Race, Ethnicity & Healthcare

Let me say something directly: if you’re a woman of color navigating perimenopause, you’re dealing with a double burden. Your body may be going through this transition differently than the “average” the medical literature describes—and the healthcare system has historically been worse at believing you, treating you, and caring about your outcomes.

Both of these realities matter. Both deserve acknowledgment.

What the Research Shows

Timing Differences

Chinese and Japanese women tend to reach menopause slightly later than white women.

Earlier menopause means more years of living with lower estrogen—which affects bone health, cardiovascular risk, and other long-term outcomes.

Symptom Differences

Vasomotor symptoms (hot flashes and night sweats):

• Black women report the highest rates of hot flashes and night sweats
• Hispanic/Latina women also experience high rates
• Asian women report lower rates
• These differences persist even after adjusting for other factors

Duration of symptoms:

A decade of hot flashes is not the same experience as six years. This matters.

Other symptoms:

• Black and Latina women report more sleep disturbances and higher rates of depression during the transition
• Asian women are more likely to report decreased libido
• Vaginal dryness is most prevalent among Hispanic women in the SWAN data

Why These Differences?

The reasons are complex and intertwined:

Biological factors. There are genetic and physiological differences between populations that affect hormone metabolism, body composition, and symptom experience. These are real.

Social determinants of health. Chronic stress, discrimination, limited healthcare access, economic stress—these affect biology. Racism itself is a health issue that affects outcomes.

The research gap. Medical research has historically centered white women. The “average” menopause experience described in textbooks may not represent your experience.

When researchers in the SWAN study adjusted for factors like health status, weight, smoking, education, employment, and physical activity, some of the differences between groups narrowed or disappeared. This tells us that health disparities—not inherent biological destiny—drive much of the variation.

The Healthcare Problem

Here’s where I need to be honest about something that may not surprise you if you’re a woman of color:

The medical system treats you worse.

Studies show:

• Black and Hispanic women are prescribed hormone therapy at lower rates than white women
• Women of color are more likely to have their symptoms dismissed
• Pain and discomfort reported by Black women is systematically underestimated by healthcare providers
• The “classic” presentation of menopause symptoms—developed largely from studies of white women—may not match your experience, leading to missed diagnoses

If white women struggle to be believed about their perimenopause symptoms—and they do—imagine navigating this with the additional burden of a healthcare system that has historically discounted your pain and dismissed your concerns.

Unconscious Bias in the Exam Room

This isn’t about individual bad actors. It’s about a system trained on biased data, operating with biased assumptions, producing biased outcomes.

The Provider Trust Problem

Given this history, it’s entirely rational for women of color to approach healthcare with skepticism. The medical system has earned that distrust through centuries of exploitation, experimentation, and dismissal—from the Tuskegee study to Henrietta Lacks to everyday encounters where concerns are minimized.

But distrust can become a barrier to getting care you need. It’s a cruel bind: the system that failed you is also the system that has treatments that could help you.

Navigating This

Know Your Own Experience

The “typical” perimenopause described in most resources may not be your typical. If your symptoms are more severe, last longer, or present differently than what you’ve read about—that’s not you being dramatic. It may be the reality of how your body is moving through this transition.

Advocate Harder (Unfairly)

You may need to advocate for yourself more strenuously than white women. This is unjust. It’s also reality.

• Document symptoms in writing before appointments
• Be specific about severity and impact on your life
• Push back if you’re dismissed
• Request referrals to specialists
• Ask for things to be noted in your chart when they’re declined

See Finding Care for more advocacy strategies.

Seek Providers Who See You

Not all providers are equally bad at this. Some have done the work to recognize their biases, educate themselves about disparities, and provide equitable care.

Look for:

• Providers of color (if available and if that matters to you)
• Providers who ask about and acknowledge your specific concerns
• Practices that explicitly address health equity
• Menopause specialists who understand that “average” doesn’t mean “universal”

Community and Cultural Resources

Mainstream menopause resources often center white experiences. Seek out:

• Support groups and communities for women of color
• Healthcare providers from your cultural background
• Resources that speak to your specific experience

You shouldn’t have to filter everything through a lens that doesn’t fit you.

A Note to All Readers

If you’re white and reading this:

Understand that the woman in the waiting room next to you—with the same symptoms—may be having a harder time getting care. She may be experiencing more severe symptoms for longer duration. And the system may be believing her less.

This isn’t about guilt. It’s about understanding that “perimenopause is hard for everyone” exists alongside “perimenopause is harder for some.”

The Larger Truth

The menopause experience shouldn’t vary based on race. The quality of care you receive shouldn’t vary based on race.

But they do.

Until the healthcare system fixes itself—which requires acknowledging the problem, training providers differently, and dismantling systemic biases—women of color will need to navigate both the physiological reality of their transition and the social reality of a system that serves them less well.

Both of these burdens are real. Neither is your fault.

If you’re a woman of color navigating perimenopause, I see you. Your experience is valid. Your symptoms deserve the same attention and treatment as anyone else’s—even if you have to fight harder to get it.

You shouldn’t have to fight harder. But you deserve care regardless.