What Every Black Woman Should Know About Navigating Menopause

Menopause is different for Black women. Symptoms tend to start earlier, last longer, and be more severe. Black women are also less likely to seek treatment, and when they do, are less likely to be prescribed Menopausal Hormone Therapy (MHT), the safest and best way to treat most women’s symptoms. For Black History Month, we hosted a webinar with Dr. Kudzai Dumbo, a prescribing physician and the Director of Advocacy and Outreach at Alloy, and Dr. Sharon Malone, our Chief Medical Advisor. They were joined by our Community Manager, Rachel Hughes, for a conversation about hormones, menopause, and what every Black woman needs to know to navigate this transition.

We recommend you watch the whole webinar on our YouTube, but are sharing some highlights below, which have been edited for brevity and clarity. Please note that our webinars are for educational purposes only and should not be used as personal medical advice.

Rachel Hughes: Dr. Sharon Malone, you've had many moments that have really crystallized for you why this work is so necessary. I wonder if there's a particular moment that you might share with us now.

Dr. Sharon Malone: Well, thank you Rachel, and I'm so happy to be here today. And let me just say this, because I think the setting is important for understanding who I am and where I come from. I like to say I'm one of the youngest boomers, but I'm from the boomer generation, the youngest of eight kids, and I have actually seen what healthcare looks like in the segregated south. I understand from a very personal point of view what kind of medical care African-American women get or don't get. And it's not just about lack of insurance, it’s not just socioeconomic status. It is pervasive, and it’s our job to make sure that women understand what care they should be looking for. 

They should learn how to advocate for themselves, not just with menopause, but straight across the board. Because one of the things that really struck me was the huge gap in conversation between healthcare professionals and what people actually hear and see. It’s the reason I wrote my book, and it’s one of our goals here at Alloy to bridge that gap.

Rachel Hughes: Thank you. Dr. Dombo, if you would please share with us your personal why for advocating so passionately in this space.

Dr. Kudzai Dombo: Thank you, Rachel. I had the good fortune of growing up both in Zimbabwe and in the United States. So I was born here, but grew up in Zimbabwe, and my father was a physician who trained in the United States. When he went back to Zimbabwe, he was fiercely passionate about bringing the education he had gotten to really help his people. He grew up in a relatively poor family and he had always been told that the furthest he could get would be to be a teacher. He was able to get a refugee scholarship, trained as a physician here in the United States, and then went back.

I learned that if I were to make a difference as a woman, number one, I would have to make sure I was educated to a degree where I'd be in a position to make policy changes, which is why I chose to be a doctor, not a politician. I wanted to be able to speak on behalf of women, because in a culture like Zimbabwe, women’s voices were not heard. So I chose women’s health. 

Fast-forward to my residency: I trained during the Women’s Health Initiative (WHI), so the message I received during my residency was that hormones were dangerous. Hormones could cause breast cancer. As I got older, I would have friends ask me what to do. So, I started to do some research and became a prescribing physician. It wasn’t until I saw directly from patients that they were thanking me profusely for changing their lives. I realized I could arm women with education and information to help them get the care they need.

Rachel Hughes: Thank you both so much. Dr. Dombo, I want to unpack the basics of perimenopause and menopause because every day women enter menopause and have no idea, or they may live in perimenopause for many, many years, suffering any number of symptoms, and having no idea it’s perimenopause.

Dr. Kudzai Dombo: Let’s start with some definitions. Menopause is 12 months without a period. That’s when we can definitively say you’ve hit menopause. The time leading up to menopause is perimenopause. Peri means around, like a perimeter. So, it’s around menopause. The time leading up to menopause can be wrought with the same symptoms that occur during menopause. It can be wrought with irregularity in your periods, but one is not exclusive of the other. Not all women will experience perimenopause the same. And I think it's really important to identify that piece because traditionally menopause has always been the focus, but now that we’re talking about perimenopause, it’s important to know it can be an equally distressing time.

You can have symptoms up to 10 years before your last period, and they are worth addressing. So, what are those symptoms? Of course, there are hot flashes. But, there’s also anxiety, mood swings, panic attacks, depression, just feeling down, or having no motivation. I have patients who sometimes tell me, “I own my own business and I just can’t get off the couch to get to meetings.” There are skin changes. There may be hair changes. Vaginal dryness, painful intercourse. It’s all part of it. These symptoms can be hard to identify as perimenopause, and quite distressing.

Rachel Hughes: For what it's worth, anecdotally, I will share that I have suffered 45 of the maybe 50-something symptoms. I know on paper we’re not known to have 50-something symptoms of menopause, but I am sure that from head to toe, from inside out, I’ve had any number of them. 

Dr. Sharon Malone: And there’s brain fog, weight gain, we could go on and on. There are a lot of them.

I think another thing that can be really confusing is that there’s no bright line where menopause begins. You can’t know you’re in it for sure until it’s already been 12 months. And I think it catches women unaware because it happens way sooner than you think it’s supposed to happen. When you think of menopause, you think of it being somewhere in your fifties. But the perimenopausal phase can take anywhere from four to ten years. For African-American women, it’s closer to ten, and that’s a long time to be bothered by symptoms. Plus, the symptoms don’t happen in order, and it’s hard to understand how they’re connected when you start having them. You might go to an endocrinologist because you’re gaining weight, or a dermatologist because your skin is dry or you’re losing hair, or to an internist because your cholesterol has gone up. But a lot of the time, they’re perimenopause symptoms.

Rachel Hughes: Dr. Malone, I remember interviewing you years ago. I was hot flashing like a lunatic. And you alerted me to the fact that hot flashes are not benign, and it’s hard to prepare for risk you don’t know perimenopause might be teeing you up for. So, what are some of the long-term health risks associated with perimenopause and menopause?

Dr. Sharon Malone: With menopause, there are several long-term things to consider. First, bone health. After women have gone through menopause, they are at higher risk for developing osteoporosis. Second, heart health. Women typically have half the risk of heart disease compared with men before they reach menopause. In the first ten years after menopause, their risk is equal to that of men. After that, the risk is actually greater than that of men. Third, brain health. Two thirds of the people in this country with Alzheimer's are women, and Black women are twice as likely to develop Alzheimer's or cognitive decline than white women. 

Then there are prolonged symptoms of what we call GSM, which is the Genitourinary Syndrome of Menopause–painful sex, frequent urinary tract infections, urinary frequency and urgency, dry vaginas, itchy vulvas. Hair loss where you want it and hair growth when you don’t. Not all of these things have long-term health implications, but they are distressing. 

And there are interventions, like Menopausal Hormone Therapy (MHT), that can help with these things, and prevent all of these unwanted, long-term effects.

Rachel Hughes: Thank you. Let’s get to some questions from our attendees. “I went through menopause at 40 and I thought I was finished. Now I’m 58, and I am having hot flashes again. Is this just my plight for the rest of my life?” 

Dr. Kudzai Dombo: Well, you definitely have the option of looking into hormone therapy. The optimal time to start, we usually say, is before you turn 60 or within ten years of your last menstrual period. But if you do not fit into that criteria, it’s not the end of your story. It’s more nuanced than that. Whatever your situation, it warrants a conversation with somebody who has been trained as a menopause specialist. You’ll sit down and look at the entire picture, because it’s not a black and white decision.

Dr. Sharon Malone: There’s another thing we need to discuss here which is when you enter menopause. The average age is 51, but it’s younger for Black women, typically about a year younger. And that number only refers to women who go through natural menopause. 

There are lots of reasons you might go into menopause early. For example, surgery. Black women have more hysterectomies and have their ovaries out, which will put you into menopause overnight. Other women go into menopause because of chemotherapy or radiation. And others still go into menopause naturally before the age of 45. And that makes a difference. It puts you at increased risk for the long-term things we discussed like cardiovascular disease, Alzheimer’s, and osteoporosis. The Menopause Society is the governing body we use, and their guidelines are what we consult when it comes to hormone therapy. They recommend hormone therapy for premature menopause, because early menopause means you have extra years of estrogen deprivation, which puts you at greater risk. So, if you are menopausal at 40, unless you have a contraindication, you should at least be having a discussion about whether hormone therapy is right for you.

Rachel Hughes: That’s so helpful. Thank you. I don’t want to get into a whole cancer discussion because it’s always a larger, more nuanced one, but can you speak briefly to women who may have questions about whether or not hormone therapy is safe for them and how to begin to think about it as an option? 

Dr. Sharon Malone: Yes. I come from a cancer family. I have two sisters who have had breast cancer, and two of my mother’s sisters have had breast cancer. But I will tell you this: The biggest risk factor you have for developing breast cancer is living long enough to get it. So, if you have a relative who has had breast cancer, say, after the age of 60, chances are that that cancer is not genetic. But, there are lifestyle factors that can increase your risk, like drinking more than two alcoholic drinks per day, being overweight, and not exercising. Women stopped taking hormones because they were told that it increases their risk for breast cancer. But that has been revisited. I can’t tell anyone whether they will or will not get breast cancer. Your risk is your risk. Does adding hormone therapy to those things increase your risk over whatever your baseline risk is? The answer to that appears to be no. 

Rachel Hughes: Thank you. Next question: “I think a lot of us have gotten advice from our mothers who would just say, suffer through it, and with time it will pass.” I’m wondering if you can speak to that a bit.

Dr. Kudzai Dombo: I think this is common. I’ve talked to so many women in my friendship circles, in the grocery store, my Uber driver. It comes up everywhere. I’ll ask people, “What did you do?” And the same thing keeps coming up. That you just deal with it. You just suffer through. And that doesn’t have to be the message that trickles down to the next generation. 

It may be hard to change that message if it's already entrenched within a belief system. But it doesn’t have to be every Black woman’s story. And you may encounter physicians who have not been trained, which is why awareness is so important. 

The second thing that’s so important is access to menopause-trained physicians. One of the things we’re trying to do here at Alloy is bridge that gap. Whether it’s within Alloy, or wherever you go, it’s important to note that healthcare access is not just something that’s an issue for Black women in menopause. Why would the Black women’s maternal mortality rate be three times higher than it is for white women? There are racial biases at play as well. I think bias training has been started in some institutions, but it is important that it is a consistent thing that practitioners and providers are aware of what their biases are. Do they constantly believe that Black women can tolerate more? I just think it’s so important to be aware, and it should start in your thirties. Pay attention to your body. Identify your symptoms. And know where to get help.

Dr. Sharon Malone: Honestly, this is why Alloy exists. It doesn't matter where I go, access is a problem. There are simply not enough doctors to address the need.

Rachel Hughes: Thank you. This was such a big conversation. Dr. Malone, is there anything else you’d like to say before we go?

Dr. Sharon Malone: The one thing that I always say is that if you live long enough, and you have two ovaries, you’re going to go through menopause. And if you are suffering, please don’t suffer. There’s no reason for that. And it’s not just for the relief of symptoms. There are potential health benefits as well. Make your decisions based on science, based on facts, based on trusted sources, and not on fear, because I think that fear has been a big driver for why people have avoided something that really could improve the quality of your life. Don’t walk around with a fan for your hot flashes. Go get some estrogen.

Rachel Hughes: Dr. Dombo?

Dr. Kudzai Dombo: What I want to say is that if you see a healthcare practitioner and you feel dismissed, that is not the end of the story. There are people, there are doctors, there are places like Alloy that really want to hear you.

Rachel Hughes: Thank you. I want to say that this conversation does not end here. Taking care of your health starts with knowledge, action, and community. We here at Alloy are certainly here to help.

To watch the rest of this essential conversation, head to our YouTube. To learn more about our events, follow us on Instagram @myalloy.