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The effects of the menopause transition vary widely from person to person. The question is: Why? Why do some people experience menopause like an 18-wheeler driving straight for them while others seem to skate right through it?
Genetics may be one part of the puzzle. But the picture is a lot more complicated than that. Emerging research points to a multitude of factors that may shape how you experience menopause. Some of these things relate to lifestyle — behaviors we may be able to change to improve our symptoms.
Other factors — like our bodies, background, exposure to adversity (including racism) and other experiences are simply part of who we are. These aspects of our unique life stories may extend beyond the personal, reflecting broader issues within society.
Here are some of the hidden issues that may affect your menopause experience.
Socioeconomic status
The term socioeconomic status refers to aspects in someone’s life such as educational background, income and occupation. And it can have an impact on menopause. Research shows that women with higher levels of education, income and employment are more likely to have fewer or less-severe menopausal symptoms. A lower socioeconomic status is linked to earlier menopause, more-frequent hot flashes and more sleep problems during the menopause transition. Being homeless or uninsured are also risk factors for developing more severe symptoms.
Stressful circumstances
We all experience stress sometimes. Stress can be a healthy reaction to the demands of life. A small amount of stress can motivate us to confront challenges and do what needs to be done to overcome them. But if your stress switch is always turned on, it can wreak havoc on your mind and body. Chronic stress can increase your risk of a host of health problems, including anxiety and depression, tummy troubles, high blood pressure and heart disease. Chronic stress is also linked to earlier menopause and worse menopause-related symptoms.
Racism and implicit bias
Members of minority groups are underrepresented in medical research about menopause. There’s still a lot to explore and uncover, but emerging data points to the role that race — and racism — may play. For example, Black women are significantly more likely to experience frequent hot flashes and night sweats than are white women, and on average their symptoms last more than three years longer. Part of the reason may be due to structural racism — Black women are more likely to experience the socioeconomic factors linked to earlier menopause and more severe symptoms.
Adding to this picture is research on how people of color are treated for menopausal symptoms like hot flashes. One recent study of nearly 300,000 women veterans in midlife showed that non-Hispanic Black women and Hispanic women were less likely to receive prescriptions for hormone therapy compared to non-Hispanic white women — even if they experienced the same symptoms.
Gender identity
For people who identify as transgender or nonbinary, this part of their identity may impact their menopause experience.
As part of gender-affirming care, transgender people may be prescribed hormone therapy — including testosterone for trans men, and estrogen, often with an androgen blocker or synthetic gonadotropin-releasing hormone (GnRH), for trans women. In addition, many undergo some form of surgery as part of their transition. How do these treatments affect menopause hormone shifts and symptoms? That answer is different for everyone. To manage any version of a midlife transition, it’s key to work with a trusted healthcare practitioner, ideally one with knowledge of transgender health.
However, seeking and receiving care is often more difficult for those in the transgender community. In a national U.S. transgender survey, many reported avoiding seeing a doctor out of fear of anti-transgender bias. Among those who did seek care, 1 in 3 reported negative experiences such as being refused appropriate treatment or having to teach the clinician about transgender issues. Transgender people of color are especially likely to encounter discrimination in health care settings.
Experiences with health care
Regardless of gender identity, a knowledgeable medical expert who listens to you and whom you trust can have a positive effect on your health and well-being. But what if your doctor squirms or goes blank when you bring up menopause? What if you can’t afford to see a doctor at all?
More than 1 out of 10 women in the United States between the ages of 18 and 64 are uninsured. Those numbers are even higher among women with lower incomes, women of color and women who are undocumented immigrants. In one study, uninsured women were more likely to say they experienced bothersome menopause symptoms compared to women who were insured.
Another barrier to supportive health care is a lack of practitioners who are trained to discuss menopause and treat its symptoms. Research indicates that few medical residents feel prepared to talk about and manage menopause symptoms. A doctor who is uncomfortable with the topic — or worse, dismissive — may leave you feeling discouraged, confused and more anxious about what’s happening with your body.
Immigration experiences
If you or someone close to you has immigrated to a new country, you know how hard it can be to pull up roots and slowly regrow them in a new place. Immigrants may experience a deep sense of loss, missing friends and family back home. They may have to learn a new language, adapt to unfamiliar cultural expectations and adjust to a different way of life. Many global migrants and refugees experience discrimination and struggle to find stable housing, work and access to health care. All of this can affect a person’s mental and physical health.
Studies of women who have immigrated to the United States suggest that these experiences may affect the menopausal years too. The research shows a relationship between the length of time a person has lived as an immigrant in the United States and the severity of symptoms such as depression, sleep difficulties and problems with concentration or forgetfulness.
Even so, one study found that women who emigrated from outside the United States had on average less severe symptoms of menopause than women born in the United States. One possibility is that close family and cultural connections, which are more common in immigrant communities, may have health benefits that help protect women from more severe symptoms of menopause.
Another issue is that healthcare practitioners may be hesitant to educate immigrant women about menopause, feeling unprepared to discuss the topic in a way that’s culturally appropriate.
Getting the most out of your healthcare to address menopause
Your life experiences and identity may affect your journey through menopause, but they shouldn’t affect the quality of your health care. If you’ve been let down by a medical encounter in the past, consider trying again. The urge to avoid the doctor’s office is understandable if you’ve felt ignored or belittled or discriminated against, but you deserve to find a practitioner who sees, hears, respects and understands you.
The first step is to search for a clinician who is knowledgeable, experienced and reputable. The Menopause Society is a good place to start. Their website has a search tool that allows you to locate menopause practitioners by U.S. ZIP code or by country.
And if you have trusted local friends, especially if they have already experienced perimenopause or menopause symptoms, don’t be shy about asking them for a personal recommendation. That may help you find a practitioner who seems like a good fit.
The next step is to trust your gut. Does your practitioner understand where you’re coming from and take your concerns seriously? Do you feel that they care about you and have your best interests at heart? Do you have confidence in their expertise and view them as trustworthy? These are the kinds of qualities that promote a strong doctor-patient relationship. And a strong relationship with a health care provider can have a positive effect on your health.
If a doctor or other clinician doesn’t possess the qualities you’re looking for — or if you perceive subtle (or not-so-subtle) forms of discrimination — move on and look for a better fit. You deserve a trusted ally who can be a source of comfort and guidance as you surf the sometimes wild waves of menopause.
A version of this text appears in The New Rules of Menopause.
Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
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