Menopause is the point in adulthood when your menstrual cycle stops. Typically, menopause has officially arrived if you haven’t had your period for 12 months.

In the years leading up to menopause, hormone levels fluctuate as they decline. During this time, people may experience changes in their menstrual cycles or have vasomotor symptoms (VMS) such as hot flashes.

This period of time — from when hormone levels begin to decrease to 12 months after the final menstrual cycle — is known as perimenopause, or the menopausal transition. Many people refer to the whole experience simply as menopause.

Although everyone experiences menopause differently, research has suggested that racial disparities can affect the way people experience this phase of life.

In this article, we’ll examine some of the racial disparities that exist across the menopausal transition and beyond.

Sex and gender exist on spectrums. This article will generally use the term “women” to refer to a person’s sex assigned at birth.

The menopausal transition begins when estrogen and progesterone — two hormones made by the ovaries — start to decline. In most women, this happens between the ages of 45 and 55.

But research suggests that race and ethnicity may affect the timing of this transition. For instance, one study found that Black women began the menopausal transition on average 8.5 months earlier than white women.

Similar trends have been seen in other groups as well. Compared with non-Hispanic white women, Hispanic and Native Hawaiian women tend to begin the menopausal transition at an earlier age. Japanese Americans, on the other hand, may begin the transition at a later age.

Earlier age of menopausal onset in these groups is likely to be related to health and socioeconomic disparities. Black, Hispanic, and Native women tend to be at increased risk for factors that increase the likelihood of early menopausal onset, including:

  • socioeconomic stress
  • alcohol or tobacco use
  • health concerns

For instance, after adjusting for factors such as health status, weight, cigarette and alcohol use, educational attainment, employment status, past oral contraceptive use, and physical activity, the Black/white gap in age at menopausal onset was eliminated.

The menopausal transition can last anywhere from 2 to 14 years but typically lasts around 4 to 7 years in total. The duration of menopause depends on a variety of genetic and behavioral factors.

One of the biggest predictors of menopausal duration appears to be age of onset. One study that included 1,145 women found that the median duration of the menopausal transition was more than 4 years shorter for those with the latest age of onset than for those with the earliest age of onset.

This study also found that the menopausal transition tended to be longer for Black women than white women, consistent with an earlier age of onset in this group.

Changes in hormone levels during the menopausal transition can cause a variety of symptoms. These may include:

  • irregular bleeding
  • VMS (hot flashes or night sweats)
  • trouble sleeping
  • mood shifts or irritability
  • vaginal dryness, sexual discomfort, or low sex drive

Each person going through the menopausal transition is affected by these symptoms differently. Some may experience many severe symptoms. Others may not be bothered by these symptoms at all.

Research suggests that Black women are more likely than white women to experience bothersome VMS such as hot flashes. Studies have found that approximately half of Black women have VMS during perimenopause, compared with one-third of white women.

These symptoms are also more likely to be more bothersome and last longer for Black women than for white women.

Compared with white women, Black women are also more likely to experience sleep disturbances such as insomnia during the menopausal transition and may have more trouble staying asleep at night.

In contrast, new research suggests that white women are more likely than other groups to experience gastrointestinal (GI) symptoms during perimenopause.

According to a 2022 study, Asian Americans were the least likely to experience these types of symptoms. GI issues were also less common (and less severe) for Black and Hispanic women.

Even though research suggests that Black and Hispanic women tend to experience more frequent and more severe symptoms during the menopausal transition, studies have also found that these groups are less likely than white women to have their symptoms documented.

As a result, these groups are less likely to receive treatment for menopausal symptoms.

A 2022 study involving more than 200,000 women in the United States Veteran’s Health Administration system found that, compared with white women, Black and Hispanic women were 26% and 32% less likely to be prescribed hormone therapy for menopause symptoms, respectively. Black women were also less likely to be prescribed vaginal estrogen.

Several factors are likely to account for these disparities. Differences in how women discuss their menopausal experiences with their healthcare team may explain why symptoms are underreported for certain groups, for example.

Individual preferences may also play a role. Research suggests that Black women may be less likely than white women to be interested in hormonal management of menopausal symptoms.

After menopause, all women are at increased risk for developing certain health complications due to changes in hormone levels. These may include:

  • heart disease
  • bone disease (osteoporosis)
  • diabetes
  • cancer

Early onset of menopause increases the likelihood of developing heart disease later in life. Since Black and Hispanic women tend to enter the menopausal transition at an earlier age than white women, this may increase their risk of postmenopausal heart disease.

The prevalence of metabolic syndrome is also higher among Black and Hispanic women compared with white women. Metabolic syndrome refers to a collection of conditions that increase the likelihood of developing health complications such as heart disease, diabetes, or stroke. These include factors such as:

  • high blood pressure
  • elevated fasting blood glucose levels
  • dyslipidemia (unhealthy levels of lipids in the blood)

Research suggests Black women experience especially pronounced increases in the severity of metabolic syndrome during the menopausal transition, which may increase the likelihood of developing health concerns later in life.

Menopause affects everyone differently. Research shows that disparities exist in the way women of color experience the menopausal transition and in the care they receive throughout.

During this time, it’s important to advocate for yourself and your overall well-being. If you have any concerns about your health or comfort during menopause, ask your healthcare professional to help you understand the options that are available to you.