Research has found that Black and Asian women tend to go through menopause much earlier than their white peers, yet very little guidance caters to them.
On average, Black and Asian women start menopause earlier, go through it for longer and live with more severe symptoms than white women. At least, that’s according to a recent study that found Black women have their last period an average of eight months before white women.
And an older study found that women with Southeast Asian heritage can experience menopause symptoms up to seven years before their white peers. While early menopause is relatively rare (the NHS estimates that around 1% of women under the age of 40 are affected), Black women are three times more likely to go through it.
With such clear differences in the ways different communities experience menopause then, you’d think there’d be plenty of help available to accommodate. But there’s a chronic lack of research into diversity in menopause – particularly in the UK, and this is reflected in a lack of patient information. Head to the NHS website, and you won’t find any advice on how a woman’s background might affect her menopause.
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There is also a lack of data on access to care. White women have historically had better access to HRT and support (and even that’s not always been great) and face a lower risk of misdiagnosis and stigma compared with women from other ethnicities. 20 years ago, one US study reported that 15% of white women took HRT compared with only 8% of Black women. Gaps like these raise huge questions about what women of colour might be facing when they ought to be getting support.
Where are all the Black and brown women in the national discussion around menopause?
Anita Powell is a community worker from Bedford. Powell noticed that, despite living in a fairly diverse town, she often couldn’t find other women of colour to talk to about menopause. “Sometimes I was the only Black person in the room,” she says.
As well as the lack of access to support, Powell also worried about misinformation in the Black community. “The history of the Black community with medical intervention is complicated,” she says. “We get stereotyped and internalise it. Some people believe that Black women don’t go through menopause or that Black women have a tendency towards natural remedies rather than HRT.
“These are major obstacles to engaging with Black women about menopause.”
Together with Nina Kuypers, Powell co-founded Black Women in Menopause, which runs free online events every other month (the next one, on 8 December, is on contraception in perimenopause). They’re now working towards in-person events.
“Most accounts of menopause are solely based on white women’s experiences,” Kuypers says. “But everyone should have images and stories of people who look like them that they can relate to. It’s a part of who we are and how we understand ourselves.
“It gives support as well as validation. Exposure through media representation can help counter stereotypes of marginalised groups such as Black and Asian women.”
Madhu Kapoor, 56, entered perimenopause about six years ago, but noticed small changes to her health as early as her mid-40s. Kapoor left work during the menopause and now runs training workshops in workplaces on the subject.
When she first got symptoms, she googled ‘menopause’: the results brought up pages of white, grey-haired women. “That’s what I want to change,” she says. “I didn’t fit in. I felt unseen and unheard, and it took me a long time to accept that I was going through menopause.”
Kapoor was also stereotyped during hospital appointments. “They automatically think that South Asian women are vegetarian, don’t drink, and can’t speak the language. The onus should not only be on those going through menopause and perimenopause but on the medical professionals.”
Even now as a campaigner, she feels sidelined. “I have found it difficult when I have contacted various ministers and media to increase awareness as a South Asian woman but have had no replies,” she says. “I assume that my face does not fit.”
Why isn’t there any research available on women of colour and menopause?
Dr Nighat Arif is a NHS GP and presenter who specialises in women’s health. She says she’s disappointed by the lack of research into Black and Asian women’s menopause symptoms. “I tried to write a paper in 2019 but I had little data to fall back on. I relied on my clinical qualitative analysis of what I have seen and heard in my communities,” Dr Arif says.
For example, she says, women in South Asian communities haven’t historically thought of menopause as a problem, and women from faiths that hold a belief that a woman is ‘unclean’ during a period might celebrate when periods stop.
“Symptoms are not reported to the GP, or if reported they are misunderstood,” she tells Stylist. “Women get misdiagnosed with depression. If they complain of aches or pains they are told it’s arthritis or fibromyalgia, which means treatment doesn’t deal with the lack of oestrogen and prevent heart disease, which is more prevalent in Black and Asian communities, or osteoporosis.”
In particular, Dr Arif warns that Black and Asian women’s perimenopause is still poorly understood, as is the relationship between HRT and cancer risk. “Most of the data on perimenopause is conducted on white Caucasian women then trans-imposed onto all women,” she says.
“The choice of HRT is getting better awareness in ethnic minority communities. However, myths around HRT are not being busted enough for women to understand that not all oestrogens are the same.” (‘Body-identical’ systemic HRT is different from topical vaginal oestrogens prescribed for genito-urinary symptoms such as vaginal dryness, pain on intercourse, and UTIs.)
How does support during menopause differ for communities?
Dr Shahzadi Harper, a GP and menopause specialist, is also well aware of the myths surrounding HRT. “Menopause still feels like a taboo subject,” Dr Harper says. “For some women it signifies the loss of fertility and even a loss of a sense of self or worth. But women from different communities and classes need to see themselves in awareness campaigns.”
Women should not have to advocate for themselves at the doctors, she emphasises. But her one piece of advice for women of colour seeking help in perimenopause and menopause is to take someone else to the doctor’s with them: a partner, husband, friend or sister.
“Take someone who you can openly speak in front of, who will be there quietly in the background but can speak up when needed,” she says. “If there is any pushback or things that you’ve forgotten to say, then there’s somebody there to support you.”
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Dr Harper recently became an advisor to Issviva, a new platform for information about the menopause, including the issue of racial bias. She has also written a book The Perimenopause Solution. Dr Harper is from a Muslim Pakistani family and remembers feeling nervous showing her book to her mum.
“On the cover, there’s a side profile of a female nude. Mum looked at me, looked at the book, then back at me. My mum’s quite traditional and she asked me, ‘Is this book going to come out in Pakistan?’ I thought: ‘Oh no. Mum’s going to ask me why I’ve got a boob on the cover.’ But then she said: ‘Because it should be. Women need to know about these things.’”
Menopause and mental health
A lack of available information is one of the things that led Karen Arthur to speak out. Arthur, 60, is a campaigner and the founder of Menopause Whilst Black podcast. She had been working as a teacher for nearly 30 years, but in 2015, during her menopause, was signed off with anxiety and depression.
“For years, I focused on getting better, not making the connection between poor mental wellbeing and menopause,” she says. “I’m loving my postmenopausal stage now. But I went through a terrible time to get to this point so my mission is to ensure that no other woman has to, especially those who look like me.” Although much attention is paid to the physical symptoms of menopause, mental symptoms include low mood, anxiety and mood swings.
On her podcast, she continues to lead the conversation on diversity in menopause and what needs to change.
“I wish that all doctors had menopause training that takes on the nuances of racial bias instead of feeling that they’re being attacked for not doing their job,” she says. “We love doctors, but we need them to recognise that their training is based on medical biases.
“I would also like equality of menopause care for all. Not everybody can go to the doctor freely; not everybody wants to or can take HRT, and I feel that there are so many other avenues to take.”
Alongside her podcast, Arthur now runs retreats for Black women in menopause. “The Joy Retreat was born out of recognising that Black women need their own space where we don’t start by having to explain why we need to be in communion with each other,” she says. “Youth is great, don’t get me wrong, but ageing is a privilege.”
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