Race, Ethnicity & Menopause

Every person’s menopause journey is unique. But did you know that your racial and ethnic background can play a large part in your experience?

Research is beginning to show that women of different races and ethnicities can experience menopause differently. Unfortunately, because many healthcare providers are poorly educated on menopause to begin with, these differences could mean that you don’t feel heard and supported.

Progress has been slow, but research and advocacy is helping build better support for midlife women’s health as well as increase providers’ ability to recognize and respond to the impact of race and ethnicity on someone’s menopause journey.

Understanding the research yourself can help you feel more confident in advocating for yourself as you seek care.

The SWAN Study

The Study of Women’s Health Across the Nation (SWAN) is a large, multi-site study of midlife women’s health that began in 1994. It has followed thousands of women since the ages of 42-52, observing their experience with menopause and aging.

The SWAN study is particularly important because previous research was limited mainly to Caucasian women of northwestern European descent.

Hundreds of papers have been published based off of the results of the SWAN study, as researchers continue to use statistical analysis to tease apart the relationships between the many variables that were measured.

The conversation about differences between health experiences and outcomes between people of different racial and ethnic backgrounds is about more than biology. The genetic differences between humans are minuscule, which means that race is far more of a social construct than a biological reality.

As the Center for Health Progress says, “This paradox, where race is both not biologically real and yet incredibly socially and politically real, is an unusual challenge for the health care system.”

The SWAN study is comprehensive and of high quality, and continues to provide important data for researchers to understand the impact of race on the experience of menopause. However, it was not specifically designed to look at the impacts of structural racism on health. Social, economic and health variables from the SWAN data can help inform the design of future studies.

Here are a few notable conclusions from SWAN study data:

Age at Menopause

Age at menopause is an important variable for someone’s health in the decades after menopause. Earlier menopause (whether natural or surgical) is linked to a higher risk of chronic health conditions later in life.

Black women reached natural menopause about 8 months earlier than white women and underwent surgical menopause almost two years earlier.
Black women were twice as likely as white women to have had their uterus and/or ovaries removed (hysterectomy/oophorectomy), which creates the immediate onset of menopause.
Hispanic women had similar rates of surgical menopause to white women, but it occurred significantly earlier.
Japanese-American and Chinese-American women reached natural menopause later than white women and had the lowest rates of surgical menopause.

Hot Flashes & Night Sweats

Having more severe and frequent hot flashes and night sweats is linked to an increased risk of heart disease.

Black women were 50% more likely to have hot flashes than white women, even when data was adjusted for smoking and body size.
Black women experienced hot flashes for an average of 10 years, compared to 6.5 years for white women.
Chinese-American women were the least affected by hot flashes

Vaginal Symptoms

Hispanic women were the most affected by vaginal dryness and painful intercourse

Sleep

Sleep is an important protection against heart disease, metabolic issues and dementia.

Black and Hispanic women had the most difficulty sleeping and staying asleep.
Black women slept worse and for an average of 30 minutes less than white women. This difference remained after controlling for age, education and employment.
More reported experiences of discrimination among Black women were linked to worse sleep, higher blood pressure, and other chronic health issues.

Health Before Menopause

Black women were more likely to have diabetes, obesity and heart disease than white women when they first enrolled in the study
At baseline, Black women demonstrated more impact of allostatic load, the physiological markers of chronic stress on the body.

Treatment for Menopause Symptoms

Black women were less likely than white women to receive treatment for depression and hot flashes.
Black and Hispanic women were less likely to receive a prescription for hormone therapy. The cause of this difference is still unknown, but researchers suggest that it could be due to healthcare provider bias, lack of access to expert care, and/or cost. More research is warranted to understand these disparities.

What Do the Data Mean?

In some instances, the differences in health experiences between racial groups could be explained by risk factors that are associated with social disadvantage. However, higher rates of hot flashes, poorer sleep quality, greater bodily pain and higher heart disease risk especially among Black women remained after adjusting for these factors.

Clearly, there are other elements at play.

Alexis Reeves, one of the SWAN investigators and study author says:

“Even when we accounted for things like socioeconomic status and differences in health behaviors, such as alcohol use and exercise, there were still these racial differences in menopause. That kind of points to something that was unmeasured—something about being in this social construct, of being categorized as Black or Hispanic in the U.S., that is contributing to this difference.”

Race and Ethnicity Aren’t the Only Factors

The Hispanic women included in SWAN spanned several subgroups, including Mexican-Americans, Cuban-Americans, Puerto Ricans, Dominicans and Central and South Americans. Because the backgrounds of these groups are relatively different from each other, grouping these women together is not always the best way to understand their experiences.

Factors such as socioeconomic status, education, financial strain, health habits, and acculturation (English language proficiency) are just as important in understanding the differences between women in the SWAN study.

The authors of one study on SWAN data, Robin Green and Nanette Santoro, write:

“Much caution needs to be exercised in interpreting these data since the reasons are unlikely to be innate ethnic-related issues. Genetic hypotheses are under exploration but to date the data have not been explicatory of these relationships. The role of discrimination and ‘othering’ in increasing vulnerability to symptoms needs to be taken into account; clearly further research is needed.”

The directive for health researchers is clear: more investigation is needed. But what does this mean for you?

Above all, your menopause experience is unique to you. However, your race and ethnicity may play a role in shaping what you’re feeling and what you can expect. If your menopause journey doesn’t fit the “textbook,” it may be because that textbook was written with data from a very narrow population.

Getting your healthcare needs met in midlife is often an exercise in self-advocacy, and insights from the SWAN study can hopefully give you a better understanding of how to prepare and how to talk to your healthcare providers.

Resources

Check out these fantastic resources specifically designed to support women of color in their menopause journeys or connect with a Midday coach for help navigating the journey, including how to self-advocate with your provider.

Black Girl’s Guide to Surviving Menopause

Health in Her HUE

A platform for connecting women of color with health resources and culturally competent providers