Why is menopause so White?

Meet people who are working to expand the face of midlife.

Last week, I asked you all about the way menopause was talked about in your culture growing up — how you learned about it, what you heard from relatives, the traditions or language or symptom hacks culturally specific to you.

But based on what I’m hearing, maybe those don’t really exist. What I did hear was something more universal: You just didn’t hear a ton about menopause growing up. Maybe you watched your mom struggle with hot flashes, but mainly you walked into this phase of life cold (pun intended).

I had also reached out to people who think directly about questions of menopause and culture. They talked less about tradition and more about what they’re working to change and what those new models can look like. It gave me a lot to think about — and a lot to feel hopeful about.

Who gets to look like menopause

I talked to Kamili Wilson, the founder of Menopause Made Modern. Wilson’s site is dedicated to helping women of color navigate their midlife health experiences and was born out of a personal need she saw based not on cultural differences, but a fundamental lack of representation.

When Wilson turned 43, she started experiencing “weird symptoms,” everything from hot flashes to bouts of rage. She soon understood that she was in perimenopause — and discovered a problem outside of her new symptoms.

“Why, when I am Googling, are all of the images of old, White, white-haired women in their 80s and 90s, looking out the window and having a hot flash?”

(I’d like to note that while I am a White woman writing this newsletter, I’m not in my 80s or 90s and I hardly ever am photographed looking out windows.)

As she learned more about menopause and discovered that women of color — particularly Black and Latina women in the United States — tend to have more severe menopause symptoms over a longer period of time, she started to think about those countless stock photos. Not one of them looked like her, a professional Black woman in her 40s.

The conversation we’re having about menopause today isn’t culturally specific, Wilson said, but fueled by a generational shift. We’re all stumbling our way into midlife with our sweaty clothes and itchy ears, desperate for information. But as menopause has become more and more a part of the cultural zeitgeist, some people are still quite literally not seeing themselves reflected.

Compounding barriers

We have talked before about how research disparities impact women’s health outcomes in midlife and beyond, an issue that is compounded for women of color. That racial gap is being replicated even as menopause becomes a big business.

Wilson said the absence of meaningful diversity in the menopause industry only creates further barriers for women of color, especially Black and Latina women who often have a “fundamental distrust of the health care system, have experiences either of medical racism or not feeling heard or included or taken seriously.”

What trust looks like

Dr. Sharon Malone is the chief medical adviser at Alloy Health, a menopause-focused telehealth service, and a leading voice in the space to change the menopause conversation for Black women in particular.

The recent discourse around hormone therapy showed why that’s needed, she said: When the black box warning was placed on estrogen products for hormone therapy in 2003, the share of eligible patients who used it dropped from 30 to 40 percent to about 5 percent. For Black women, it dropped to less than 1 percent.

“The unfortunate thing is that Black women suffer the symptoms of menopause disproportionately,” Malone said: Their symptoms are more pronounced and last longer than any other population. They’re also less likely to recognize their symptoms as being tied to perimenopause, and thus also less likely to ask for help or treatment, she said.

“And unfortunately even when they do present with these complaints, they’re half as likely to get a prescription for hormone therapy as another person walking in with the same set of complaints. To make it even worse, when you take that prescription home, you are only half as likely to take it,” Malone said of Black women. ”These are the women that need it the most and get it the least. So I am trying to be that voice and get that message out to communities.”

Who those faces are

Malone said that having a range of diverse faces getting that message out is critical.

“You see Michelle Obama, you see Halle Berry, who is really out here, and that’s great — but these are people at a remove,” she said, adding that while it is important for celebrities to use their platform and voice, it often does very little to move the needle for real people.

Something Malone has heard is, “Well that’s a famous person.” In other words — not someone whose experience looks anything like their own.

“We need more images of people who look like regular people,” Malone said.

She herself is a member of Delta Sigma Theta, a historically Black sorority, and regularly speaks at events held by member groups, as well as at women’s groups at Black churches. “Anytime I have an opportunity to be in front of a group of Black women, I go. … The message matters and the messenger matters and the images matter.”

Privilege and power

Reshma Saujani has also made diversifying the faces of midlife her business.

Saujani is Indian American and said that while the movement happening around menopause — and all the media attention around it — is incredible, it’s also important to recognize that “why you’re seeing mostly White women doing it is because they have that privilege.”

Saujani, the CEO and founder of Moms First and the host of the popular podcast My So-Called Midlife, said she has been thinking a lot about why her mom never spoke with her about menopause. But then she realized it was obvious.

“She was a working-class immigrant — she didn’t have the privilege to go to her employer and say, ‘I’m having hot flashes and need menopause benefits.’”

Impacts beyond health

An inability to access care can have huge implications. Wilson thinks about her experiences with flashes of rage when she was perimenopausal and didn’t know it.

“It’s that intersectionality,” Wilson said. “I was deeply concerned when I was navigating my workplace bouts of rage and not having confidence that I could regulate myself well and how that would intersect with the Angry Black Woman trope — it was very top of mind for me at the time and I thought, ‘How can I get a handle on this’ and ‘ I’m experiencing this, there must be other women who are experiencing this too.’”

Wilson said she hopes more people understand that having holistic conversations about representation carry huge economic impacts. Many women — and women of color — might be shut out from professional opportunities or advancement just because they are going through menopause and don’t know what’s happening to them and how to advocate for themselves.

“It’s affecting women’s earning potential. It’s affecting their professional credibility,” Wilson said. “I can only imagine if I hadn’t given voice to my symptoms over the years, how would people be perceiving me? ‘She’s off.’ ‘She’s forgetful.’ ‘Why does she just break out in sweats all the time?’”

A new script

Saujani said that one of the motivations behind launching her podcast was that “we literally need to have a new script for women in midlife” — including, but not limited to, showing a diverse set of faces and experiences who can show exactly what potential midlife can hold.

“Zarna Garg became a comedian after 16 years of staying home. Ketanji Brown Jackson made her dream since she was a child come true. Yvette Nicole Brown has a love of her life at 53. You’re seeing women who are actually entering the best stage of their life and they’re rewriting those norms. The thing is, we don’t always hear about them as the norm, we hear about them as the exception,” she said.

As a woman of color with a platform, Saujani said that she understands the privilege she has to shift the narrative. She hopes more women — and more different kinds of women — start to talk about midlife and quite literally put a face to.

“You don’t have to have it all happen in the first half of your life. I’m excited about this being the best time of my life, the period of my life where I accomplish the most, because I don’t feel anywhere close to being done.”

I almost forgot

A new report from the Geena Davis Institute analyzed films released from 2009 to 2024 to see how menopause narratives are portrayed on screen.

What they found? Menopause is nearly invisible.

Of the 225 films in that span featuring a 40-plus female character, only 6 percent (14 films) mentioned menopause, and usually through some kind of side comment. Only one film featured a prominent menopause storyline.

Menopause most commonly showed up as a punchline, playing to stereotypes about emotional volatility in this phase of life.

They also found that menopause storylines have not gotten more common in recent years, with a steady drop-off in films that mention menopause in the past nine years in particular. It’s gone hand-in-hand with a decline of women over 40 as characters in comedies.

This dearth of representation has a real impact on people’s understanding of menopause. A nationally representative survey of adults of all ages in the United States conducted as part of this analysis asked respondents about their perceptions of menopause on-screen.

Fourteen percent of American adults — and 1 in 5 people of color — said that TV and film were their first exposure to the concept of menopause.

So a friendly reminder to those who decide what media gets made: Representation matters.