​Meet K.E. Garland of Jacksonville, Fla., a mother of two daughters (ages 19 and 22) and loving wife of 25 years. As if preserving a marriage for a quarter century and raising a family were not enough, K.E. is also a published author, educator and the creator of the menopause awareness site, NavigatingtheChange.

I recently had the privilege of contacting Ms. Garland, who altruistically agreed to answer some behind-the-scenes questions about her experience through “the change.” The 48-year-old Garland is still in perimenopause, not actual menopause, as she has not yet gone a full 12 months in a row without menstruating.

Now for the Q-and-A!

Many people think there’s a connection between when women started their periods and when they go through menopause, though there isn’t much science to back this claim. How old were you when you started your period? And how would you describe your menstrual cycles?

I started my period when I was TEN years old! It took me a while to figure out what was going on, even though my father explained it to me. My periods were always predictable; if I didn’t have a period, it was because I was pregnant.

How would you characterize your pregnancies? Were they uneventful, difficult on in between?

My pregnancies were very normal. For both, I was almost fully dilated and didn’t know it until I went to the last appointment. For my second pregnancy, I had to have a C-section because, instead of feeling the baby’s head, the OB/GYN felt her feet (breech position).

What do you recall experiencing as your earliest perimenopause symptoms, and when?

I think I was around 44 or 45. The biggest issue I had initially were periods every other week! It was the most distressing thing I’ve ever gone through. The first time it happened, I had on white pants and was headed to work, which is 60 miles from my home. I just happened to have to use the bathroom, and that’s when I found out I was having another period, even though I’d just had one two weeks’ prior. This is one of the sure signs of perimenopause – irregular periods.

What have been the most challenging symptoms, and how have you gone about trying to relieve them?

Later, I began having hot flashes, night sweats and insomnia. After doing a little research, I found that drinking alcohol, especially wine, and having sugar at night right before bed increases hot flashes and night sweats, and that can also cause insomnia. I stopped drinking wine or anything right before bed. Also, I’ve switched to a plant-based diet, which includes more vegetables and fruits, and less meat. Some of the meals I enjoy are veggie tacos or coconut curry-chickpea-type recipes.

Is anything off limits, as far as what you will do to get relief for symptoms?

So far, I haven’t had to do anything too crazy, but usually if a new symptom comes up, I try to first do something natural, like change my diet, and then seek other ways.

What have your encounters with the medical community been like, particularly in dealing with perimenopause?

Doctors have been NO HELP to me. My gynecologist told me I was “going through menopause,” and she could prescribe birth control to alleviate the symptoms. I didn’t even understand why she would suggest birth control. But now I do . . . it’s all hormonal. In fact, my experience with doctors is part of the reason I began the website, NavigatingtheChange. I was researching so much that I figured I’d include what I found in order to help other women who may be struggling.

Is your experience of (peri)menopause anything like that of your mother, as far as you know? Have you talked to other female elders or relatives about their experiences?

My mother died when I was 16, and I did talk to my grandmother, who will be 95 in October. She said, “I only had a little sweating!” So, yeah, no one in my family full of women had said a word to me about this very important time period, not one word.

What do you most wish you had known beforehand?

I really wish there would have been some type of ceremony or something. Wouldn’t it be cool if all of the elders would give you one thing that could help you? For example, I’d give my daughters turmeric or ginger tea because it helps settle your stomach and your nerves (bloating and anxiety are symptoms of menopause). It would be a coming-of-age box.

For some women, perimenopause is so hard that it’s difficult to envision the future. If you’re able to think 20 years into the future, what do you envision?
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Twenty years from now, I hope to be done with all this menopause brouhaha! All of the crones say that phase is very liberating, so it sounds like a much more relaxing time. I hope that in 20 years, I’m walking around like one of those so-called crazy-looking women with wild hair, who could care less what others think about anything. I think I’m almost there! 

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.