Many factors come into play when women enter menopause, making each woman’s experience unique. However, results from the Study of Women’s Health Across the Nation (SWAN) show that women of color tend to enter perimenopause and menopause at earlier ages than their white peers, have longer transition periods, and experience more intense hot flashes and vaginal symptoms.
Black Women May Have a Longer Transition, Worse Symptoms: Racial and Ethnic Disparities in Menopausal Symptoms
The SWAN study has found the following so far:
Severity and Quantity of GI Issues Also Related to Race, Ethnicity, and Menopause Status
Hispanic women were more likely to have higher severity scores for constipation, weight gain, and bloating.
If you are having significant GI problems — diarrhea, bloating, nausea, or stomach pain — follow up with your physician. It could be a complication of menopause, but it could also be a sign of another condition.
What an Earlier Menopause Means for Personal Health Risks
“If you get your menopause earlier, it means you will get the biological effects of the menopause — bone density decline, increase in fat mass, decrease in muscle, increase in cholesterol — all earlier, which in turn means you will have the later-life health consequences (osteoporosis, heart disease, falls) a bit earlier,” says Arun Karlamangla, MD, professor of medicine in the division of geriatrics at David Geffen School of Medicine at UCLA in Los Angeles, and also a member of the SWAN team.
Results Will Help Women of Color Access Better Healthcare
These findings are important, says Dr. Santoro. “I have practiced medicine in environments where the menopausal experience of Black women was simply not appreciated. Not knowing that a Black woman is likely to have longer and worse menopausal symptoms does her a disservice, because the clinician might tend to minimize the impact of her symptoms and might be less likely to offer her hormone therapy or other treatments. Having a better idea of how long symptoms will last is also helpful, and knowing more about differences in the timing of menopause may influence the decisions to do testing, such as a bone density screening, and other aspects of menopause care.”
Allostatic Loading: What It Is, How It Hurts Health
No one is entirely sure for the reasons behind this disparity in menopause experiences, but researchers believe it all has to do with a specific type of wear and tear on the body, something called “allostatic load,” says Karlamangla. The body is constantly trying to maintain homeostasis, keeping its physiological parameters tightly regulated — your blood pressure, heart rate, blood glucose level, and more. But when faced with challenges or adversity, these systems temporarily go outside that normal operating range: Your heart rate and blood pressure go up. “It goes outside the usual resting state to react to stimuli — a normal and healthy allostatic response. The long-term negative consequence of responding too often is allostatic load; the stress response systems get worn down.
Allostatic loading is what happens to these physiological systems if the challenges come too frequently, or the stress is severe or chronic. This could mean they lose the ability to react to new challenges, or take a very long time to calm down and come back to the resting state, or the resting state itself could become altered. “We see that allostatic load is higher in people who have had chronic stressors in their lives,” says Karlamangla. “More generally speaking, we find on average that people from disadvantaged communities have greater allostatic load than people from more advantaged communities.”
Nature vs. Nurture? Genetics vs. Socioeconomics?
No researcher so far has been able to definitively untangle race and ethnicity from socioeconomic factors or genetics from environmental influences on the menopause transition, says Santoro. She adds that the only site that recruited Latina women (New Jersey) wound up with a relatively socially disadvantaged group, so the data may not be as broadly applicable to, for example, college educated Latina women, who are not well represented in SWAN. (Neither are Latina women of Mexican descent, as there are fewer in New Jersey.) “SWAN was able to recruit substantial numbers of Black women, and also substantial numbers of middle-class Black women, so we think we captured a fairly representative group of Black women, and we were one of the first studies to do so,” she says.
Race as a Social Construct
Santoro adds that since the SWAN study was conducted, researchers have recognized that race and ethnicity are a social construct. “The social environment has shifted to more of a de-emphasis on race and ethnicity per se as predictors and more on the sorts of things that go along with race and ethnicity, such as BMI, education, income, and perceived discrimination that may be responsible for the differences we are observing between ethnic groups. Doctors can and should ask questions about employment status, housing status, food insecurity, and some very basic things that lead to stress and allostatic loading.”
How Women of Color Can Advocate for Their Health
“We are on the steep part of the learning curve in appreciating how we have shortchanged women of color. We have all seen that it doesn’t matter who you are, even if you are Serena Williams, you risk not being listened to, and not having your symptoms receive appropriate attention,” says Santoro. Many experts still don’t know about symptoms in different types of women so advocate for yourself and with your doctor.
Santoro advises you bring someone with you to your doctor appointments to have a second pair of ears or who can speak up if you are momentarily flustered. That extra person in the room can reiterate and reinforce what the patient is saying. “It’s a pretty sorry state of affairs that a second person is needed to get medical professionals to listen to an adult Black woman, but if that is what it takes, then that is what needs to happen,” says Santoro.
Bring your doctor a list of your symptoms in order of importance to you. List any other symptoms beyond the obvious ones (hot flashes, vaginal dryness, sleep or mood issues) that you think may be related to your menopause transition. As Santoro notes, “Sometimes there are oddball or nontraditional symptoms that women have that respond well to hormone therapy or other treatments, and it’s good to get them out in the open from the start.”
