You learn a lot of surprising things when you train as a menopause educator. Like menstruation, it’s a perfectly natural process that’s cloaked in secrecy. Most of us stumble into it perimenopause knowing very little about what to expect or even what the word means: menopause is when you’ve gone 12 months without a period. Perimenopause is the wild ride of fluctuating and plummeting hormones that comes before.
Another little-known aspect is how much the cumulative effect of stress on your body can affect your experience of perimenopause and beyond. The discomforts of “the change” go way beyond hot flashes to include insomnia, brain fog, depression, and more. Everyone’s experience is different. But certain trends emerge. Most alarming of these is how much harder the stages of menopause are for people (women and non-binary people with ovaries and a uterus) of color. It starts earlier, lasts longer, and the side effects are more intense.
People of color reach menopause earlier
The mean age for reaching menopause in most industrialized countries is 51.5. But black and Latinx people in the US reach menopause about two years earlier. So many different factors affect the age of menopause that it’s hard to tease out why exactly this the case, but there does seem to be a notable correlation here.
The phases of menopause last longer for people of color
Reaching menopause earlier doesn’t necessarily mean it’s an easier transition. If anything, it’s more difficult. People of color tend to experience vasomotor fluctuations (hot flashes and night sweats) for a longer period of time, beginning in perimenopause, and sometimes lasting into the post-menopause years. According to data collected in SWAN, the mean amount of time white women experience vasomotor discomfort is 6.5 years. For Latinas it’s 8.9 years, and for black women it’s 10 years.
This age and length difference matters not just for our comfort, but also for our overall health. Entering menopause at an earlier age is associated with a shorter life expectancy, higher risk of cardiovascular disease, greater loss of bone density, and higher risk of fracture and osteoporosis. (On the other hand, it’s also associated with a lower risk for breast, endometrial, and ovarian cancers.)
Menopause is a hotter hell for people of color
In addition to an earlier and more lengthy perimenopause, people of color report experiencing menopause-related discomforts more intensely. This is not surprising, considering other factors like a history of intimate partner violence and sexual assault or living in a dysfunctional neighborhood are associated with more severe menopause-related side effects. It’s another example of the relationship between stress and how you experience menopause.
Is all of this due to “weathering”?
Around the same time I was getting my menopause education I read a landmark New York Times feature which shed light on the high maternal mortality rates for black women, Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis.
In the feature, journalist Linda Villarosa, author of the forthcoming book Under the Skin: Race, Inequality, and the Health of a Nation (Doubleday, 2020) spotlights the stories of individual mothers and presents report after report that paint a disturbing picture. She notes that a Department of Health and Human Services report shows pre-eclampsia and eclampsia “are 60 percent more common in African-American women and also more severe.” And she points to a CDC study published in the New England Journal of Medicine that looked at nearly a million linked birth and death certificates and “found that infants born to college-educated black parents were twice as likely to die as infants born to similarly educated white parents. In 72 percent of the cases, low birth weight was to blame.” These are just two examples of the health gap for pregnant black women.
Why is this happening? Villarosa points to the work of Dr. Arline Geronimus, professor in the department of health behavior and health education at the University of Michigan School of Public Health, who originated the theory of “weathering.” This describes how the accumulation of toxic stress, largely due to a lifetime of constant racial-based discrimination and aggression, micro and overt, literally deteriorates the bodies of black women.
Weathering can actually be measured. In a review of data from the Study of Women’s Health Across the Nation (SWAN) Geronimus and her team found that by the time they reach 49–55, black women are 7.5 years “older” biologically than white women the same age, based on their respective telomere length.
As for why the burden of stress is greater for black women, Villarosa draws a straight line to racism. “For black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions — including hypertension and pre-eclampsia — that lead directly to higher rates of infant and maternal death. And that societal racism is further expressed in a pervasive, longstanding racial bias in health care — including the dismissal of legitimate concerns and symptoms — that can help explain poor birth outcomes even in the case of black women with the most advantages.”
I believe people of color reach menopause earlier and experience discomforts more intensely and for a longer time for the same reason. If the chronic exposure to the physiological effects of stress can complicate pregnancy and childbirth, it follows that it would affect our menopause as well.
I want to know more
So that’s the picture painted by researchers. It’s compelling. It tells me we need to look at this more, from multiple perspectives. What do we people of color take away from this? What can doctors learn?
What’s missing from this picture are the voices of marginalized people themselves who are in menopause, and that is something I’d like to explore more. I want to hear your stories. If we’re going to break the taboo of menopause we’re going to need to paint a more complete picture.
I’m starting with a survey. If you want to help tell the story of menopause, please introduce yourself via my short (promise!) questionnaire. I’m not sure what form this project will take, but I know I can’t do it without your voice.
Higher rates of cardiovascular disease among women of color is unacceptable to me. Greater suffering for women of color is unacceptable to me. Right now, at this moment, we are at a cultural moment when it is unmistakably clear that our world needs more leadership that reflective of ourselves, in all our gender representations and colors. We need our elders, and we need them in glowing health. We need menopause to be better for people of color.