Menopause is different for women of color — here’s why

For generations, the conversation around menopause has been hushed, and largely excluded the experiences of women of color, leaving a critical gap in both public discourse and medical understanding.

While menopause is a universal transition that affects all women, research increasingly shows that Black and Latina women often face distinct challenges during this life stage — from earlier onset and more severe symptoms to reduced access to appropriate healthcare.

The silence surrounding the experiences of women of color stems from multiple sources: cultural taboos around discussing women's health, historical mistrust of the medical establishment, and the systematic exclusion of women of color from medical research.

Now, more and more women of color are breaking this silence. Public figures like Michelle Obama, Oprah, and Salma Hayek have all opened up about their menopause journeys. Halle Berry even started her own menopause company.

Medical researchers are also beginning to address this gap, launching studies specifically focused on the menopausal experiences of women of color and developing more culturally competent treatment approaches.

Here, we explore the unique challenges women of color face during menopause, the health impact of the disparities, and the importance of advocating for yourself and your health at every stage.

Earlier menopause onset

Women have long been underrepresented in health research, which has contributed to a dearth of understanding around women’s bodies. This is one of the reasons the Study of Women’s Health Across the Nation (SWAN) is so groundbreaking. Beginning in 1994, this ongoing research examines women’s midlife health across socioeconomic and ethnic backgrounds. Among the findings: While the average age of menopause in the United States is 51 to 52 years old, Black and Latina women experience menopause earlier. It also shows that Black women spend 3.5 more years than white women in perimenopause, the stage leading up to menopause.

While Black women reach menopause at an average age of 49, versus 50.9 years for Latinas and 52.9 for white women. It also shows that Black women spend 3.5 more years than white women in perimenopause, the stage leading up to menopause.

More intense symptoms

This perimenopause transition is important, because it’s when most women, regardless of race, experience the bulk of their menopausal symptoms as hormone levels fluctuate. Think: irregular periods and mood swings. Per SWAN, the symptoms and their severity vary greatly between groups. For Black and Latina women, vasomotor symptoms like hot flashes and night sweats are more prevalent, more bothersome, and longer-lasting — with research showing they can last for up to 10 years compared to 6.5 years among white women.

“And there have been other studies that corroborate that and some newer data showing that Native American women may have more severe vasomotor symptoms than Black women,” reveals Dr. Monica Christmas, M.D., director of the Center for Women’s Integrated Health at UChicago Medicine.

“More intense menopause symptoms can disrupt quality of life, work, and the ability to perform daily activities,” says Yamnia I. Cortés, Ph.D., associate professor at the University of Iowa College of Nursing and director of the CortésMenoLab, which aims to promote the health of women in midlife and beyond.

In addition to vasomotor symptoms, sleep takes an extra hit for many women of color. Years of night sweats could be one reason why. “Black women consistently report waking up several times at night [during menopause],” says Cortés. Research via wearable sleep devices mirrors this: Black women sleep less and have more interrupted sleep, and they’re also two times more likely to get less than six hours of sleep than white women.

Why such disparities?

Untangling exactly why many women of color experience earlier menopause and more severe symptoms is no easy task. There’s no one answer. There is, however, a key 2022 SWAN report that makes it clear that structural racism is a major contributor. This can include socioeconomic challenges, discrimination, and a lack of access to care among other things, says Cortés.

All of this adds up to stress on the body, sometimes referred to as allostatic load. And research shows that Black women have the highest allostatic load of all groups.

“Allostatic load is the ‘wear and tear’ of stress on the body over time due to a constant activation of the stress response ("fight or flight"), which triggers the release of hormones like epinephrine and cortisol, says Cortés." The presence of these hormones triggers other bodily systems to adapt to the stressor (e.g., increase blood pressure, blood sugar, immune response).

The physiological impact is significant. Chronic inflammation becomes more prevalent, oxidative stress increases, and the body's regulatory systems face constant strain. These biological changes can directly affect the timing of menopause by influencing the rate at which ovarian follicles are depleted.

“Observational studies have shown that women with higher levels of stress had lower levels of ovarian reserve markers (AFC, AMH),” says Cortés. What’s more, “it has been noted that women with more adverse childhood experiences or trauma exposure may experience menopause earlier, though we do not have enough evidence to say this is the pathway or a cause and effect.”

The inflammatory processes associated with high allostatic load may also have the potential to interfere with normal hormonal signaling, which researchers are exploring as a possible contributing factor to more severe menopausal symptoms, although further study is needed to see if there is a true connection, says Cortés.

Adding to this burden, the chronic stress response can affect other aspects of health, including cardiovascular function, metabolic processes, and immune system regulation. This creates a cycle where early menopause may further compound existing health challenges, making the transition particularly difficult for Black women who may already be managing other stress-related health conditions.

Missing medical care

Although Black and Latina women are more likely to experience a more disruptive menopause transition, they’re also less likely to receive medical help for it. Some of this boils down to cost. Black people are 1.5x more likely to be uninsured compared to white people. More than 60% of the midlife Latina women in Cortés’ research, for example, did not have health insurance.

It could also be due to a lack of access to information, fear, or the perception of having to grin and bear menopause [in their cultures],” says Cortés. And as with many conditions, being less likely to try anything for symptom management may lead to a lower quality of life and worse health outcomes. Despite the data showing that Black women experience poorer quality sleep and more sleep disturbances during menopause, Cortés notes they are “less likely to self-report sleep problems to health professionals or to seek care for sleep problems.”

But then there’s also the matter of trust, which is hard to quantify but can be a significant factor and goes beyond simply having a provider. “Women of color are less likely to access culturally tailored care in their language or preference,” Cortés says. “This takes into account people's lived experience, identity, cultural values, and attitudes of menopause. This is important to build trust and come to shared decisions about symptoms management and treatment.”

The health impacts

Recent studies suggest that menopause (and its disruptive symptoms) isn’t just something women go through, says Tené T. Lewis, Ph.D., professor of epidemiology at the Rollins School of Public Health at Emory University. It’s something that can dramatically alter the course of their health. “Hot flashes and night sweats have been linked to heart disease and stroke in later life. So, there are a lot of reasons to address and treat them.” This is especially true for Black women, adds Lewis, who already have the highest levels of heart disease and stroke. Here are the postmenopause health impacts you should be aware of — underscoring just how significant it is to go through menopause earlier, and for longer:

Cardiovascular Health

• Black women already face higher rates of heart disease, and early menopause compounds this risk
• The earlier loss of estrogen's protective effects on the cardiovascular system can accelerate the development of heart disease
• Research shows increased risk of stroke and hypertension among Black women who experience early menopause

Bone Health

• Accelerated bone density loss due to earlier estrogen decline
• Higher risk of osteoporosis and fractures
• This is particularly concerning as Black women are often underscreened for bone health issues

Mental Health Effects

• Increased risk of depression and anxiety during the transition
• These symptoms often go undertreated or unrecognized in Black women

Metabolic Impact

• Greater risk of insulin resistance and type 2 diabetes
• Changes in body composition and increased central adiposity
• Higher likelihood of metabolic syndrome

Quality of Life

• Extended period of living with postmenopausal health conditions
• More years spent managing symptoms and health risks

Potential impact on work life and relationships during peak career years

Evidence-based treatment

Although menopause is an incredibly complex time of life for women of color, the foundation for treatment is radically simple. “It starts with lifestyle,” says Christmas. Healthy diet and exercise are key for both managing menopause symptoms and improving overall quality of life. This includes a protein-rich, well-balanced diet and regular activity that prioritizes strength training, as research shows it can improve bone density, hormonal and metabolic changes, and hot flashes in menopausal women. Stress management is also key since women of color experience higher levels of stress throughout their entire lives.

When it comes to treatment options, such as hormone replacement therapy (HRT), it’s important to remember there isn’t a one-size-fits-all solution. Risk factors such as your medical history and family history should be taken into consideration. “Hormone therapy can definitely help with managing hot flashes and night sweats, but it’s not like this magic jelly bean,” says Christmas. The best thing to do is to talk to a menopause-informed doctor about your symptoms and your lifestyle to see if you can find a combination of medication (if needed) and other treatments that can help.

Whatever treatment you decide to try (or not try), now is the time to double-down on your self-care routine, says Christmas. Because while menopause is something we can’t control, we can control the way we care for ourselves. “We have to be kind and gentle [to ourselves]. We have to be intentional about how we move our brains and our bodies, and be meticulous about what we’re fueling our bodies with,” says Christmas.

The need for more research

While health practitioners are beginning to acknowledge women of different racial and ethnic backgrounds may experience menopausal symptoms differently, beyond the SWAN study, research into those differences is extremely limited. But in order for there to be more representative research, there needs to be more diverse participants. That requires significant trust-building from the medical system with women of color, especially Black women as they’ve historically been used for medical research against their will, as was the case of Henrietta Lacks and countless others.

Christmas is working on an international project right now called Menopause Priority Setting Partnership (MAPS). “It is designed to bridge the gap between existing research and what patients and healthcare providers want to know about menopause. We’ve had almost 3,000 responses and only 35 of them identified as being Black,” Christmas explains. “There are historical reasons why we have not wanted to participate in research. We’ve been taken advantage of and put into and put into medical research without our permission dating back to slavery. But if we’re not part of the process, the data doesn’t include us.”

Cortés believes it’s on the medical community to implement community engagement strategies to build that trust. “In my work, we try to partner with community organizations and be visible in the community. We provide menopause health information and build collaborative relationships,” says Cortés. “We also need research study teams that reflect the composition of the communities we are trying to reach, including the scientists designing and conducting the research.”

What about weight?

It’s estimated that women gain 5-8% of their body weight during menopause. This can make menopause feel worse since “obesity is linked to more severe vasomotor symptoms,” says Cortés. Why the weight gain? “It’s multifactorial, with strong influences due to diet, activity level, and genetics,” says Christmas. But once again, hormones play a big role. The reduction in estrogen slows metabolism and increases body fat. While women of color have higher rates of overweight and obesity, there is no data that suggests “race or ethnicity impacts weight gain during the menopause transition,” says Christmas. But if you’re going into menopause earlier, that means more years fighting against hormone-related weight gain.

More research about the interplay of weight and menopause symptoms is simply vital, says Lewis. “It isn’t 100% clear whether weight itself contributes to hot flashes and night sweats, and when (early versus later) in the menopausal transition being higher or lower weight might matter,” says Lewis.

Up to this point, findings from research studies on that topic have been mixed. This could be because so many women have menopause symptoms, of all different weights.

No matter what, maintaining a healthy weight during menopause has been recommended, and is very important, whether women have menopause symptoms or not, says Lewis. “We know blood pressure increases at a faster rate for women as they age, and cholesterol levels are directly impacted by menopause. All of these factors, along with hot flashes and night sweats, contribute to heart disease and stroke. Black women have higher levels of all of these risk factors to begin with,” says Lewis. “Maintaining a healthy weight throughout menopause using the strategies that WeightWatchers promotes will go a long way towards helping women protect their hearts and brains in later life,” says Lewis.

Advocating for your health

Until there’s more inclusive research, there are steps women can take to ensure better treatment. “It’s about doing the due diligence and research beforehand, especially if somebody isn’t giving us the care that we think we deserve, or if we don’t feel that they gave us a good explanation and validated what our concerns were,” says Christmas. “Sometimes we kind of back down because historically we haven’t been given a voice to fight for ourselves.” Here are some tips for getting what you need out of each doctor’s appointment.

• Research new healthcare providers. To find doctors who you feel comfortable with, look at their websites, read their bios, and take a look at our patient reviews. You can search for a menopause-certified provider on The Menopause Society website. There are also many new telehealth providers that specialize in mid-life and menopause who you can meet with from your home, and who often take insurance. WeightWatchers Clinic for Menopause is a great option, with menopause-trained clinicians and access to medications like HRT if appropriate.

• Prepare before each appointment. Before you go in for your appointment, Christmas suggests bringing a list of all the medications you’re taking currently and as well as the ones you’ve taken previously. It’s also helpful to know not only your personal medical and surgical history, but any relevant family history as well.

• Ask for clarification or help. If you’re having trouble understanding what the doctor is saying or you’re confused about a test they ordered, it’s perfectly fine to speak up, ask questions, or even ask to speak with someone else.
• Be clear about your needs. Christmas encourages patients to be proactive and outspoken about their needs. “It’s imperative that you are clear about what you’re coming in for. That makes the difference in ensuring you’re actually seeing the right provider.” If you’ve avoided care in the past, that may start with acknowledging that you deserve it.