By: Mylika Scatliffe,
AFRO Women’s Health Writer
There is a lot about menopause that is mysterious, but it doesn’t have to be a mystery.
Most of the time when the average American thinks about menopause, they conjure images of a woman experiencing vasomotor symptoms of the condition – the hot flashes and the night sweats. But there is a lot more to it.
Dr. Dea Sloan-Bultman, clinical faculty at Howard University College of Medicine in the Department of Community and Family Medicine told the AFRO knowledge is key.
“We should empower women to know what menopause looks and feels like,” she said.
“Black women on average enter menopause eight months to two years earlier than our White counterparts and we need to make this to be talked about more –instead of being tacked on to the end of more exciting topics like, pregnancy, contraception and abortion.”
Sloan-Bultman explained the three phases of menopause – perimenopause, menopause and post menopause.
“Perimenopause is the period leading up to menopause when we start to experience symptoms like hot flashes, irregular periods and decreased libido, all brought on by the decreasing levels of estrogen in our bodies. This phase can persist for years. The symptoms vary from woman to woman, so it is difficult to predict,” said Sloan-Bultman. “On average perimenopause occurs in Black women between the ages of 40-48, with most starting menopause between the ages of 48-50.”
“There is still taboo around the subject of menopause compounded by the stigma associated with aging that makes women keep conversations about it closer to the chest. There’s also the embarrassment that some women may feel when they are visibly affected by hot flashes and people seeing them break out into a dripping sweat,” said Sloan-Bultman.
“We’re not sharing information and we should arm each other with knowledge,” said Sloan-Bultman.
She confirmed the next phase is menopause, when a woman goes 12 months without a period. The final phase is known as post menopause and encampasses the rest of a woman’s life after menopause is completed.
Sloan-Bultman wants Black women to be aware of not only the commonly known vasomotor symptoms but lesser known and discussed effects of menopause like mood swings, muscle aches, decreased concentration, less ability focus on tasks and sleep disruption, and that they are also more likely to have fibroids which increase in size and number as they get older.
“Sleep disruption can mean getting too much or not enough sleep; sometimes women are only getting one or two hours of sleep at a time,” said Sloan-Bultman.
“Then there are genitourinary symptoms. The cells in the vagina get smaller, meaning they produce less moisture leading to painful sex and irritation with urination,” said Sloan-Bultman.
Sloan stated that many of her patients, who are mostly Black, said they don’t feel heard when trying to talk to medical providers. “This is exacerbated by distrust in the medical profession due to systemic racism,” said Sloan-Bultman.
Consequently, women may find it difficult to relate to a doctor that doesn’t look like them and cannot truly empathize about what a woman experiences.
“This still a male dominated field and providers may not really hear or have the ability to understand and relate to a patient as they discuss the effects menopause is having on their quality of life,” said Sloan-Bultman.
“Women will spend about a third of their lifetime in the final phase, and with this phase comes increased risks for cardiovascular disease and osteoporosis” said Sloan-Bultman. “In essence it’s the first step toward the rest of a woman’s life. We take the post menopause-based period of life as being risk-based area of life and we want to do all we can to modify these risks.”
“For example, hormone replacement therapy is an option to help manage symptoms like hot flashes, decreased libido, and vaginal dryness, but the treatment comes with its own risks, like increased chance of developing endometrial cancer,” said Sloan-Bultman. “ So, with that risk we have to balance managing the symptoms and minimizing risks.”
Black women historically have not participated in clinical trials and research about the menopause phase of life, but hopefully that is changing. “Several research groups are essentially targeting hospital systems that are caring for very specific patient populations. Here at Howard, we are sitting on a wonderful patient population that everyone wants to study all the time,” said Sloan-Bultman.
“Part of the push comes from organizations and pharmaceutical companies identifying that there is a gap in the type of research they have surrounding this pathology. They
] reach out to our department and other historically Black institutions or other medical facilities that are treating the patient populations they are looking to recruit,” said Sloan-Bultman. “In the past, when looking to test and market new medications they were going to suburban clinics or even clinics that didn’t accept insurance.”
Sloan-Bultman said the time is now for Black women to be a part of more menopause clinical trials and studies.
“It’s overdue, and we are underwhelmed with the research right now– especially inclusive research,” she said. “I try to empower patients with data points to make informed decisions. We need to talk about it more so women will know what menopause looks like and feels like for them– and how to navigate it without it having such a large impact on their quality of life.”
For more information on menopause, please visit the National Institute on Aging’s information bank found here. For more information on how menopause directly affects Black women, please see the Black Girl’s Guide To Surviving Menopause.