Why menopause is different for Black women
Black women go through menopause two years earlier than White women...
By Dr Aziza Sesay, Founder of Talks with Dr. Sesay, VC and Creative Director of Black Female Doctors UK
Menopause is a universal change for more than half the world’s population, yet the experience is far from equal. Black women face unique challenges: menopause often arrives earlier, lasts longer, has more severe symptoms and is met with less support from healthcare systems. Despite being a natural stage of life, menopause sits at the intersection of gender, race, health inequality and structural bias. And Black women disproportionately bear the cost.
Black women go through menopause 2 years earlier
On average, menopause occurs around the age of 49 compared with 51 in White women. This matters because later menopause is associated with protective benefits, particularly against cardiovascular disease and bone loss due to the longer presence of oestrogen.
Black women are three times more likely to experience premature menopause, before the age of 40. Symptoms such as hot flushes and night sweats are around 50% more common, tend to be more severe, worsen with age and last significantly longer, approximately ten years compared with around six and a half years in White women.
Despite this heavier symptom burden, Black women are historically less likely to receive medical treatment. Studies have shown that only 8% of Black women used hormone replacement therapy (HRT), compared with 15% of White women. Research is lacking and disparities in access, trust and treatment persist.
The hysterectomy factor
Black women are two to three times more likely to undergo hysterectomy for benign conditions such as fibroids. Menopause following hysterectomy, particularly when the ovaries are removed or affected, is often more severe. According to USA research (The Study of Women’s Health Across the Nation in 2022), African American women who experienced menopause as a result of hysterectomy reported more intense hot flushes than White women, further contributing to the severity of symptoms.
Importantly, Black women often enter midlife with a more adverse cardio-metabolic profile, including higher rates of obesity, diabetes, high blood pressure and physical limitations. Cardiovascular disease is already the leading cause of death in women, and these factors compound the risks associated with the loss of oestrogen after menopause.
Why do these disparities exist?
The reasons are complex and deeply rooted.
Socioeconomic and lifestyle factors such as upbringing, employment, income, number of children, diet, exercise, smoking and alcohol use all play a role. These are shaped by broader societal inequalities that disproportionately affect Black women.
Chronic stress is a key driver. Living with the cumulative effects of racism, both systemic and interpersonal, has a measurable physiological impact. Chronic stress is linked to earlier menopause, worse symptoms and poorer overall health outcomes.
Access to healthcare is another major factor. This includes the ability to attend appointments, health literacy, feeling safe and heard in clinical settings, and having symptoms taken seriously. Many Black women report being dismissed, misdiagnosed or told they are “too young” for menopause, or that symptoms are due to anxiety or depression.
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Bias and stereotypes in healthcare sadly persist. Harmful assumptions, such as Black women having higher pain thresholds, can result in delayed diagnosis and inadequate treatment. Menopause symptoms may be minimised, normalised or overlooked entirely.
Health beliefs and stigma also play a role. Menopause is rarely spoken about openly in many Black communities, reinforcing silence, shame and lack of awareness. Common misconceptions include:
“Menopause is something you just get on with.”
“My mother didn’t take anything, so neither should I.”
“Menopause is natural so medications are absolutely unnecessary.”
“HRT is dangerous.”
“Herbal remedies are safer and work better.”
Misunderstandings around post-menopausal bleeding, sometimes seen as a return of fertility or a ‘final bleed’ when it can be a sign of health issues.
Finally, there is minimal research focused specifically on Black women and menopause. We do not yet fully understand the role genetics may play, largely because Black women remain under-represented in research trials.
Representation matters
When menopause narratives centre almost exclusively on White women in healthcare, research, and media, Black women are rendered invisible. Change must happen at multiple levels from education and awareness, openness within families and communities, addressing systemic and institutional racism, more representation in research and policy, and better healthcare professional training.
Practical tips for Black women seeing a GP about menopause
Before the appointment
If possible, book with a female clinician if that feels more comfortable.
Consider requesting a double appointment so you don’t feel rushed.
Keep a symptom diary: what you’re experiencing, when it started, how it’s changed and how it affects your life.
Ask about family history if you’re able to as early menopause can run in families.
During the appointment
Bring someone with you for support if helpful.
Clearly explain your symptoms, concerns and what you think might be happening.
Discuss your expectations for treatment and next steps.
Ask questions and seek clarity, you deserve to understand your options.
Advocate for yourself if you feel dismissed. Make notes if useful.
Request reputable, evidence-based resources.
After the appointment
Reflect on how the consultation went and whether you feel informed.
Review the information provided.
If you didn’t feel heard or supported, you are entitled to seek a second opinion. Do not suffer in silence.
Menopause must not be seen as just a ‘trivial inconvenience’, nor is it something Black women should simply endure as it can be quite severe and disruptive for many women. It is a significant life transition which can have profound physical, emotional and long-term health implications. Addressing menopause disparities requires listening to Black women, believing Black women and centering their experiences in healthcare, research and policy so everyone can be represented and supported.
Take The Female Lead’s Menopause Journey survey and share your experience to help women in the future: thefemalelead.typeform.com/menopause
