We often say that menopause isn’t one size fits all. But what does that mean, in concrete terms?

To answer the question, we turned to results from the multi-year Study of Women’s Health Across the Nation (or SWAN, for short). The goal of this study, which was initiated in 1996 and published in 2019, was to better understand the menopause transition in an ethnically and racially diverse sample of women. Here’s what researchers found:

On the onset & duration of menopause

• Black women experience menopause ~8.5 months earlier than white women
  As a reminder “menopause” is defined as the moment in time when you’ve gone 12 months without a period.
• Menopause symptoms last ~3.5 years longer for Black women than white women (10-year average vs 6.5 years)

On symptom prevalence, severity & duration

• Black women are more likely than white women to experience hot flashes 6 days a week or more
• Black women get 30 fewer minutes of sleep than white women during the menopause transition
• Black women are more likely than other racial groups to get fewer than 6 hours of sleep per night

On the use of hormone replacement therapy

• Black women are 50% less likely to use HRT during menopause than white women

While researchers noted that Black women were more likely to present risk factors (eg., smoking, obesity) that increased the likelihood and severity of certain menopause symptoms, that doesn’t fully explain the disparity — even after controlling for body mass index (BMI) and tobacco use, there are still racial differences in duration and severity of symptoms, especially vasomotor symptoms (hot flashes and night sweats).

While more research is needed to better isolate and understand this disparity, experts have several hypotheses:

• Policies, laws, and social structures rooted in systemic racism that perpetuate inequities in access to care
• The physical effects of racism and discrimination, which activate our body’s stress response system — via the hypothalamic-pituitary-adrenal (HPA) axis — resulting in metabolic dysregulation and systemic inflammation
• Black people are 1.5x more likely to be uninsured than White people and more likely to be on Medicaid or public insurance (38% vs 20%, respectively)

Learn more

We certainly have a long way to go in listening, learning, and advancing how we understand the menopause experience — and how we build Elektra Health to best serve women with the support and care they deserve. That starts with education.

Readings we recommend:

• By the Numbers: How Menopause Affects Different Demographics (Oprah Daily)
  ​​“As a woman of color myself, the most important thing to remember is that there’s no issue that’s too small to discuss with your provider. If you feel as if your provider hasn’t answered your question, feel welcome to say, ‘I’m thankful for our conversation, and I want to talk more with you about X, Y, or Z because this is something that’s impacting me and I worry we haven’t thought through it enough.’” — Sherri-Ann Burnett-Bowie, MD, one of the principal authors of the SWAN study
• What is “Normal” When It Comes To Menopause? Hint: Nothing (Oprah Daily)
  “Leading women like Oprah Winfrey, Michelle Obama, and Tracee Ellis Ross have gone public with their experiences. By all accounts, the menopause market is booming, from emerging telehealth enterprises to wellness empires. More and more employers are implementing menopause-friendly work policies, a topic now regularly covered in journals like Harvard Business Review….It would seem we are on the brink of a new movement—dare we say, era—for menopause. And to be honest, that gives us pause. Because any time a social shift is so deliberately defined, so rapturously reflected and reported on, the first question we inevitably ask ourselves is this: Who stands to be left behind?” — Omisade Burney-Scott & Jennifer Weiss-Wolf
• Health Divide: Menopause and Black Women (verywellhealth)
  “The increased stress and trauma Black people face as a result of ongoing discrimination, reduced access to health care, and varying degrees of economic advantage play a large role in the disparity of experiences. Black people are met with discouraging barriers to care due to structural racism in the medical community, which influences risk factors and lifestyle factors that impact menopause. All of this leads to a harder time getting symptom relief.”

​​“As a woman of color myself, the most important thing to remember is that there’s no issue that’s too small to discuss with your provider. If you feel as if your provider hasn’t answered your question, feel welcome to say, ‘I’m thankful for our conversation, and I want to talk more with you about X, Y, or Z because this is something that’s impacting me and I worry we haven’t thought through it enough.’” — Sherri-Ann Burnett-Bowie, MD

Pioneering researchers and thought leaders doing work in this space:

• Omisade Burney-Scott, founder of Black Girl’s Guide to Surviving Menopause™
• Dr. Tina Opie, who explores the connections between diversity, inclusion, and equality as Chief Vision Officer at Opie Consulting Group LLC
• Makeba Williams, MD, FACOG, NCMP, a The North American Menopause Society-certified provider and founder of the University of Washington Health Menopause Clinic
• Ashlee Wisdom, MPH, founder of Health In Her HUE, a platform connecting women of color to culturally-sensitive healthcare providers
• Karen Arthur, host of Menopause Whilst Black podcast
• Carleeka Basnight-Menenedez, international menopause consultant, speaker, and author