Menopause Uncovered

Reclaiming Health, Culture and Power

Menopause is a universal biological transition, yet its experience is anything but uniform.

While the clinical definition marks the end of menstruation, the lived reality for millions of women, particularly Black women and women of colour, is shaped by a complex interplay of biology, culture, healthcare access and systemic inequities. Despite the fact that over 13 million women in the UK alone are currently peri or postmenopausal, the topic remains under-researched, underfunded and under-discussed in both medical literature and public discourse.

Recent longitudinal studies, such as the Study of Women’s Health Across the Nation (SWAN), have revealed significant disparities in the onset, duration and severity of menopausal symptoms across ethnic groups. Black women, for example, experience menopause earlier, endure vasomotor symptoms for longer and report higher rates of depression and sleep disturbances, yet are less likely to receive hormone therapy or mental health support.

These disparities are not simply clinical oversights, they are rooted in structural racism, cultural stigma and a healthcare system that often fails to recognise or validate the experiences of marginalised women.

Moreover, the concept of allostatic load, the cumulative physiological toll of chronic stress, offers a compelling framework for understanding why women of colour face more severe health outcomes during menopause. Studies from the University of Michigan and Harvard School of Public Health show that Black women consistently score highest on allostatic load indices, regardless of income or education, pointing to the insidious effects of racism and social stressors on long-term health.

This article seeks to move beyond symptom checklists and clinical generalisations. It aims to centre the voices and realities of women whose menopause journeys have been shaped not only by hormones, but by history, culture and care or lack thereof. From GP gaslighting and misdiagnosis to intergenerational silence and cultural reframing, we explore the multifaceted dimensions of menopause and offer evidence-based strategies for reclaiming health, identity and agency.

Let us begin by examining the core health issues associated with menopause and how they manifest differently across racial and cultural lines, before moving into the systemic barriers and opportunities for transformation.

 

1. Heart Disease and the Cost of Being Dismissed

Before menopause, estrogen helps protect the heart by keeping blood vessels flexible and maintaining healthy cholesterol levels. After menopause, estrogen levels drop significantly, increasing the risk of cholesterol build-up, high blood pressure and heart disease. Post menopausal women reach the same risk level for heart disease as men of the same age.

But here is where the disparity deepens, Black women and women of colour are more likely to be misdiagnosed or dismissed when they present symptoms of heart disease, especially during or after menopause. This is a form of GP gaslighting, where legitimate concerns are minimised, attributed to stress or brushed off as “normal aging.”

Studies show that Black women are less likely to be referred for cardiac testing. More likely to have their symptoms overlooked, even when presenting with classic signs of heart disease. Under represented in cardiovascular research, which means their symptoms may not align with the “standard” diagnostic criteria shaped around white populations.

This dismissal delays diagnosis and treatment, increasing the risk of serious complications. When menopause already elevates cardiovascular risk, being unheard or disbelieved by your GP can be life-threatening.

For women of colour, the intersection of racial bias, gendered assumptions and lack of culturally competent care means that heart disease is not just a medical issue, It is a systemic one.

2. Osteoporosis, Misdiagnosis and Missed Opportunities

Estrogen plays a vital role in maintaining bone density. After menopause, its decline accelerates bone loss, increasing the risk of osteoporosis, a condition where bones become brittle and prone to fractures. Up to 20% of bone loss can occur during the menopausal transition and 1 in 2 postmenopausal women will experience an osteoporosis-related fracture in their lifetime.

Yet for Black women and women of colour, osteoporosis is often underdiagnosed and undertreated. GP gaslighting plays a role here too, symptoms like joint pain or fatigue may be dismissed as “normal aging” or attributed to lifestyle, rather than prompting bone density scans or specialist referrals. Cultural assumptions that osteoporosis is a “white woman’s disease” further delay diagnosis, despite evidence that Black women suffer more severe outcomes when fractures do occur, including longer recovery times and higher disability rates.

3. Stroke, When Symptoms Are Ignored

The risk of stroke doubles every decade after age 55 and menopause-related hormonal changes, especially the drop in estrogen, contribute to increased vulnerability. Women who experience early menopause (before age 40) are at significantly higher risk of ischemic stroke.

However, stroke symptoms in women, such as confusion, fatigue or dizziness, are often misinterpreted or dismissed, especially in Black and ethnic minority women. GP gaslighting can result in delayed emergency care or misdiagnosis, with symptoms attributed to anxiety or menopause itself.

This delay can be fatal. Studies show that Black women are less likely to receive timely stroke interventions and more likely to experience long-term complications.

4. Urinary Incontinence, Silenced by Shame and Dismissal

Urinary incontinence (UI) affects up to 50% of postmenopausal women, yet it remains one of the most underreported and under treated conditions. Estrogen withdrawal weakens pelvic muscles and urethral support, contributing to stress and urge incontinence.

For women of colour, UI is often compounded by cultural stigma and GP dismissal. Many feel embarrassed to raise the issue and when they do, They are told It is “just part of aging” or offered superficial advice without proper assessment. In South Asian and African communities, UI may be seen as shameful or taboo, leading to silence and suffering.

This lack of culturally sensitive care means many women go years without effective treatment, despite the availability of pelvic floor therapy, medications and surgical options.

5. Oral Health, Overlooked and Under-prioritised

Menopause affects oral health in ways that are rarely discussed. Declining estrogen levels can lead to dry mouth, gum disease, bone loss and burning mouth syndrome. These symptoms can impact nutrition, speech and overall wellbeing.

Yet oral health is often excluded from menopause care conversations and women of colour are disproportionately affected by limited access to dental care and GPs who overlook oral symptoms. Complaints like mouth pain or bleeding gums may be dismissed or misattributed, delaying diagnosis of serious conditions like periodontitis or osteoporosis-related jawbone loss.

Cultural norms may also discourage prioritising dental health, especially in communities where systemic barriers already limit access.

Menopause Is Not A One-Size-Fits-All and That’s the Problem

The data is clear, menopause does not affect all women equally. White women typically reach menopause around age 51, while Black, Hispanic/Latina and South Asian women experience it earlier, often by two years or more. It is not just about timing. The duration and severity of symptoms also differ significantly. Black women, for example, endure hot flushes for up to 10 years, compared to 6.5 years for white women and report higher rates of depression and sleep disturbances.

But these disparities go beyond biology. They are shaped by culture, healthcare access and systemic bias.

Despite experiencing more severe symptoms, Black and Hispanic women are 26–32% less likely to be prescribed hormone therapy and often receive less support for mental health, vaginal health and chronic conditions like hypertension and diabetes. This is not just an oversight, It is a reflection of structural inequities in healthcare.

One of the most damaging manifestations of this is GP gaslighting. Women of colour frequently report being dismissed or disbelieved when they raise menopause-related concerns. They are told It is “just stress,” “normal aging,” or “not menopause yet.” Their pain is minimised, their symptoms overlooked and their access to treatment delayed, if offered at all.

This dismissal is compounded by cultural silence. In many ethnic minority communities, menopause is still a taboo subject. It is seen as a symbol of loss, of fertility, femininity and youth. Women are expected to “suffer in silence,” not complain and “get on with it.” Many grew up in households where menopause was never discussed, leaving younger generations without the language or role models to navigate this transition.

Yet there is also resilience. In some African cultures, older women are honoured as “Queen” or “Mother,” embracing aging as wisdom. Humour, optimism and community support often fill the gaps left by formal healthcare systems.

Still, we cannot ignore the toll of chronic stress and racism, what researchers call allostatic load. Black women have the highest scores across all socioeconomic levels, meaning their bodies carry the cumulative burden of stress over time. This “weathering” effect contributes to earlier menopause, longer transitions and worse health outcomes.

Why This Matters

Menopause support must reflect the realities of diverse women’s lives, not just the dominant narrative shaped by white, middle-class experiences. That means:

• Challenging GP gaslighting and advocating for inclusive, evidence-based care.

• Creating spaces where women of colour can speak openly and be heard.

• Recognising menopause as a cultural experience, not just a clinical one.

When we change the conversation, we change the culture. When we change the culture, we change lives.

Achieving Health Goals After Menopause

Menopause marks a significant biological transition, but It is also a powerful opportunity to reset and refocus on long-term health. With estrogen levels declining, women become more vulnerable to conditions like heart disease, osteoporosis, diabetes and depression.

However, research shows that targeted lifestyle changes can significantly reduce these risks and improve quality of life.

Here are five key strategies supported by clinical evidence:

1. Prioritise Nutrition for Bone and Heart Health

According to Johns Hopkins Medicine, postmenopausal women should increase their calcium intake from 1,000 mg to 1,200 mg per day and vitamin D from 600 IU to 800 IU to support bone density and reduce fracture risk. Vitamin D also enhances calcium absorption and supports immune function

• Eat calcium-rich foods (leafy greens, dairy, fortified plant milks).

• Include vitamin D sources (fatty fish, eggs, fortified cereals).

• Limit processed sugars and saturated fats to reduce cardiovascular risk.

2. Exercise Regularly to Preserve Bone Mass and Boost Mood

Physical activity is one of the most effective tools for managing postmenopausal health.

Weight-bearing exercises like walking, jogging and resistance training help preserve bone mass, while aerobic activities improve heart health, metabolism and mental wellbeing.

Research shows that sedentary women are more likely to develop heart disease, obesity, high blood pressure and osteoporosis. Exercise also releases endorphins, which improve mood and reduce stress. Aim for 150 minutes of moderate aerobic activity per week, plus 2 sessions of strength training.

3. Manage Weight and Metabolism Through Balanced Eating

Declining estrogen levels can lead to weight gain, especially around the abdomen and increase insulin resistance. A balanced diet rich in fibre, lean protein, healthy fats and whole grains can help regulate blood sugar and support metabolic health.

The St. Jude Wellness Centre recommends reducing refined carbohydrates and increasing fibre intake to at least 25g per day to prevent visceral fat gain and type 2 diabetes.

Consider intermittent fasting (12–14 hours overnight) to improve insulin sensitivity and support metabolic reset.

4. Support Mental and Emotional Health

Mood swings, anxiety and depression are common during and after menopause. These symptoms are often exacerbated by poor sleep, hormonal fluctuations and life stress. Regular exercise, mindfulness practices and social connection can help mitigate these effects.

Exercise has been shown to reduce symptoms of depression and anxiety by increasing serotonin and endorphin levels. Yoga and mindfulness also show promise in improving sleep and reducing vasomotor symptoms. Try to incorporate daily movement, breathwork or guided meditation to support emotional resilience.

5. Work With a Trusted Healthcare Provider and Advocate for Yourself

Navigating postmenopausal health requires personalised care. Whether considering hormone therapy, managing chronic conditions or addressing sexual health, It is essential to work with a provider who listens and respects your experience.

Women of colour are more likely to experience GP gaslighting, where symptoms are dismissed or misattributed. This can delay diagnosis and treatment, especially for conditions like heart disease, osteoporosis and depression. Keep a symptom journal, ask questions and seek second opinions if needed. Culturally competent care is not a luxury, It is a necessity.

The Takeaway

Menopause is not a decline, It is a recalibration. With the right strategies, this phase can become a launchpad for lifelong health. Nutrition, movement, emotional wellbeing and advocacy are your tools. Use them boldly.

What We are Still Learning and Why It Matters

As we open up the conversation around menopause, It is clear that there is still so much we are only beginning to understand. Beyond the physical symptoms and healthcare disparities, menopause touches every part of a woman’s life, her identity, her relationships, her sense of purpose. For many, It is a time of reckoning with roles that are shifting, bodies that are changing and cultural expectations that have long gone unchallenged.

Women of colour, in particular, face unique challenges. They often navigate menopause without the benefit of open dialogue, culturally competent care or intergenerational guidance. The silence around menopause in many communities means that younger women may enter this phase without the language or support to make sense of it. And when they do seek help, They are too often met with dismissal, a GP who downplays their symptoms, a system that does not see them, a culture that tells them to endure quietly.

But this phase also holds immense potential. It is a chance to reclaim health, redefine identity and reshape legacy. It invites us to ask not just how we survive menopause, but how we thrive through it, emotionally, creatively and collectively. The more we speak, the more we shift the narrative. The more we listen, the more we build a culture that honours every woman’s journey.

Taking Charge of Your Menopause Journey

Menopause is not something that happens to you, It is something you can move through with intention, clarity and strength. Yes, the symptoms are real. Yes, the disparities are frustrating. But your mindset and lifestyle choices can transform this phase from one of uncertainty into one of empowerment.

Start by reframing the narrative. Menopause is not a loss, It is a liberation from expectations that no longer serve you. It is a time to prioritise your health, rediscover your passions and advocate for the care you deserve. Whether It is nourishing your body with whole foods, building strength through movement or finding joy in creativity and connection, every choice you make is a step toward thriving.

Do not forget, mindset matters. When you believe that this chapter is yours to shape, you begin to see possibilities instead of limitations. You stop waiting for permission and start leading your own transformation.

So take charge. Track your symptoms. Ask questions. Challenge dismissive healthcare. Build community. Celebrate your wisdom. You are not invisible, you are evolving.

---

If this post spoke to you, let it speak to others too. Show your support by liking it, share your own story or insight in the comments and pass it on to someone who might need to hear that They are not alone. Every time we engage, we help another woman feel seen, heard and empowered.

Together, we are not just changing the conversation around menopause, we are changing the culture.