Women ages 45 to 55 experience hot flashes, a menopause symptom that typically lasts up to 6½ years. But Black women are more likely to endure the condition accompanied by night sweats — 80 percent, compared with 65 percent of White women — and can face symptoms for up to 10 years. For a long time, it was a taboo for them to talk about what they were enduring.
It’s against this backdrop that Sen. Akilah Weber Pierson (CA-79) partnered with the Washington, D.C-based health nonprofit, Partnership to Fight Chronic Disease, on Monday, September 21st, to present guidance on menopause, symptom management, preventive care, and health disparities affecting Black women.
“This is just another way to normalize the conversation because it is a normal part of a woman’s life to go through menopause,” said Weber Pierson, an obstetrician-gynecologist. She said women had suffered in silence for a long time. Understanding the symptoms and the available resources is important, she said.
Dr. Shereen Binno, a Menopause Society-certified practitioner, and Dr. Latisa Carson, San Diego County’s only Black woman obstetrician-gynecologist in solo practice, led the presentation to an audience of women at the Southeastern Live Well Center.
Menopause is a time at which women in their midlife have gone 12 months without a menstrual period. The transition often brings hot flashes, sudden waves of intense heat felt mostly in the upper body, caused by the ovaries’ declining production of estrogen, the hormone that regulates periods and pregnancy.
The panel highlighted that most menopause studies were done with data from White women’s experiences, leaving out Black women’s enduring transition from the midlife condition. This is compounded by the “inherent bias” Black women confront, which affects the way they are cared for, Dr. Carson said.
Dr. Carson acknowledged that limited access to doctors and health insurance, along with long appointment wait times, are among the hurdles women face in detecting and treating diseases early.
“We try to empower [Black] women to advocate for themselves, to do research, come in with a list of questions and concerns that you may have, and make sure that those get addressed before you leave your visit,” Dr. Carson said.
Risk of heart disease during menopause
The doctors emphasized the CDC’s National Center for Health Statistics’ report that heart disease is the number one killer of women.
“At the age of about 52, our risk of heart disease starts to equal that of men because we don’t have the protection of estrogen,” Dr. Carson said. She said women face rising blood pressure and cholesterol after menopause, conditions that heighten heart disease risk.
Patients should know their numbers, Dr. Carson encouraged, starting with blood pressure. She said a healthy reading is below 120 over 80, recommending women check it at a pharmacy — sitting down and resting for 10 minutes beforehand — or buying an at-home blood pressure gauge, especially for those with a family history of hypertension. Testing at different times of day — morning, afternoon and night, can reveal patterns.
Dr. Carson recommended total cholesterol should stay below 200, though doctors also look separately at “good” and “bad” cholesterol and triglycerides to assess overall risk. High triglycerides (a type of fat found in the blood that the body uses for energy) are often blamed on fatty foods, Binno said. But they’re just as likely tied to high-carbohydrate and processed foods, which the body converts into triglycerides, raising the risk for diabetes.
Dr. Carson also recommended women check their hemoglobin A1C levels, a test that measures average blood sugar over the previous three months. The results can reveal whether someone is pre-diabetic or diabetic without knowing it, she said. She noted that women who come in with recurring yeast infections are sometimes found, after an A1C test, to have undiagnosed diabetes or prediabetes.
Breast cancer has a higher mortality rate in Black women
Breast cancer occurs less often in Black women than in white women, but it kills them at a higher rate — a disparity Dr. Binno described as “scary.” The gap in mortality is even wider among women under 50, she said.
Dr. Binno said the mortality is caused by fear of being examined and fear of mammogram screening, a specialized test designed to detect breast cancer early. Dr. Binno and Dr. Carson emphasized the best screening for breast cancer is mammogram screening, though many patients prefer ultrasound for fear of radiation.
Hormone therapy is the best remedy for menopause
The panel noted that hormone therapy — including estrogen taken as a pill or applied as a gel, patch, ring or vaginal ovule (an oval-shaped medication inserted into the vagina) — is the “gold standard” for managing hot flashes and night sweats.
For women who cannot take hormones — particularly cancer survivors — the panel recommended FDA-approved neurokinin receptor antagonists and neurotransmitter medications. These can come with side effects such as decreased libido, which is already lower for many women in their mid-40s, Dr. Binno said. Women can also try off-label options like gabapentin, clonidine or low-dose antidepressants, and cognitive behavioral therapy that help women better tolerate hot flashes.
“You shouldn’t be told if you can’t take hormones for whatever the risk is, that there’s nothing that they [doctors] can completely do, because there are things that we [doctors] can do,” Dr. Binno said.
