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MENOPAUSE: WHAT'S HAPPENING
The median age of peri-menopause for Black and Latina women is younger than that for white women.
Apr. 27, 2022
Here, other important facts to know.
The road to menopause can be a confusing and stressful time. Known as perimenopause, it’s when your reproductive ability begins to wane. The time frame, which is marked by the cessation of your period for 12 consecutive months, is known as menopause. And, approximately 1.3 million women in the United States become menopausal each year.
“The signs of perimenopause can start anywhere from 5-10 years before the final period,” explain Sharon D. Malone, M.D. FACOG, CNMP, a leading OB/GYN with a focus on specific health challenges associated with menopause. "Generally speaking, by the time a woman is in her mid-40s, she is presumed to have begun the transition."
During perimenopause, your body is basically subjected to a hurricane of symptoms: menstrual irregularity, hot flashes, mood swings, irritability, brain fog, breast tenderness, depression, fatigue, anxiety, weight gain, palpitations, acne, sleep disturbances and changes in libido. The thing is, “not all women experience all of these symptoms, and [the symptoms] don’t show up in any particular order,” says Dr. Malone, who is also the Medical Director of Alloy Health. “But, 80% of women experience some constellation of these symptoms.”
The Mystery of Menopause—And Emerging Patterns
Despite so many commonalities, each woman’s journey in this area is uniquely her own. And at the same time, studies show that there’s a pattern among a large segment of women in the United States, namely Black and Latina women.
Research from the Study of Women’s Health Across the Nation (SWAN), a large, multi-site longitudinal, epidemiological study designed to examine the health of women during the midlife years, has revealed that Black and Latina women begin perimenopause at an earlier age than their white counterparts, with the transition to menopause lasting on average 1-2 years longer. The study also found that these ethnic groups tend to have more severe symptoms including vasomotor symptoms (think hot flashes), vaginal dryness, cold sweats and dizziness.
Additionally, research in menopause revealed that Hispanic women were likely to have more severe constipation, weight gain, and bloating. These ethnicities also have a higher percentage of sleep issues, specifically as it relates to staying asleep and early morning wakeups, found SWAN.
More seriously, women who begin menopause early have a two-fold increased risk of heart disease and stroke, per the Multi-Ethnic Study of Atherosclerosis. The same “post-menopausal women are more at risk for cardiovascular disease, type-2 diabetes, osteoporosis, sexual dysfunction, recurrent UTIs, and GI problems such as bloating, constipation and irregularity due to changes in the gut microbiome,” adds Dr. Malone. And these are just the physical symptoms. According to the SWAN study, Black and Latina women are also more likely to report feelings of depression.
Also worth noting: Even though disparities are heightened for both Black and Latina women, Kourtney Sims, M.D., FACOG, NCMP, and chief medical advisor for Phenology and an OB/GYN in private practice in Houston, TX says that if you look at the SWAN study, Latina women tend to weather some aspects of the menopausal storm a little bit better thanks to cultural norms in terms of attitudes and familial support.
Many theories point to why there are such disproportionate affects, but an exact cause has yet to be pinpointed. One, according to Dr. Malone, is that Black and Latina women enter perimenopause at higher weights than their white or Asian counterparts. Increased levels of stress, or rather how women respond to it, may also play a role, according to a study in PLOS ONE.
“We are more at risk in general,” adds Dr. Kourtney, citing issues such as lower socio-economic status, lack of access to care, higher waist-to-hip ratios, depression, anxiety, sleep issues, and day-to-day racism. “So, whenever we get to a period in our life when we are going through a hormonal transition, all of those pre-determining factors that were just part and parcel of your evolution as a Black woman or as a Latina woman, come to bear.” All of which contributes to how you fair during menopause.
What Can Be Done?
While “perimenopause is not something that is going to kill you,” Dr. Kourtney says, it can impact your quality of life if you’re carrying a greater symptom burden.
That’s why you want to set yourself up for success from the onset. This means coming into this time with your healthiest self.
“If we want to improve symptomatology during menopause, then we need to start work a decade before,” explains Dr. Kourtney. “Nobody necessarily thinks about it from, this extra weight I'm carrying, this extra stress that I'm dealing with daily, this sleep that I'm not getting at night, in seven years that’s going to make my hot flashes worse, that's going to make me possibly transition into menopause earlier.” But it can and often does.
For those who are a little late to the game, Dr. Kourtney says you have to be more intentional with shoring up your health. “It’s not that the work is any different in terms of lifestyle changes,” she says. “You’ve got to double down, though.” And that means going to your primary care physician (PCP) and getting all of your numbers (think blood pressure, hemoglobin A1C, fasting insulin) checked, making sure you're getting eight to 10 hours of sleep each night, getting key nutrients like antioxidants, flavonoids and polyphenols through a vegetable-heavy diet or supplements. These are the difference-makers. The importance of exercise, stress reduction and dietary modifications cannot be overstated while you’re in the midst of this transition period.
Not sure where to start on a wellness improvement journey? Consider talking to a nutritionist. You can chat one-on-one with a Registered Dietitian trained in menopause-related topics by downloading the Phenology app. This gives you the chance to ask an empathetic professional about how your nutrition, wellness, hydration and lifestyle can affect your symptoms, and get real answers via text-based chat.
And know that you are not necessarily going to get what you need from your regular OB/GYN or your PCP. That’s why Dr. Kourtney recommends a menopause specialist (You can find one at The North American Menopause Society) to ensure the best care for this specific time in your life.
Dr. Malone adds that menopausal hormone therapy is also an option for healthy women, and when started around the time of natural menopause, it decreases the risk of type-2 diabetes, osteoporosis, colon cancer and vaginal and urinary symptoms.
Research published in Obstetrics & Gynecology, however, shows that women of color aren’t always given replacement hormone therapy as an option. “Sometimes, unfortunately, the color of your skin or your perceived cultural group or class can impact the recommendation that your provider will make at the time of service,” Dr. Kourtney says. “Should it be that way? No. But most of us are familiar with inherent bias and inherent bias is not exempted from physicians unfortunately.”
What must not be overlooked is that this is not just about Black and Latina women suffering more severe symptoms, and for longer periods. According to Dr. Malone, the take home message is that Black and Latina women are less likely to be treated for their symptoms. In other words: health disparities are at play here. That’s why Black and Latina women must remain vigilant about their health, especially when it comes to this often-taboo topic, and be staunch advocates for their care. Doing so can help make this midlife stage much more bearable.
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