Health Gap: Menopause and Black Women

Menopause is an important transition in a person’s life. Defined as the period of time after a person has stopped menstruating, menopause usually occurs between the ages of 40 and 58. Symptoms related to menopause include vasomotor symptoms (hot flashes and night sweats), sleep disturbances, mood changes, genitourinary syndrome, cardiovascular and metabolic changes, and loss of bone mineral density.

While everyone experiences menopause differently, for black women the change can start earlier, be more physically and emotionally challenging, and cause more severe symptoms than white women.

Throughout menopause, black women are reported to have higher levels of vasomotor symptoms (such as hot flashes and night sweats), poorer sleep quality and shorter sleep duration, and a risk increased depression. Black women in pre-menopause or early perimenopause experience vasomotor symptoms at a higher rate than white women and experience them for a longer period of time. Black women also have higher rates of depressive symptoms during menopause, which are due in part to socioeconomic factors like increased stress and less social support than their white counterparts. Together, these factors can also negatively impact sleep quality.

Illustration by Mira Norian for Verywell Health

This disparity is due to a combination of environmental and socio-economic factors. The increased stress and trauma that black people face due to continued discrimination, reduced access to health care, and varying degrees of economic benefits play a large role in the disparity of experiences. Black people face daunting barriers to care due to structural racism in the medical community, which influences risk factors and lifestyle factors that impact menopause. All of this makes it more difficult to relieve symptoms.

For black women, menopause can start earlier, be physically and emotionally more difficult, and cause more severe symptoms than white women.

To help understand these inequalities, our Health Divide on menopause and black women provides:

Discussion of the main symptoms of menopause and their impact on black women Expertise from Dr. Monique Rainford, OB-GYN, assistant clinical professor at Yale Medicine and member of the Medical Expert Council of Verywell Health Personal stories of four people who have experienced menopause in connection with our partner Parlons Menopause

Read on to learn more about the challenges affecting black women going through menopause.

– Dr. Jessica Shepherd, OB-GYN and Chief Medical Officer of Verywell Health

Illustration by Mira Norian for Verywell Health

Menopause Symptoms Ask the Expert Monique Rainford, MD

Obstetrician-gynecologist, assistant clinical professor

Monique Rainford, MD, is board certified in obstetrics and gynecology and is currently an assistant clinical professor at Yale Medicine. She is the former chief of obstetrics and gynecology at Yale Health.

Read more How is the menopause experience different for black women?

Dr. Rainford: Black women are 50% more likely to have vasomotor symptoms such as night sweats and hot flashes, have symptoms for an average of 3.5 years longer than white women, and are less likely to receive hormone therapy. However, although they have more symptoms and a longer duration of symptoms, they are less likely to receive treatment. This implies that they bear a higher burden of suffering from these symptoms during these years.

What is the impact of problems of access to care on black women in menopause?

Dr. Rainford: Black people are one and a half times more likely to be uninsured than white people and more likely to have Medicaid or public insurance than white people (38% to 20% in 2021). Research has shown that with Medicaid insurance, individuals are 1.6 times less likely to successfully schedule a primary care appointment and 3.3 times less likely to schedule a specialty appointment. As a result, lower overall insurance rates and lower private insurance rates result in reduced access to primary care for issues such as menopause. And since Medicaid is less widely accepted than private insurance, that not only means less access to primary care provider choices, but likely less access to providers who specialize in menopause treatment. Additionally, implicit and explicit biases can affect how seriously their concerns about their menopausal symptoms are taken and how effectively they are addressed.

What treatment options are available to help manage menopausal symptoms?

Dr. Rainford: Treatment options for menopause include hormone therapy, usually in the form of estrogen and if a woman still has a uterus, a progestin is often added to protect the lining of the uterus from developing abnormal changes. Treatment can be oral or topical medications such as patches, gels, or sprays. Other options include certain medications that are commonly used to treat depression. These antidepressants may improve menopausal symptoms in women who do not have depression. Also, since alcohol and caffeine can make symptoms worse, women with symptoms can try reducing them to try to improve their mood.

How would you recommend women discuss menopause with their health care providers?

Dr. Rainford: Women should raise concerns if their menopausal symptoms are bothersome. If they find that their symptoms are not being adequately addressed at a particular visit, they should schedule a follow-up. Likewise, if they are not comfortable with their suppliers or feel that their supplier is not meeting their needs, they should look for another supplier. Women should not give up on treating their symptoms. Sometimes it takes persistence and multiple visits or getting a second opinion from another provider.

Key words

Menopause Perimenopause Hormonal therapy Hot flushes Night sweats

Menopause

Menopause is the biological process marked by a hormonal drop that causes the cessation of menstruation. It is diagnosed when a person has not had a period for 12 consecutive months.

Perimenopause

Perimenopause is the stage preceding menopause which is marked by a gradual and natural decrease in estrogen hormones and the onset of menopausal symptoms.

Hormone therapy

Hormone therapy is a medical treatment used to increase or decrease hormone levels. At menopause, hormone therapy can replace the decline in estrogen and progesterone to help improve symptoms.

Hot flashes

Hot flashes are brief periods when a person suddenly feels hot and develops sweating and flushing, usually on the face, neck, and chest. They are more common during menopause.

Night sweats

Night sweats are night sweating experiences during sleep. They are a common symptom of menopause.

Personal stories Learn more about menopause About our partner

Let’s Talk Menopause is a national 501(c)(3) nonprofit organization invested in changing the conversation around menopause so that women get the information and healthcare they deserve. The organization empowers women to navigate through all stages of menopause, advocates for change in the medical community’s investment in menopause care, and facilitates community and support by connecting women in the transition from menopause. Let’s Talk Menopause provided Verywell Health with the personal story links for this Health Divide.

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