamechanger for your experience and overall health.
The Takeaway
- Black women experience earlier and more severe menopause symptoms.
- Chronic stress, racism, and healthcare disparities worsen menopause outcomes.
- Black women are less likely to receive hormone therapy despite its benefits.
- Lifestyle changes, natural remedies, and seeking menopause-trained healthcare professionals, like Midi clinicians, can help.
- Advocacy and open discussions about menopause are essential for better care for all women.
Frequently Asked Questions (FAQs)
Does race affect menopause?
Yes, studies show that Black women enter menopause earlier (by an average of 8.5 months) and endure more severe symptoms when compared to white women.
How does menopause affect Black women?
Black women experience longer-lasting hot flashes, worse sleep disturbances, and higher risks for depression, anxiety, and cardiovascular events, like stroke.
How do Black women deal with menopause?
Black women, like all women, can benefit from treating their menopause symptoms, whether through hormone replacement therapy, other hormonal and non-hormonal medication, as well as lifestyle changes (diet, exercise, stress management) and alternative therapies.
If you’re in perimenopause or menopause and want guidance from clinicians who specialize in women’s midlife health, book a virtual visit with Midi today.
Hormonal change is at the root of dozens of symptoms women experience in the years before and after their period stops.
Our trained menopause specialists can help you connect the dots to guide you towards safe, effective solutions.
Whether you need personalized guidance or a prescription routine to tackle symptoms—including brain fog, hot flashes, sleep trouble, mood swings, and weight gain—we’ve got you covered.
Midi’s mission is to revolutionize healthcare for women at midlife, wherever they live and whatever their health story. We believe that starts with education, to help all of us understand our always-changing bodies and health needs. Our core values guide everything we do, including standards that ensure the quality and trustworthiness of our content and editorial processes. We’re committed to providing information that is up-to-date, accurate, and relies on evidence-based research and peer-reviewed journals. For more details on our editorial process, see here.
