By Dr Michelle Bartholemew & Dr Sharon Wray

This piece first appeared in Issue Two of the ADF As One Magazine. Learn more here.

This discussion piece aims to raise awareness and understanding about menopause and, specifically, how Black women experience menopause.

Whilst we recognise that the term Black has both political and racial applications, for this discussion piece, the term is used to denote individuals who are not White (women of colour) who are of African and African Caribbean descent (hooks, 1990; Maylor, 2009).

Black women are not a homogenous group; they have different cultures, different attitudes towards menopause, different environmental and living conditions, and they are from other social classes.

All of these can impact how a woman experiences the menopause (Prasad, 2023).

Indeed, it has been pointed out that experiences of menopause need to be defined ‘more broadly than just a set of treatable symptoms, because symptoms themselves may have various cultural meanings’ (Dillaway et al., 2008: 767).

For example, assumptions about the average age of the onset of transitional life health events, such as menopause, are often inadequate as they are based on white populations.

As such, very little research has been conducted on the different ways women from diverse racial and ethnic groups experience menopause (Reeves et al., 2022; Prasad, 2023).

This article piece will explore menopause, what it is and how it affects the health and well-being of Black women. The cumulative impact of racial and social discrimination on menopausal transition will also be examined.

What is the Menopause?

Menopause is a transitional life stage that signifies the end of fertility and the cessation of menstruation. It is thus a stage in a woman’s life that signals the end of the ability to have children (although for some, this is not the case as they have always been infertile and menstruated).

Menopause does not happen straight away and is, for many women, a gradual process characterised by hormonal changes and menstrual irregularities. For example, the number of mature eggs in a woman’s ovaries lessens; thus, ovulation becomes irregular.

The production levels of the hormones oestrogen and progesterone decrease, and the drop in oestrogen levels causes most of the symptoms of menopause (WHO, 2022; National Institute on Aging/National Institute of Health, 2023).

Menopausal Symptoms

On average, women experience menopause between the ages of 45 and 55 years, with 45 years and under being seen as early menopause (WHO, 2022; British Menopause Society, 2023; National Health Service, 2023).

However, there is evidence to suggest that some Black women experience menopause differently from other women (Reeves et al., 2022; British Menopause Society, 2023). For example, Reeves et al. (2022) found that Black women not only experienced menopause 1 to 2 years before some other ethnic groups, but Black women also had a more prolonged transition phase.

For some women, regardless of ethnicity, symptoms can last for 10 years (Steffan and Potocnik, 2022). Similarly, Kracht et al. (2022) found that Black women have an increased rate and duration of menopausal symptoms.

Such symptoms, which differ amongst women, include hot flushes, sleep disturbances, vaginal dryness, reduced cognitive performance, weight gain and thinning hair (Kracht et al., 2022; Prasad, 2023).

Further, Kracht et al. (2022) and Prasad (2023) found that Black women, when compared to women from other ethnic groups, were less likely to experience an increase in mood changes.

Research suggests that the reason for these differences has been attributed to an accumulation of negative stressors which have a detrimental impact on health (Geronimus, 2006; Simons et al., 2016; Reeves et al., 2022).

Menopausal Experiences

The fact that Black women experience discrimination is well documented (Curtis and Lawson, 2000; Wray and Bartholomew, 2006; Simons et al., 2016; Chouhan and Nazroo, 2020; Simons et al., 2021).

This discrimination is based in part on ethnicity and gender, and there is evidence to support the association between these and overall adverse health outcomes. Modood et al. (1997), Curtis and Lawson (2000), and Wray and Bartholomew (2006) found that the cumulative impact of racial discrimination and social and economic inequalities across the life course affect women’s health as they grow older.

Thus, whilst lifestyle behaviours such as exercise, diet, smoking and drinking alcohol play a role, the marginalised, stigmatised positions Black women may hold within society influence experiences of health and menopause (Simons et al., 2016; Simons et al., 2021).

Over time, it is argued that multiple discriminations, such as the stress of dealing with structural barriers and material hardships, limited employment opportunities and the potentially negative stereotypes of health professionals, lead to biological wear and tear, increase the rates of illness and disability (Geronimus et al., 2016; Ronald et al., 2021; Simons et al., 2021).

It is this social and biological wear and tear that impacts Black women’s experience of menopause (Ronald et al., 2021; Simons et al., 2016; Simons et al., 2021).

It is then not surprising that Black women are more likely to commence symptoms of menopause earlier than other groups of women. Summary How menopause and related symptoms are experienced amongst Black women is an under-researched area.

Whilst there is evidence to suggest that Black women’s experiences and symptoms (exacerbated by the stressors attributed to racism and discrimination) may be an early indication of future health concerns (Malek et al., 2019; Prasad, 2023), we also need to consider the health impact of complex inter- connecting oppressions and how these impact on how Black women experience and make sense of the menopause (Malek et al., 2019; Prasad, 2023).

If you would like further information about Black women and menopause – research, events and information, please see Black Women in Menopause – Events and Resources blackhealthandbeyond.co.uk