It’s time to talk about Black women and menopause
America’s long history of discrimination against Black women is taking a real toll on how they age
Will you be in Austin for SXSW? We’re hosting a party — and we’d love to have you join us! I’ll be leading a discussion on midlife health, its place in our culture and what it really takes to shift the narrative. We’ll have food, drinks and plenty of time to connect. This is a space to share experiences, ask questions and build community.
You can RSVP for the party here. Please feel free to share with anyone else in your network who will be in town and might want to join us — I hope to see you there!
Black people reach menopause earlier. They experience more severe symptoms. And they also experience more adverse health outcomes directly correlated with perimenopause and menopause: diabetes, hypertension, dementia, breast cancer.
Dr. Sharon Malone is the chief medical advisor for Alloy Health, the author of “Grown Woman Talk: Your Essential Companion for Healthy Living” and the host of the podcast “The Second Opinion with Dr. Sharon.”
And making menopause care more accessible to Black women is her life’s work. (Yes, you might have seen her talk about this with her friend, former First Lady Michelle Obama, too.)
Malone is a big fan of hormone therapy — something less than 1 percent of symptomatic perimenopausal and menopausal Black people are prescribed. (Overall, it’s prescribed to about 5 percent of symptomatic perimenopausal and menopausal people in the United States.)
While hormone therapy is not for everybody — obligatory “talk to your doctor” caution — Malone and many other experts believe it’s underprescribed.
And for Black women, Malone said, that’s a big problem.
“It’s unfortunate because Black women are the ones who actually suffer longer, they go into menopause earlier, and they’re more susceptible to the long-term health implications of lack of hormones,” Malone said. “And of course, here we are in another disparity situation, not because of biology, but because of access and information.”
Behind the disparity
First, she said, Black women tend not to have the same level of trust in the medical community because that trust has not been earned.
“Black women’s complaints are ignored generally,” she said. “Women’s complaints are ignored generally, but if you are a woman and Black, then you are getting the least of the least.”
Second are the persistent tropes and biases that continue to loom large in the American medical system, especially the idea of the “strong Black woman.” Some medical professionals believe that Black women are able to endure a higher level of pain and that they simply do not experience the same number of symptoms as their White peers.
“They do,” Malone clarifies. “They’re worse.”
Research has shown that Black women who grew up during the Jim Crow era faced greater discrimination and disparity when it came to the evaluation and treatment of their menopause symptoms. This means that as recently as the late 1990s and early 2000s, America’s history of racism was impacting the healthspan and lifespan of Black women. The cultural trickledown of this is very real.
“And so you have a situation where Black women who suffer earlier, longer and more severely are less likely to bring it up when they see a doctor. Even when they see a doctor and bring it up, that doctor is less likely to prescribe for you because of all these biases that we have,” Malone said.
“The cancer thing”
For a lot of people, many of the most disruptive symptoms of perimenopause and menopause can be treated with hormone therapy. But for Black women, a fear of breast cancer is often a driving factor in continued skepticism about that treatment, Malone said.
And with good reason — while breast cancer rates are similar between Black and White women, mortality rates among Black women are 38 percent higher. Among Black women under the age of 50, this disparity is even greater, with young Black women facing double the mortality rate of White peers.
So when the Women’s Health Initiative study in 2002 tied hormone therapy to increased risk of breast cancer, an increased level of caution was stoked in the Black community as well.
“We already know that we have disproportionately higher risks of dying from breast cancer and then someone tells you, ‘Here’s this medication and it’s going to increase your risk,’ that gets you to shy away from it,” Malone said.
But, Malone said, those fears have been blown out of proportion. More study is needed, but for many people, hormone therapy will help more than it increases the risk.
“The big message for hormone therapy that I also want women to understand is that hormones are the most effective treatment for the symptoms of menopause,” Malone said. “Menopause and perimenopause are way more than just hot flashes, and there are particular risk factors that Black women are more susceptible to. So when you’re talking about hypertension and diabetes and heart disease and even the risk of dying from breast cancer, these are all things that are also impacted positively by hormone therapy.”
History and present
Malone said she knows that in the absence of access to trusted doctors, many Black women are turning to alternative “cures” for their symptoms — many of which are ineffective at best, and pose new risks at worst.
But she also understands and has empathy for the history that is driving so many Black women down that road.
“For 99 percent of the time that Black people have been in this country, we haven’t had access to medical care,” she said. “It’s a recent thing — having insurance, being able to access care in a non-segregated environment. There’s always been this sort of two-tier system.”
Because of this, Malone said, Black Americans have a rich history of community-based care: healers, midwives and others well-versed in treatments that have been passed on from one generation to the next.
And this system has provided many important developments in women’s health care, often in life-saving ways. “Think about midwifery — this all came from Black women who ran that in the South. There is some communal, ancestral knowledge that is important,” Malone said.
But she wants the health care system to gain trust. And that takes intentional work from within the system.
Grown women talk
Malone hopes she can play a crucial role in what she sees as a key dynamic in addressing these disparities in the Black community by being a facilitator of intergenerational conversation.
It’s why her book is called “Grown Women Talk.”
“When I was a kid growing up, when my mother would be talking about things, they would make you leave the room. ‘This is for grown folks, you have to leave.’ So you never heard about all these things that happen. So we all walk into this phase of life completely blind.”
By constantly forcing a conversation, Malone hopes to address the disparities faced by Black women in the United States, especially when it comes to menopause care.
It’s also why she joined Alloy Heath, a telehealth company, and has overseen outreach to Black women there — “not because Black women are genetically or physiologically different from anybody else, just because you have to understand the cultural context of your patient to be able to treat them.”
She sees telehealth as a crucial measure in overcoming the real disparities faced by Black women.
“I tell family stories, I tell patient stories,” Malone said. All of this is to serve a mission of making sure that people understand that maternal mortality isn’t the only health disparity experienced by Black women — and that their experiences in menopause can fuel so many of the health outcomes that later become part of even more grim statistical reference points.
It’s where she hopes her work — at Alloy, on her podcast, through her social media — can help.
“They know there is someone there who looks like them, that has gone through this — and they feel safer inside,” Malone said. “We have to acknowledge the fact that bias is built into our medical education, in our system and how we practice medicine.”