How does race affect menopause care?

How racial bias affects menopause care

In February 2022, a US study found that Black women had their final menstrual period more than eight months earlier than white women, on average¹. The study also reported that Black women were twice as likely as white women to have had their womb or ovaries removed, and therefore were half as likely to experience natural menopause - 30%, compared with 15%.

These differences can have a big impact on someone's health and wellbeing. For example, the younger you are when you start menopause, the higher your risk of cardiovascular disease and death.

Racial bias and HRT

In the UK, as evidence mounts for hormone replacement therapy (HRT) - considered the most effective treatment for menopausal symptoms - several changes are scheduled to make it easier and cheaper for women to access treatment.

However, experts have raised concerns that Black, Asian and minority ethnic women may be left behind. There are known to be historic racial divides in the use of HRT in the Global North that persist today - a 2023 UK study found that doctors were significantly more likely to prescribe HRT for white women than for other ethnicities².

But given the impact that menopause can have on a woman's quality of life - not to mention the struggles that many women face having their symptoms recognised and addressed - doctors and the media have a role to play in bringing all women up to date on the symptoms they might expect at midlife, and the evidence for HRT's benefits and risks. This includes how HRT may increase your risk of breast cancer, and how it could reduce your chances of osteoporosis.

De-stigmatising menopause

Dr Shahzadi Harper is a specialist in menopause, and the author of The Perimenopause Solution. She warns that misconceptions and misunderstanding around menopause particularly affect women's attitudes to HRT.

"Women may not know that there are newer, better forms of HRT available nowadays, which are body identical and transdermal - meaning they can go through the skin ," she explains.

Concerns about the relationship between HRT and cancer risk may still be putting women off, she adds, potentially leaving them exposed to bigger risks to their health. It's now thought that starting HRT early in menopause could reduce your risk of heart disease³ - a condition that kills twice as many women as breast cancer⁴.

Dr Harper says that, although menopause is becoming less of a taboo in some cultures, for many communities it's still an unwelcome topic. For example, Chinese American and Korean American women are generally more reluctant to discuss their sex-related symptoms than Filipino Americans and many non-Asian communities⁵.

"I think there is a cultural stigma about it, because menopause, in many cultures, may be seen negatively - sadly there's a notion that, because a woman is no longer fertile, she's no longer useful," she says.

One way of tackling stigma, Dr Harper suggests, is to shift the focus away from sexual health symptoms, such as vaginal dryness, toward other overlooked symptoms, such as cystitis or thrush.

"Menopause is nothing to be ashamed or frightened of," she says. "Getting help and advice doesn't always have to mean HRT - it's just about getting a better understanding of menopause and knowing how to improve what you're already doing.

"The more that we speak about it, the better. It just takes one or two to get that ball rolling."

One paper on menopause and Asian American women found that these women experienced different symptoms, depending on what sub-ethnic group they belonged to⁵. It concluded that these experiences are highly influenced by cultural attitudes towards symptoms.

This led to greater differences between Filipino Americans and Chinese and Korean Americans - the former reporting more positive attitudes alongside milder symptoms.

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How bias affects women

Outside of clinical research, women themselves are clear on their experience of discrimination. A 2022 survey by the Fawcett Society found that 45% of Black and minoritised respondents said it took many appointments with their GP to establish that symptoms were menopausal, while only 30% of white women reported the same⁶.

In 2022, unions also warned MPs that Black and ethnic minority women could face additional difficulties with menopause at work where there was existing racial discrimination.

To help tackle racial bias at menopause - and to make useful information more accessible to a wider audience - Dr Harper runs a weekly 'Power Hour' event on her Instagram, where she answers questions about menopause in the hope that it empowers and supports women trying to navigate menopause.

These experts are helping Black and ethnic minority women get better representation in menopause care - they call for MPs, medical schools and the media to listen, learn, and take action.

Further reading

1. Harlow et al: Disparities in reproductive aging and midlife health between Black and white women: the Study of Women’s Health Across the Nation (SWAN).

2. iNews: Ethnic minority women in England far less likely to get menopause treatment, data shows.

3. Women's Health Concern: HRT and heart disease.

4. British Heart Foundation: Twice as deadly as breast cancer.

5. Im et al: Sub-ethnic differences in the menopausal symptom experience: Asian American midlife women.

6. Fawcett Society: Landmark study: menopausal women let down by employers and healthcare providers.