30 years of research shows we can and should be doing a lot better.

By Selene Yeager

February is Black History Month in the U.S. (It’s October in the U.K. and July in Australia) — an annual celebration of achievements by Black Americans. And there are many in the menopause space.

There are researchers out there doing essential work like Monica Christmas, MD, director of the Menopause Program at the University of Chicago Medicine, Sherri-Ann Burnett-Bowie, MD, MPH, Associate Professor of Medicine, Harvard Medical School, and Tené T. Lewis, PhD, Associate Professor in the Department of Epidemiology in the Rollins School of Public Health at Emory University, all of whom are among the investigators working on The Study of Women’s Health Across the Nation (SWAN), a decades long multi-site longitudinal, epidemiological study designed to examine the health of women during their middle years and which has examined the health of midlife women across ethnicities. 

And, of course, there are high profile Black women opening up and normalizing the conversation surrounding menopause. I appreciate Michelle Obama for kicking down the door in 2020 and being open about how her hot flashes were unbearable and how hormone therapy helped. When people were still reluctant to talk publicly about menopause, CBS News' Gayle King spoke on air about crime scene periods and how she’d never even heard the word perimenopause until she went to her doctor. And, of course, Oprah Winfrey showed us that even if we have a billion dollars and boatloads of power at our disposal, our doctors can still miss menopause when we come in thinking we’re dying from heart palpitations. 

Black History Month is also a good time to take a closer look at the racial inequities that still exist in the realm of menopause. Research shows menopause starts earlier and is more challenging for Black women than for other races and ethnicities.

Way Past Time We Do Better

In doing some background research for this blog, I came across a study from 1994 titled Menopause and African-American women: clinical and research issues that noted: “Unfortunately, there is very little epidemiologic data on menopause or its antecedents in African-American women or in women of other minority groups...To stimulate epidemiologic research into the process of menopause among African-American women, this report will examine data from clinical and government sources. A common problem is that these sources overlook aspects of menopause important for the health of black women in mid and later life, such as menopause-associated symptoms, potentially beneficial hormonal therapies, and potentially debilitating skeletal disease.” 

And this is the opening paragraph of a paper titled A review of African American women's experiences in menopause in the November 2022 edition of Menopause…nearly 30 years later: “Little is known and reported about the experiences of African American women as they transition to and experience menopause. Accepted norms are based on the experience of a predominantly White population. The aim of this study is to review available data about the distinct experiences of African American women during the menopause transition and menopause.”

Everyone knows how women as a whole have been overlooked by research and medicine. Everyone knows about the dearth of research on menopausal women. Black women in menopause have been exponentially overlooked. 

That’s not to say we haven’t learned anything over the decades. We have. But the truth is, it’s not great. A 2022 scientific review of 25 years of research based on SWAN reported that Black women reach menopause 8.5 months earlier than White women and have worse symptoms such as hot flashes, depression and sleep disturbances, but are less likely to receive hormone therapy, as well as medical and mental health services. This report echoes earlier SWAN findings that Black women were 50 percent more likely than White women to have vasomotor symptoms like hot flashes and night sweats and also endure hot flashes longer – 10 years versus 6.5 for non-Hispanic White women.

Research indicates that chronic exposure to racism is to blame, as the daily stress it brings can cause early health issues. In reference to the 2022 review, lead author Siobán Harlow, professor emeritus at U-M’s School of Public Health said in a press release: “Our analysis suggests that the enduring influence of structural racism — differential access to the goods, services, and opportunities of society by race — is a major contributor to the health disparities between Black and White women in midlife.” 

These findings were echoed by a study presented at the 2023 Annual Meeting of The Menopause Society this past September showing again, that even though Black women have more menopause symptoms, they still receive less treatment than White women. They may also be less likely to report their symptoms and to minimize their suffering. 

“I had noticed for years that Black women were very quick to deny menopause symptoms unless specifically asked if they had X, Y, or Z symptoms and even less likely to admit that symptoms were interfering with daily life,” said Dr. Sally MacPhedran, co-author of the study and an associate professor in the Department of Reproductive Biology at Case Western Reserve University School of Medicine in a press release. “This study really solidified what I had observed in clinical practice and that is that many Black women downplay and normalize menopause symptoms even when their quality of life is impacted.”

The research reinforces that healthcare professionals must ask patients about their specific menopause symptoms so they can discuss the options that could help them improve their quality of life,” said Dr. Stephanie Faubion, medical director for The Menopause Society in the release. “Black women should have the same access as White women to the available treatment options.” 

We couldn’t agree more. 

For more resources on communities talking about the experience of Black women in menopause, check out:

Black Women's Health Imperative (BWHI)

Black Girls Guide to Menopause

Black Women in Menopause 

Menopause Whilst Black 

Black Menopause and Beyond

The Black Menopause Collective

Menopausal Black Woman