Menopause is an almost universal experience for women in middle age. And most women will experience some physical, mental and emotional changes in the years leading up to and after the end of their menstrual cycle.
While vasomotor symptoms such as night sweats and hot flashes are common to most women, how long they last and how severe they can be varies by race and ethnicity. Cultural norms can have a significant effect on how women experience menopause as well.
Read: Menopause symptoms are far from universal >>
“I had a Latina patient who was having a hard time processing what was happening physically in terms of her hot flashes and night sweats, but also felt like there was no one she could talk to about what she was feeling emotionally,” she said. Makeba L. Williams, MD, professor in the department of obstetrics and gynecology at Washington University School of Medicine in St. Louis. “She said her village was there for her when she had her babies, but no one talked to her about what to expect during menopause. She was almost afraid to tell her mom that she was considering hormone therapy because that was countercultural to her.”
As with other health conditions, racial, ethnic, and cultural disparities can make a difference in menopause care. We spoke with Williams about the connections between racial disparities in menopause and what women can do to make sure they receive care that honors their personal and cultural needs.
This interview has been lightly edited for clarity and length.
Healthy Women: What data are there on racial differences in menopausal symptoms?
Makeba L. Williams: In the SWAN study on women’s health, we found that African American women report having more hot flashes and night sweats. They are taken more often and also for a longer duration — an average of 10 years. It’s nearly 9 years for Hispanic women, 6.5 years for white non-Hispanic women, and even fewer years for Asian women.
Healthy Women: Do we know the reasons for these racial differences?
Makeba L. Williams: We don’t know exactly what drives them. But if we think about women’s health at midlife in a holistic way, vasomotor symptoms like hot flashes and night sweats can be markers for cardiovascular disease. When we consider who is most affected by cardiovascular disease, we come back African American women. This connection leads to more overall health disparities for African American women.
Healthy Women: Living in neighborhoods with higher concentrations of air pollution and less green space may be related to younger age at menopause. What might be the correlation between these factors?
Makeba L. Williams: We are still trying to understand how the environment affects the transition to menopause. Is there a direct connection? Or is it influenced by other factors, where exposure to air pollution and less access to green space cause other conditions that lead to an earlier age at menopause? It is an area that needs to be explored, but we know that socioeconomic disadvantage, stress, caring responsibilities and chronic exposure to racism and discrimination are associated with worsening symptoms. We see many of these factors in African Americans who have these disproportionate levels of menopausal symptoms.
Healthy Women: What other connections did the SWAN study reveal?
Makeba L. Williams: We observed increased cigarette and tobacco use among African Americans and less physical activity. Longer duration of hot flashes and night sweats were associated with stress, lower educational attainment, stress, financial strain, poor social support, obesity, smoking, and lack of a partner. There is still much we don’t know, as women of color have been largely excluded from menopause research. We need to be more inclusive in recruiting diverse research populations to better understand what causes these disparities.
Watch: HealthyWomen Congressional Briefing: Women in Clinical Trials >>
Healthy Women: Can cultural contexts of menopause influence women’s physical, mental, and emotional symptoms?
Makeba L. Williams: Culture can make a difference in what women reveal to others, what they talk about, and what is normative. White women can be more likely to seek treatment, while some women of color may feel they have so many other things to worry about and not seek treatment. In the grand scheme of things, the thought might be, “Do I have time to worry about a hot flash or night sweats? Or a little weight gain around my waist even though I’m working out?’ We can also think about differences in body shapes, which bodies are celebrated in different communities, and how weight is distributed, which means that weight gain may not be considered problematic in some non-white cultures. While 80% of women in menopause will experience hot flashes and night sweats, the level of discomfort can be very different and what these symptoms represent can mean different things between cultures.
Healthy Women: In many Western nations, menopause is often portrayed as a negative experience. Does this differ outside of western contexts?
Makeba L. Williams: A common theme in the literature is that many Minority women perceive this transition as positive. They have an attitude of acceptance and laugh off their symptoms because in the grand scheme of things, they feel they have all these other positive benefits of middle age and menopause. Many will feel liberated for the first time in their lives because they are not facing some of the challenges associated with the reproductive period, such as pregnancy or bleeding. If you are African American and disproportionately affected by fibroids, when your period stops, suddenly you don’t have to worry about having to remember a second pair of clothes or change your daily activities because you don’t know when your period might come. Also, in many cultures, reaching a certain age and point of maturity it comes with respect. There is a feeling that you have reached that famous station in life.
Healthy Women: What is the best way to prepare after menopause, regardless of your cultural background?
Makeba L. Williams: Every woman deserves to have the best menopause care. This may look like asking your health care provider for guidance about menopause in general. This may sound like she’s arguing and saying, “I know there are differences from one person to another and how they experience menopause. Tell me more.” I hate to see women continue to suffer in silence because their mothers or aunts did and their own health care provider won’t raise the issue. I want patients to have agency in seeking information and then they decide what is best for them.
This resource was created with the support of Astellas.
