By Anissa Durham
Hot flashes, weight gain, and night sweats — are some of the most well-known (and common) symptoms of menopause. But common doesn’t mean easy. For the more than one million women who experience menopause each year, “the change,” as it’s called, can cause serious physical and mental health difficulties — which makes it even more frustrating when you don’t have accurate information about what’s happening to your body.
Indeed, for many Black women — beyond the idea that menopause happens once you no longer have a period, plenty is still unknown.
Part of the unknown is the lack of research studies that focus on the different ways Black women experience menopause. Some studies date back to the early 2000s, and the severity of symptoms leaves Black women questioning what is happening to their bodies and if it’s even related to menopause.
Due to cultural taboos, our moms and aunties might not have shared their experiences. And, given that research shows healthcare providers don’t always take Black patients’ concerns seriously, we may not necessarily get help from the doctor.
In a 25-year study on the menopausal transition of women, researchers found Black women were more likely to reach menopause 8.5 months earlier than white women — and have worse symptoms like depression, untreated hypertension, and sleep disturbances.
Despite this, for Black women, menopause doesn’t have to be as intimidating as it seems.
Word In Black sat down with Liza Swedarsky, an associate gynecologist at Mass General Brigham, Division of Urban Health, and clinical instructor at Harvard Medical School. With more than 20 years of experience, she explains the ins and outs of the menopausal experience.
Word In Black: What is the difference between perimenopause and menopause?
Liza Swedarsky: Perimenopause is the time period before the actual final menstrual period. We’re born with all these follicles or eggs that our body is going to make and ovulate once they meet with sperm, then we conceive a pregnancy or embryo. So, once we have exhausted our follicles, you have your final menstrual period because your menstrual period is really the byproduct of you not having a fertilized egg or pregnancy that month.
The perimenopausal period is the time period before your very last menstrual period when you’re considered menopausal. It’s considered more of an early transitional phase where women start to not ovulate a follicle or egg. When you’re menopausal, that means you had 12 consecutive months with no menstrual period, and that indicates that you’re no longer ovulating follicles.
WIB: What are common, well-known symptoms and lesser-known symptoms of menopause?
Swedarsky: The most common symptom and most well-known is hot flashes. Joint pain, and trouble sleeping, there’s been association with the menopausal transition and symptoms of depression, anxiety, and difficulty remembering things. Those are the most common in the early menopausal transition. And once we get later into menopause, women start to experience more severe effects of lack of estrogen such as vaginal dryness, urinary frequency, vaginal discomfort, and pain with intercourse.
When women go through menopause, they start to have an increased risk of cardiovascular disease, high blood pressure, and bone loss. Probably one of the most common complaints women see me for as a gynecologist besides hot flashes is decreased sex drive and having more difficulty achieving orgasm — if they are able to orgasm. Burning with sex, pain with sex is not something very often talked about with women in their 40s — about the discomfort women start to experience when the estrogen levels drop.
Studies have shown that Black women are more likely to go through earlier menopause if they smoke. Stress levels can affect the hormonal mechanisms in the brain, and women may go into slightly earlier menopause. Caring for a very diverse patient population … I don’t necessarily see Black women coming in with more severe menopausal symptoms than white women. That could potentially be because Black women are less likely to come in and complain about hot flashes.
WIB: How is menopause experienced differently in Black women?
Swedarsky: With 20 years of clinical experience to say how do Black women experience menopause versus white or Latina — it’s all an individual experience. I do think I find Black women seem to have less hot flashes than white or Latina women, and that could be associated with weight.
Women in general, whether Black, white, Latina, or any race who are more full-figured and have more weight on them, seem to not have the hot flashes and the vaginal dryness, and some of the severe menopausal symptoms that thinner women have. This seems to be an area that is helpful in the menopausal transition. I don’t see as many Black women presenting with severe hot flashes as white and Latina women have.
WIB: Why is there a disconnect between the way Black women and non-Black women get medical treatment during this menopause transition?
Swedarsky: What I find, as a Black woman myself and in Black communities, the topic of menopause somehow seems to be a little bit taboo. I think it’s taboo, really, for all women — there’s fear around it, fear of the unknown. I feel that there’s not as much education in Black communities and enough conversation about the different phases of life and reproductive life and what to expect. So, I find that Black women, when they’re presenting for gynecologic care, are often not educated by their providers.
Women often see their primary care physician first, or they have a gynecologist. I’m seeing the education piece across the board is missing. I see that particularly often in Black women and Latina women if they only speak Spanish, but it depends on their provider. When Black women present with menopausal symptoms, there just hasn’t been a lot of education, so that they have expectations about what their bodies are going to do.
It seems like there’s less discussion among women of color in their communities about these personal health matters. People are more guarded in general about sharing. Not only are they not receiving education from their providers, there is less dialogue within communities about it.
WIB: Do you thik because there is, at times, less education that this contributes to why Black women are less like to complain about menopausal symptoms?
Swedarsky: Black women, at large, we’re a very resilient group. The trajectory of Black women in terms of moving into professional spaces and getting higher degrees has created a resilience in a way that we push through things. I find that there’s sometimes a disconnect between the emphasis on the life and caregiving of children, family members, parents, and the self.
Many Black women, with just the strength and the resiliency that’s required in life — moving through stress and their work-life balance — can sometimes ignore the symptoms in the body, or they just push through it. They push through it because that’s what we’ve learned to do.
If the body is speaking, you’re having hot flashes, or trouble sleeping, it’s important to get to a space where the mind and body are connected as one. Knowing that I’m still the steward of my health care, I’m the boss of my body, I can get the information and make decisions.
There is fear in the Black community — which is deeply rooted in our history of how medicine has progressed, using Black bodies for research and in developing instruments. I do think that for Black women, there’s still space that we need to build trust. In gynecology offices, it’s a very private space where women are vulnerable. So, establishing trust is important, and if they don’t feel that trust, they’re less likely to talk about what they’re feeling in their bodies.
