Menopause in Black women

Menopause essentially occurs when a woman has not had her period for 12 consecutive months (1 year). That is, a ‘pause’ in menses – men-o-pause.  

Perimenopause is the period in which a woman transitions from her normal reproductive menstrual cycle to the menopause. These are both natural biological processes that happen to every woman regardless of ethnicity, socioeconomic background or geographical location.

But are there any differences in this process for Black and white women?

What is distinctive about menopause in women of colour?

• Regarding the onset, duration and severity of symptoms, menopause has unique characteristics in Black women. Menopause has been observed to occur at an average age of 49.3 years for Black women and 51 years for white women.
• Two and a half decades of research by the Study of Women’s Health Across the Nation (SWAN) has revealed that Black women experience menopause 8.5 months earlier than their white counterparts.
• The SWAN results also demonstrate that Black women have menopause symptoms including hot flushes for a longer period than white women – 10 years compared to 6.5 years, respectively.
• Black women are also three times more likely than white women to undergo premature menopause, or menopause before the age of 40, according to research by the American Heart Association.

Why is menopause different for Black women?

Black women often experience menopause differently, and while the exact reasons are not fully understood, many contributing factors have been linked to chronic stress, something Black women have historically endured more than white individuals.

This stress is not just about the everyday demands of life. It is deeply rooted in the legacy of historical racial injustices that have shaped structural racism, leaving behind lasting effects that still impact Black women’s lives today. These include unequal access to healthcare, exposure to discrimination and medical research that has largely focused on white populations, resulting in guidance and treatments that do not always meet the needs of Black women.

Access to healthcare that is culturally sensitive and aligned with the lived realities of Black women remains limited. Many also navigate hostile work and social environments, often facing both racism and misogyny. These intersecting pressures have been shown to take a toll on the body, contributing to chronic stress, inflammation and, in some cases, earlier onset of menopause.

But the experience of menopause for Black women isn’t shaped by stress alone. It’s also influenced by the weight of expectations, trauma and complex personal histories that add to the mental load.

This includes:

• misogyny, which compounds during menopause as Black women face both gendered and racialised discrimination,
• historical burden, where a legacy of resilience can be inspiring but also emotionally exhausting,
• cultural and family expectations, which may discourage rest or self-prioritisation during this life stage,
• unfair comparisons and pressure to succeed, which can hold back the personal growth menopause might otherwise bring,
• hidden traumas, such as fertility struggles or divorce, which may resurface with intensity,
• unexpected singlehood and anxiety tied to the biological clock, leading to feelings of isolation or urgency,
• de-sexualisation of older women, which society wrongly promotes, when in fact this stage can spark a powerful rediscovery of self,
• socioeconomic challenges, including financial strain and barriers to healthcare, that make symptom management more difficult.

How will this information help me?

Far too often, Black women endure intense physical and emotional changes, like hot flushes, sleep disruption, anxiety and joint pain without the support or information needed to make sense of it all. This lack of awareness can delay diagnosis, worsen symptoms and increase the risk of serious complications.

For example, oestrogen declines during menopause and this drop increases the risk of heart disease and stroke, especially if menopause happens earlier than expected. Studies show that among both Black and white women, those who go through premature menopause face a 40% higher lifetime risk of developing coronary heart disease, even when other risk factors like smoking, high blood pressure and diabetes are taken into account.

Oestrogen is also essential for maintaining bone health. When levels fall, it increases the risk of developing osteoporosis, making bones weaker and more likely to break. This risk can go unnoticed until a fracture occurs, by which point the damage is already done.

The truth is, knowledge is power. Black women deserve to know what’s happening in their bodies, why it’s happening and what can be done about it.

Understanding the biological changes of menopause, the mental load it adds and the racial disparities in care helps women advocate for themselves and seek the right support.

Beyond the health risks, recognising these challenges allows us to normalise the conversation around menopause, break harmful taboos and ensure that Black women are no longer overlooked or underserved during this major life transition. The more we know, the more we can do to protect our health, plan for the future and live well through menopause and beyond.

What causes menopause?

Although it is a natural biological process, there are a number of factors that can lead menopause.

• A decline in natural levels of reproductive hormones. Your ovaries begin producing less oestrogen and progesterone, the hormones that control menstruation, as you approach your 40s. Your fertility also begins to wane at this time and finally, your ovaries cease producing eggs, resulting in the cessation of periods.
• Oophorectomy (ovaries removal surgery). Your ovaries generate the hormones oestrogen and progesterone, which regulate your monthly cycle. After the surgical removal of the ovaries, menopause immediately begins. Due to hormonal changes occurring suddenly rather than gradually over many years, signs and symptoms might be severe.
• Chemotherapy and radiation treatment. As ovarian function may have been disrupted by the course of treatment, particularly those directed at the ovaries or organs surrounding the ovaries such as the womb, intestines and bladder, menopause may be an unintended side effect.
• Primary ovarian insufficiency (POI). Primary ovarian insufficiency, which can be genetic or caused by autoimmune disorders like systemic lupus erythematosus (SLE), can lead to premature menopause by preventing your ovaries from producing enough quantities of reproductive hormones. According to the Daisy Network, ovarian function can fluctuate over time so women with POI may still have occasional periods.
• Premature menopause. Menopause before the age of 40 occurs in about 1% of women (premature menopause), frequently there is no know cause.

What are the signs and symptoms of perimenopause/menopause?

There is a large spectrum in the symptoms that all women can experience in the perimenopause and menopausal periods, with some not having any symptoms at all to some women feeling very overwhelmed by their symptoms.

Research also suggests that Black women are less likely to seek help for their symptoms, and this may negatively impact the current and future wellbeing of these women.

Commonly reported symptoms are:

• irregular periods,
• vaginal dryness leading to painful sex,
• temperature dysregulation which causes women to feel inappropriately hot or cold leading to:
• hot flushes (characterised by a sudden feeling of heat in the upper part or all of the body),
• chills (usually accompany the hot flushes),
• night sweats,
• sleep problems,
• mood changes,
• brain fog and concentration problems,
• weight gain and slowed metabolism,
• loss of skin elasticity,
• drier skin and hair,
• breast changes,
• joint aches and pains.

Complications of menopause

It is important to understand that whilst menopause is a natural process, there are some physical health issues that can occur as a result of hormonal changes in the body.

• Heart and blood vessel (cardiovascular) disease. Oestrogen protects the heart and blood vessels mainly by reducing cholesterol build up in the vessels. The drop that occurs during menopause can lead to an increased risk of having heart disease.
• Osteoporosis. Oestrogen also protects the bones. Therefore, as the level drops, it can cause the bones to become brittle and weak, leading to an increased risk of fractures.
• Genitourinary syndrome of the menopause (GSM). As the tissues of the vagina and urethra lose elasticity due to reduced oestrogen, one may experience frequent, abrupt, strong urges to urinate, followed by an involuntary leak of urine (urge incontinence), or release of urine with coughing, laughing or lifting (stress incontinence). There can also be an increase in urinary tract infections.
• Sexual dysfunction. Vaginal dryness brought on by decreased moisture production and suppleness from reduced oestrogen can produce discomfort and contact bleeding during sexual intercourse. Furthermore, many women report low libido which can heighten this.
• Heavy bleeding. There are a variety of changes that can occur in the perimenopausal period. Many women report a change in their bleeding pattern; this can range from lighter and less frequent bleeding to heavier and more frequent bleeding. For a variety of reasons, including a higher background incidence of fibroids, Black women are more likely to get the latter pattern. This can be hugely distressing as women may flood constantly and unpredictably impacting their ability to function. Furthermore, women can get increased pain with their bleeding and complications from anaemia (low haemoglobin/red blood cell count) such as fatigue, light-headedness and palpitations. It is important to see a doctor if you are suffering from these as urgent investigations and treatments may be needed.

Tips to manage your menopause transition

There are steps you can take to help make this transition a smoother and healthier ride.

Up your physical activity

Studies have shown that 30 to 45 mins of exercise each day gets your heart pumping and prevents heart disease. Keep in mind that heart disease is the leading cause of death worldwide, so this really is a boon for your current and future physical and mental wellbeing. Such physical activity also reduces hot flushes, boosts your mood and can help to achieve a healthy weight.

Strength building exercises are also important for muscle, joint and bone health and flexibility exercises such as Pilates, Yoga and TaiChi can also help with this, as well as, calming down the mind and reducing stress.

But remember, all movement counts. Many modern perimenopausal and menopausal women are time poor so if all you can do is try to sit less and walk more, that’s a great start.

Another tip is to build it into your lifestyle such as incorporating physical activity into social events with friends and family or as specially scheduled and prioritised ‘me time’.

Review your mental load and aim for a manageable amount

Many women are carrying an inordinate mental load for society. Things to consider are workload in the home and/or professional environment, the invisible mental load (logistical and strategic thinking and planning for self, partner, work colleagues, dependants etc), and caring responsibilities for younger and/or older dependants, especially for those in the sandwich generation, who are simultaneously supporting ageing parents while raising children.

It’s helpful to think of life as juggling glass and rubber balls. Some things, like your health and close relationships, are glass balls that can shatter if dropped. Others, like certain work tasks, are rubber and will bounce back. Take some time to figure out what the priorities are. What can be removed? What can be shared? What can be outsourced? Educate family, friends, work colleagues, managers and anyone who can provide support and understanding about the perimenopause and menopausal period.

Low hanging fruit such as notifications from emails, 24-hour news cycle or social media apps can be quietened so that your interactions with these platforms are more intentional with better boundaries in place. Use ‘Focus’ or ‘Do not disturb’ modes on smartphones.

Try to live at 80% of your capacity to leave space for unexpected challenges such as an acute/chronic health issue, bereavement, miscarriage, divorce/separation or house move that can heighten the experience of the perimenopausal and menopausal symptoms.

Remember, the symptoms don’t exist in isolation. The biology of hormonal changes can be affected by the weight of the mental load you are already carrying. It is a bio-psycho-social dynamic.

Self care

This is important for stress management and can help to improve symptoms. Prioritise time for doing what you enjoy. This is protected ‘me-time’.

I advocate a block of three to four hours a week for this. It is time that should be free of work or caring responsibilities and can be for anything such as personal grooming, hobbies, spa time, nature walks, brunch with friends, attending the theatre, group sports, singing in a choir, watching a movie/TV series etc.

For time-poor perimenopausal and menopausal women this is often left on the backburner, but it is so important. Utilise family and friend networks to achieve this.

It is important to build a village of people to have support during this time.

Quit smoking

This protects you from cancers, heart disease, stroke and diabetes.

Eat well

Ensure you follow a healthy diet and minimise your intake of spicy, fatty and processed foods, alcohol and caffeine, as these have been linked to worsening the experience of hot flushes. Aim to eat the rainbow by including a variety of colourful fruits and vegetables in your meals. Each colour provides different essential nutrients, antioxidants and plant compounds that support overall health, balance hormones and reduce inflammation.

Take a vitamin D supplement

Usually 1000IU daily, if you do not have adequate sunlight exposure, and a calcium supplement if you do not have enough intake of this in your diet.

Keep cool

Consider carrying a portable fan if you experience hot flushes.

Spend time in nature

Spending time in green spaces and enjoying nature can be a powerful way to cope with menopausal symptoms. Research shows that exposure to natural environments has a positive effect on mental and physical health, helping to reduce stress, anxiety and depression, which are common during menopause. Being in nature can lower cortisol levels, regulate mood and promote relaxation. It also encourages physical activity, whether it’s a walk in the park or gardening, which can improve cardiovascular health, support bone strength and manage weight.

Strengthen your pelvic floor muscles

This is achieved by Kegel exercises.

Change your perspective about menopause

A negative outlook on menopause can be associated with more frequent and severe symptoms. Having a positive outlook on the transition can improve your experience.

When to see a doctor

• Quality of life symptoms. If symptoms like hot flushes, night sweats, mood changes, sleep problems or joint pain are starting to affect your daily life, your relationships or your ability to function, it is a good time to speak with a doctor.
• Early menopause. If you notice signs of menopause before the age of 40, this is called premature menopause. It is important to see a doctor, as it can carry a higher risk of long-term health problems including weak bones and heart disease.
• Treatment options. Talking to a doctor can help you explore ways to feel better and protect your health. There are different treatment options available, and your doctor can guide you to the ones that suit you best. It is about finding what works for your body and lifestyle.

To help decide what you might need, your doctor may examine you and carry out tests if necessary to rule out other causes. Hormonal blood tests are usually not needed during perimenopause, especially in those aged over 45 years with typical menopausal symptoms, because the symptoms often give a clear picture. However, a blood test may help confirm that menopause has occurred.

Hormone replacement therapy

Hormone replacement therapy often called HRT, is one of the most effective ways to relieve symptoms and support long term health.

HRT is the most effective treatment for menopausal symptoms, including brain fog, mood problems, reduced libido and relief of vasomotor symptoms (hot flushes) etc. Many women report that HRT improves their quality of life.

There are many other added health benefits of HRT such as preserving bone density, reducing risk of heart disease if started during the perimenopause or within five to ten years of the menopause, improved skin and hair health, improved vaginal, sexual and genitourinary health.

There is also some building, but not yet conclusive, evidence that it may protect from memory problems later in life.

Oestrogen (in the form of oestradiol, a body identical form naturally derived from yams) is what is most widely used as HRT. This can be applied topically as a patch, gel or spray or taking as a tablet.

Progesterone is used alongside oestrogen for women who still have a uterus or uterine lining in their body as without this it can cause proliferation of the womb lining which can rarely lead to womb cancer. The progesterone can be administered as a combined patch, intrauterine coil or tablet. There is a body identical progesterone called utrogestan which is gaining an increase in popularity because of its improved safety profile.

Are there risks with HRT?

The main barrier to Black women considering HRT is the misconception, often based on misinterpreted data, that oestrogen increases the risk of breast cancer. In reality, there is strong and clear evidence showing that oestrogen-only HRT can actually reduce the risk of breast cancer in women. While there is a small, increased risk with combined HRT (when progesterone is added), the risk is even lower when using utrogestan. To put it into perspective, among 1,000 women using oestrogen plus progesterone HRT for more than five years, there may be an additional 5 to 10 cases of breast cancer. This is a relatively low risk compared to the potential benefits of symptom relief and long-term health support that HRT can offer.

HRT’s relationship with heart disease is complex. It can protect against heart disease if started within a specific time frame, often referred to as the “window of opportunity.” However, if HRT is initiated after this window, typically after the age of 60, it may result in around 5 to 10 additional cases of heart disease in 1,000 older women. While this is a slight increase, it is still considered low. There is also a small increased risk of strokes and cardiac events, but this is primarily seen in women who begin HRT 10 years after menopause. This helps explain why many doctors are cautious about starting HRT in women over the age of 60.

There is a slight increased risk of ovarian cancer with HRT. There is also a small increased risk of venous blood clots, but this risk is negligible when using topical routes of oestrogen application and with utrogestan. Long-term use of HRT might result in about 1 to 3 additional cases of ovarian cancer in 1,000 women.

The decision to start HRT is deeply personal and should be based on a balance of benefits and risks. Factors such as your age, personal medical history, family history, lifestyle, social setup, and personal preferences all play a role in this decision. It’s important to book a consultation to discuss this further.

Remember, individual risks can vary, but it’s important to emphasise that these risks are generally low. The decision to use HRT should be made in consultation with a healthcare provider, considering a woman’s specific health and medical history. This ensures an informed choice that is tailored to individual needs and circumstances, while acknowledging the overall low risk associated with HRT.

Supplements and herbal treatments

There are several supplements and herbal treatments that may help symptoms of the menopause including primrose oil, black cohash and red clover. The challenge with this is that currently we do not have enough research data to support their use as a prescribed treatment and the doses in the different supplements available to be purchased are often arbitrary. Furthermore, they can interact with other prescribed medications.

It is for this reason that most medical professionals trained in western medicine are unable to advise on use of these for the treatment of perimenopause or menopause symptoms. However, women can do their own research or consult with other healthcare specialists trained in herbal medicines if they wish to investigate this path.

Other treatments

Vaginal oestrogen

Using a vaginal lotion, pill, or ring, oestrogen can be delivered directly to the vagina to relieve vaginal dryness. This treatment releases small amounts of oestrogen, which is absorbed by the vaginal tissues. It can help ease genitourinary syndrome of the menopause, vaginal dryness as well as discomfort with intercourse.

We also advise washing the vagina with an emollient as a soap substitute as soap dries out the vaginal skin further. In addition, lubrication is advised during intercourse to improve comfort and pleasure.

Low-dose antidepressants

Some women experience mood swings or depression during menopause, which is perfectly normal. However, for some, low-dose antidepressant medications can be helpful. When considering the use of antidepressants during menopause, it’s important to exercise caution, particularly if you have a history of breast cancer or are taking tamoxifen, a medication used to reduce the risk of breast cancer recurrence. Certain antidepressants, such as SSRIs (Selective Serotonin Reuptake Inhibitors) like paroxetine and fluoxetine, and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) like bupropion and duloxetine, may interfere with tamoxifen, so it’s best to avoid these.

Instead, safer options like sertraline, citalopram (SSRIs), or venlafaxine (SNRIs) are generally recommended, as these are less likely to affect the effectiveness of tamoxifen. These medications can help improve mood, manage menopause symptoms, and enhance emotional well-being.

It’s also worth noting that there is no clear evidence supporting the use of antidepressants for menopause-related low mood in women who do not have a pre-existing diagnosis of depression. In these cases, HRT may be a more appropriate option to manage both mood and physical symptoms of menopause.

Gabapentin or Pregabalin

These medications can help manage menopausal symptoms, particularly hot flushes and night sweats, by stabilising nerve activity. They can reduce the intensity and frequency of these symptoms. However, they may cause side effects such as weight gain, sleepiness, dizziness, and dry mouth.

Oxybutynin

While primarily used to treat overactive bladder and urinary incontinence, Oxybutynin can also be prescribed off-label to manage menopausal symptoms like hot flushes and night sweats. It works by reducing the activity of certain nerves, which helps decrease the frequency and severity of hot flushes. Side effects may include dry mouth, dry eyes, headaches, and stomach pain.

Clonidine

Originally used to treat hypertension, Clonidine helps regulate body temperature by affecting neurotransmitters in the brain, thus reducing the frequency and severity of hot flushes. Possible side effects include dizziness, sedation, difficulty sleeping, and constipation. Women with low blood pressure should avoid Clonidine.

Fezolinetant

This newer treatment works by blocking certain signals in the brain that cause hot flushes and night sweats, without using hormones like oestrogen. By preventing the brain from sending the wrong signals, Fezolinetant helps balance the body’s temperature regulation and reduce the severity of hot flushes.

Cognitive Behavioural Therapy (CBT)

CBT is a psychological treatment that can be effective for managing menopausal symptoms. It focuses on identifying and changing negative thought patterns and behaviours. CBT helps manage symptoms such as hot flushes, mood swings, and sleep disturbances by teaching coping strategies, relaxation techniques, and ways to reframe negative thoughts. It can be delivered through structured therapy sessions or self-help resources, making it a valuable addition to managing menopause symptoms.

Seek help

If as a Black woman, you are experiencing symptoms of the perimenopause or menopause, please seek help and book a consultation with a healthcare professional. It can be potentially life-changing for your current and future health.