Black women often experience earlier, longer, and more severe menopausal symptoms. According to a 2022 landmark study of Women’s Health Across the Nation (SWAN), on average, Black women reach menopause 8.5 months earlier than white women. Black women also tend to experience more frequent and intense hot flashes (vasomotor symptoms) and higher rates of depression and anxiety.
While genetic research continues to unravel the biological reasons behind this phenomenon, socioeconomic factors, chronic stress, and healthcare discrimination may contribute to this disparity.
At the same time, many clinicians report limited training in perimenopause management.
A 2022 survey of 99 U.S. obstetrics and gynecology (OB/GYN) residency program directors found that only 31.3 percent reported having a menopause curriculum in their program, meaning 69 percent of OB/GYN graduates have no menopause education.
With perimenopause and menopause gradually becoming destigmatized in conversation, it’s just as important that clinicians be prepared to support patients navigating this pivotal — and inevitable — life stage.
Here’s how physicians can support their patients.
Perimenopause is the transitional period leading up to menopause, when women’s ovaries gradually produce less estrogen. This change in hormone levels can lead to significant physical and emotional side effects like hot flashes, mood swings, sleep disruption, weight gain, and more.
Perimenopause affects each person differently, but there are surprising trends among Black women. The average age of menopause is 51, but for Black women, the median age of menopause is 49.3 years. One study suggests that current and past smoking habits are linked to earlier menopause among African American women. And Mayo Clinic data found that early menopause has serious risks. “The long-term consequences of premature or early menopause include adverse effects on cognition, mood, cardiovascular, bone, and sexual health, as well as an increased risk of early mortality,” the 2015 Climacteric article said.
In addition to smoking, higher body mass indices (BMIs) and persistent psychosocial stress are contributing factors. The weathering effect is at the heart of the matter, and SWAN data showed that higher levels of everyday discrimination were associated with increased vasomotor symptoms.
But Sophia Yen, MD, MPH, MSCP, co-founder of Pandia Health, said that “even after adjusting for socioeconomic status, BMI, smoking, discrimination, depression, and anxiety, Black women continue to have more severe and longer-lasting VMS. This suggests that additional unmeasured biological, genetic, or social factors contribute to the disparity.”
UK-based pharmacist and functional medicine health coach with Wellnaissance, Sheree-Ann Michelle, coaches many women battling burnout with under-diagnosed hormonal and biological issues. She also notes evidence that lifestyle factors associated with health inequity, including sleep disruption, dietary patterns, and reduced access to preventative healthcare, compound the hormonal picture.
“And critically, Black women are significantly less likely to be offered or to receive hormone replacement therapy, meaning their symptoms are more likely to go unmanaged for longer,” she explained. “This is not biology. It is the physiological consequence of systemic inequality, and it demands a clinical response that acknowledges that reality.”
In Michelle’s experience, Black women often wait several years before receiving an accurate diagnosis or appropriate perimenopause treatment. “Symptoms are attributed to stress, depression, or lifestyle rather than being recognized as a hormonal transition requiring clinical support,” she noted.
Not all clinicians received adequate training on perimenopause management. However, many clinicians are independently trying to learn and support patients. “Many are starting to educate themselves through seeking additional education through groups like the Menopause Society, ACOG, online courses, HERmedicine, and Harvard’s coursework,” said Sameena Rahman, MD, a board-certified OB/GYN and certified Menopause Practitioner in Chicago.
Other organizations or initiatives include Power in the Pause by Black Women’s Health Imperative (BWHI), MenoThrive Wellness, and Let’s Talk Menopause.
Physicians can also learn more about the socio-cultural reasons why early menopause may hit Black patients differently. For example, Dr. Itunuoluwa Johnson-Sogbetun’s A Personal Guide to Menopause for Black Women explains feelings of grief that might go unsaid, like Black women’s “unexpected singlehood” at this stage of life and “the mental load Black women carry” to overperform at work while experiencing debilitating symptoms.
Clinicians can gently suggest lifestyle changes that may alleviate perimenopausal symptoms, including sleep assistance, exercise, stress reduction, nutrition, and community groups.
“Offering and educating women of color on the use of menopausal hormone therapy and building bridges to medical care and research are important,” Dr. Rahman said, “especially for a system that has given women of color more than enough reasons not to trust them.”
Crucially, clinical guidelines and assessment tools should be updated to reflect the diversity of perimenopausal experience, but until then, a one-size-fits-all approach won’t do.
Dr. Yen points to new research conducted by experts in Nigeria and the U.S. on the treatment option fezolinetant (Veozah). Also, elinzanetant (Lynkuet), which recently became FDA-approved, is a neurokinin receptor antagonist that may help people with moderate to severe VSM associated with menopause.
She also says perimenopausal patients with genitourinary syndrome of menopause (GSM) may benefit from hormonal contraceptive formulations, which address abnormal uterine bleeding and prevent unintended pregnancy.
When estrogen goes away, blood vessels don’t dilate as well. They fill with low-density lipoprotein (LDL) and triglycerides (TG). Fat deposits can accumulate around the heart and in the liver, and insulin resistance is greater. Dr. Yen said hormone replacement therapy (HRT) might help with cholesterol lowering and preventing diabetes, and GLP-1s are a good idea for women with BMIs of 30 or greater.
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