Women of Color / Black Women Affected Sooner, More Severely by Perimenopause

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.