​I recently had the privilege of being featured on Menopause Coach Kitty Anderson’s YouTube Channel, Create a Menopause Recovery in the video titled “Keisha Is a Black Woman Using HRT in the United States: Perimenopause Was Traumatic Without HRT!”

I responded to Kitty’s call for women of color to come forward and share their experiences of recovery from perimenopausal or menopausal symptoms, especially those who are using hormone replacement therapy (HRT). I actually encountered Kitty Anderson before; I enlisted her help to coach me through some continued challenges I was facing after I had started HRT months before. I even featured her on The Real Peri Meno blog in the post “Kitty Anderson: Menopause As a Social Justice Issue,”profiling her own journey as a menopausal woman who uses HRT herself and her experiences in becoming an expert on the topic.

My journey, from the process of realizing I was perimenopausal and not suffering from some other malady, and the maze I went through in navigating the medical system, is here on my blog on the post titled “Shocked By Perimenopause? I Was, Too.”

I wish more Black women (and women in general) would go public about their perimenopausal woes and the solutions that are working for them. While I am using HRT, I don’t expect ALL women to do so. But I do explore the reasons why Black women seem less likely to pursue HRT in “Why It Seems Like Black Women Don’t Use HRT.”  Using HRT is a highly personal decision, just like choosing to use any prescription medication is.

Please watch / listen to the interview in depth. Here are a few points I considered after the fact that I want to state for the record:

Choose the medical practitioner, healthcare professional or physician who works for and with you! Regardless of color, too. That healthcare advocate who opts to partner with you in your care may not look like you, sound like you or any in way be like you, but they may be exactly what you need at that moment – and as a permanent ally in your long-term care. The best doctors in this journey for me have been an older (60+) white woman and a younger white man. It was a Black gynecologist who really let me down, along with a slew of others.

Be prepared to pivot. No day in perimenopause is guaranteed to be the same. Your symptoms may be well controlled and absent one day, and then they might pipe up the next. That may not necessarily mean that you need to reinvent the wheel, but it does mean that a versatile mindset is more important now than perhaps it has ever been. As symptoms change during perimenopause, and as hormones choose to cause a commotion every now and again (even while on HRT), realize that dosages may change, you may need to add in new medications and you may need to drop things that no longer work for you.
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If you speak out about perimenopause, be prepared for . . . silence. When I went public about my perimenopause experience, I knew it was going to require being vulnerable. I didn’t know how people would react or what they would say. So far, in terms of my personal sphere, the response has largely been one of silence. No one I know personally is really asking any questions or sharing any of their experiences, but I know they are reading the material here, taking notes and considering options. I started this blog to help others, even as I continue to help myself in the background.

I am a Black woman.

I am a Black woman in both the traditional, archetypal sense, but I am also a Black woman who has historically been a bit unorthodox, unconventional and different. I am my own person and have never, if not rarely, fit into any standard checkbox, including common, prevailing ideas of what it means to be one.

When I realized I was in perimenopause, after a multi-month torture of horrible symptoms, of which insomnia, low-level anxiety and night sweats were my most intractable problems, I sought answers. Not only did I seek answers from medical professionals, I led the charge by doing my own research. Most of those entrusted to safeguard and care for my health fundamentally were not prepared to do so. Out of nine doctors, only three took me seriously. Of those three, one agreed that it might be perimenopause; one nudged me further to consider it as the absolute diagnosis; and the final one declared it to be so and immediately put me on hormone replacement therapy (HRT).

This process involved reading peer-reviewed studies, scientific publications, results from clinical trials and other rigorous, academic materials. I also mined stories of what real women were experiencing by watching YouTube videos, engaging in online forums, reading blogs and listening to podcasts.

Sadly, most women I know of in real life remain silent about perimenopause and menopause.

In my pre-HRT life and before I began consulting physicians, I explored many natural or easy-to-access things first. As one supplement or tincture failed after another, I began to spot a rather glaring chasm: White women seemed to be using pharmacological agents and treatments way more than Black women. While White women were using HRT to replenish their estrogen, progesterone and sometimes testosterone levels, Black women were using over-the-counter vitamins marketed as menopause remedies, in addition to tinctures that had black cohosh, sage, chamomile and chasteberry (vitex) in them.

While White women were taking antidepressants like low-dose Celexa (citalopram), Lexapro (escitalopram), Zoloft (sertraline), Wellbutrin (bupropion) or Effexor (venlafaxine) for their vasomotor symptoms (night sweats, hot flashes), hormonal anxiety / depression and  sleep problems, Black women were taking Nyquil, meditation and St. John’s Wort for the very same constellation of symptoms.

Indeed, in a post that appeared in a Black women’s wellness group I follow, someone asked what women were doing for their perimenopause and menopause symptoms, and some of the responses included: dandelion root tea, black seed oil, turmeric, elderberry, vitamin D, wild yam root, red ginseng, valerian, horny goat weed, dong quai, CoQ10, prunes, flaxseed, primrose oil, hibiscus tea, lemon water, burdock root and cranberry juice.

For those women who look to conventional pharmaceuticals as a last resort (and I was one of those women at one time), a few ideas seem to be consistently hailed by both Black and White women. They include melatonin for sleep, magnesium for sleep and muscle aches, and ashwagandha for anxiety and promoting calm.

But still, there is a definite gulf between the percentage of African-American perimenopausal / menopausal women using prescribed medications and HRT vs. White women in the same boat. While I have not uncovered any research that explores why this is, I have my own hypotheses:

Lack of information. It can be very difficult to get accurate, useful information about perimenopause and menopause, especially if one only seeks out help from her primary care physician and stops there. Most general medicine doctors receive minimal information, if any, about menopause during their medical training. Even OB/GYNs’ training focuses more on birthing babies than treating women beyond the reproductive stage. Many physicians will disregard perimenopausal symptoms and instead link them to stress or burnout, or treat / test them as other problems related to thyroid, migraine disorders, or depression, rather than viewing it is the multifaceted perimenopausal condition that it is.

Dismissive doctors. Even when women perform a root-cause analysis and figure out that their condition is likely perimenopause, their doctor may dismiss this as a possibility, often claiming that the 40-something year-old woman in their office is “too young.” Even though hormonal changes in women begin happening from the mid-30s onward, far too many physicians don’t understand that symptoms of hormone change happen way before periods stop. It also doesn’t help that many Black women don’t appear to be the age that they are. So a 45-year-old Black woman may look 35, but have night sweats, emotional turbulence, migraine headaches, hot flashes and irregular periods – only to be told that she is way too young for perimenopause to be a consideration.

Inadequate medical treatment. Even if a doctor agrees that a woman is in perimenopause, they may prescribe ill-suited solutions, like birth control pills when she really needs HRT. Most patients really respect their doctors’ opinions and believe whatever they recommend to be absolutely valid and true. So, if a perimenopausal woman fares poorly on birth control pills, she may think the problem is not the prescription, but her instead. She may seek no further solutions and wing it from that point on.

Medication stigma. Multitudes of women are prescribed antidepressants when they hit perimenopause and menopause. In the U.S., one out of every four women in their 40s and 50s is on an antidepressant, and the uptick in their use at the time perimenopause happens is likely not accidental. There are many reasons for this, including the rationale that this class of drugs helps with vasomotor symptoms (hot flashes and night sweats), insomnia, anxiety, depression and panic attacks – all of which are perimenopausal symptoms. And though antidepressants are now used to treat various issues, such as nerve pain, headaches, low libido and smoke cessation, in the Black community, the common idea remains that if someone takes a drug in this class, they must be “crazy.”

Strong Black Woman Syndrome. Black girls are raised to become Strong Black Women. We are groomed and nurtured to believe in ourselves, never trust anyone too much, always be ready to provide for and fend for ourselves, and to “tough out” some of the most irreconcilable and devastating situations, from racism at the workplace and marginalizing beauty standards to everyday micro-aggressions and undeniable assaults on our humanity. Perimenopause is a time of vulnerability, and Black women are not given much space in this society (or in our families or communities) to take that sorely needed time for our own selves and sanity during this phase of life. Sadly, doing so can even seem like a sign of weakness.

Hormone Replacement Therapy (HRT) can be expensive. Sadly, most women who would really benefit from HRT never receive it. Part of the reason for this is its cost. Honestly, it can be expensive, even for those with ample insurance coverage. Some women are spending at least $70 out of pocket each month for their estradiol patches and oral micronized progesterone capsules, even after insurance pays its part. Others are paying $130 or more a month out of pocket, with no insurance coverage. And some women are spending even more if they pursue alternative HRT routes, such as pellets or custom-compounded HRT. In an inflationary economy and with many vital monthly expenses, and where incomes aren’t keeping up with the cost of living, some just don’t have the financial bandwidth to comfortably afford HRT.

Downplayed by doctors. Sadly, maltreatment within the medical industrial complex is still a major problem for Black patients. All too often, our concerns are sidelined; our pain complaints are maligned as “pill seeking” or complaining; and many of our medical problems just aren’t taken too seriously. Consider how bad White women are treated when seeking help with perimenopause, and for Black women, it’s probably at least 10 times worse. Mainly, it is only the most well-researched, the most valiant and the most well-funded (or willing to spend the funds) women who get proper, timely perimenopause treatment. And by virtue of circumstances, including implicit bias and a lack of healthcare equity, those women who get the care they desperately need usually aren’t Black.
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Belief in God. Now, don’t get me wrong. There isn’t a thing wrong with having a belief in a Higher Power, and standing firm and resolute in the promise of healing, restoration and deliverance from our mortal ails as a result. But sometimes our characteristic spirituality and faith cause us to delay treatment and scoff at medical interventions – seeing such as a sign of weakness, a lack of faith and evidence of a soul too focused on worldly, or ephemeral, things. I believe in God, pray every day and feel that God has given human beings the information, capability and talent to create interventions and medicines to treat the frailties of the human condition. I believe that God wants us to have quality of life, not merely quantity of years.

Perimenopause is not a linear experience – that is, its course, symptomatology and severity vary by each individual woman, though there are some common denominators.

However, for years scientists have been investigating many perimenopausal factors, including onset, level of debility and longevity of symptoms by racial groups and ethnicities. One of the most interesting and compelling studies is the SWAN study, also known as the Study of Women’s Health Across the Nation, which first started in 1996.

A subset of this major research study has unearthed race-specific findings, showing that the perimenopause experience may in some ways be associated with ethnicity. Given the diversity of women participating in SWAN over the years, researchers have had the capacity to evaluate women’s experiences from a physical, racial, biological, sociological and psychological lens. At the start of the SWAN study, 28 percent of participants were African-American, 47 percent were White, eight percent were Hispanic, eight percent were Chinese and nine percent were Japanese. Study participants were followed every year during the first 10 years and then every other year subsequently.

Many facts about menopause digest key points into an aggregate, one usually represented by the largest swath of the U.S. female population – white women. But within the predominating factoids about menopause, such as the average age of complete menopause being 51 in the United States, are other layers of nuance and differentiation. For example, the average of menopause for Black women is two years sooner, age 49. (Note: Menopause is defined as going 12 months in a row without a period. By most estimates, perimenopause – the time leading up to menopause when women are often symptomatic – can last 4-12 years).

Key Racial and Ethnicity Findings

• African-American women were more likely to undergo surgical menopause, or hysterectomy. Women whose ovaries have been removed face increased morbidity from strokes, fractures, Parkinsonism, cognitive impairment, dementia, depression and anxiety. These issues are amplified if the ovarian removal occurred before the age of 45.
• Hispanic women were more apt to experience an early or premature natural menopause.
• Black women reported higher incidence of heavy menstrual bleeding, while Hispanic women were more likely to develop type 2 diabetes. White women had the lowest bone density in the cohort.
• Hispanic women are not a monolith. Within this population, there are different nationalities and countries of origin. Puerto Rican women had the highest rate of metabolic syndrome, anxiety, depression and insomnia when compared to other Hispanic women. Yet Central American women reported greater vasomotor (hot flashes and night sweats) symptoms than other Hispanic sub-groups.
• African-American women had the highest BMI in the study, and researchers believe there is a connection between menopausal symptoms and BMI. Hispanic women had the second-highest BMI. Both Black and Hispanic women reported more severe and frequent hot flashes than other women.
• Lower socioeconomic status was related to an earlier menopause. Financial strain, adverse life events, daily stress and inadequate social support correspond with both depressive and menopausal symptoms. In the U.S., Black and Hispanic women as minorities face more race-related disparities in daily life. Some characterize the physiological manifestations of pronounced and ongoing stress as “weathering” that causes medical issues and aging due to an increased allostatic load (wear and tear on the body from chronic stress). Interestingly, Black women report hot flashes for 10 years, Hispanic women for almost nine years, and white women for around six and a half years.