Black Women Face Earlier Menopause Onset and Inadequate Care

Menopause marks a significant biological transition, yet not all women have the same experience. Mounting evidence reveals stark disparities by race in the United States—Black, Hispanic, and Asian women often face earlier onset, more severe symptoms, and receive different levels of care. For the purpose of brevity, this article will focus primarily on disparities between Black and white women, explore the latest research trends, underlying causes, and steps toward equitable care.

First, the Definitions

Menopause is a term that is often used incorrectly. Medically speaking, menopause doesn’t begin until women experience a full calendar year without a period. The period preceding menopause (when menstruation first stops) is referred to as perimenopause. The term vasomotor refers to the constriction (or expansion) of blood vessels, which in turn, impacts blood pressure and cardiac activity. 

Most of what the medical community knows about menopause today comes from the findings of the SWAN study. SWAN, or the Study of Women’s Health Across the Nation, was initiated in 1996 to study the menopause transition over a period of 25 years. What the study revealed were significant disparities in menopause diagnosis, treatment and management. While the study itself didn’t address systemic racism, several studies in the wake of the SWAN findings have begun to identify and address links between socioeconomic conditions and menopause’s effects.   

The Disparities Laid Bare

According to the research, the median natural menopause onset is about 52.17 years among Black women, compared to 52.88 years in white women—a difference of approximately 8.5 months. However, those merely represent the average ages; according to VeryWellHealth, the onset of menopause can typically occur between the ages of 40 and 58. It should also be noted that the onset of vasomotor symptoms of menopause such as hot flashes and night sweats often begin during perimenopause for Black women and last longer, on average 10.1 years for Black women—versus 6.5 years for white women. 

Further complicating matters is the preponderance of Black women who do not complete the perimenopause phase naturally. Black women are twice more likely than white women to enter menopause due to surgical intervention, while also being 50% less likely to use hormone therapy to ease symptoms prior to surgical intervention, despite the obvious severity of, and risks associated with, vasomotor and mental health symptoms. 

Why Can’t Black Women Identify the Symptoms?

Black women are approximately 50% more likely to experience vasomotor symptoms (VMS) than White counterparts, reporting more intense and frequent episodes. Over half of Black women experience VMS during perimenopause, compared to only one-third of White women. 

When it comes to mental health, depression is more common among Black women, with 20% versus 13% of white women reporting clinically significant symptoms.

Black women also report worse sleep quality—sleeping about 30 minutes less nightly—even after adjusting for socioeconomic factors. Which is obviously linked to the prevalence of hot flashes and night sweats that impact Black women, leading to insomnia, and mood changes that collectively impact mental health. 

However, most Black women have no idea that perimenopausal symptoms can begin to crop up in their 30s. Why is that? Mainly because most healthcare providers don’t know either. Only 31% of ObGyn residency programs in the US report having a menopause curriculum, and those that exist are primarily elective. 

Then, on top of those factors is the ongoing issue of a lack of culturally competent providers, which is critical in areas that are impacted by sociological stressors like a historical distrust in the medical profession or the role of sexual shame, two of many areas related to racial disparities currently being studied.  

Research Trends: What’s Behind the Disparities?

As noted above, structural racism is now being addressed in relation to the SWAN study, discovering that decades-long discrimination and socioeconomic strain accelerate health decline—a framework known as the “weathering hypothesis” (news.umich.edu, en.wikipedia.org).

For example, Black individuals are disproportionately uninsured or on public insurance, which correlates to lower attendance of primary and specialty care visits. However, even in health care systems designed to be egalitarian, such as the VA system, Black and Hispanic veterans were still 25‑32% less likely to receive hormone therapy compared to white veterans.

In addition, Black women are less likely to have symptoms documented in medical records, in turn, contributing to fewer referrals and prescriptions.

Altogether, these factors may result in menopause being far more of a health risk to Black women. Prolonged undiagnosed and untreated symptoms correlate with elevated risks for chronic health conditions: cardiovascular disease, osteoporosis, metabolic syndrome, and mental health disorders. Add to that the fact that Black women enter menopause earlier menopause and tend to have inadequate access to hormone therapy and one can surmise how long-term health outcomes tend to be exacerbated for Black women.

Conclusion

Menopause isn’t equal. Black women in the U.S. often endure earlier onset, more severe and prolonged symptoms, and experience systemic disadvantages in care and treatment. These disparities are rooted in structural racism, socioeconomic inequities, healthcare system failures, and cultural differences.

Holistic solutions demand provider training, culturally informed care, expanded access, policy change, and inclusive research. Through such efforts, medical professionals can ensure all women navigate menopause with dignity, relief, and equity.