The Health Divide: Menopause is having a moment, but not all women are benefiting equally

After a tap class on Wednesday nights, about 10 of us go to a bar down the street. We are all women, ages 42 to 71, and our conversation often lands on menopause. Hot flashes. Brain fog. Insomnia and weight gain. Hormone patches vs. pills vs. gels. We share links, so now my social media feeds crank out posts from menopause “influencers” and ads for products that claim to relieve symptoms.

It’s worth celebrating the explosion of attention to a fundamental life change that affects half the population, but has lingered in the shadows for decades. “There’s a moment happening with menopause,” said Carrie Anne Karvonen-Gutierrez, associate professor of epidemiology at the University of Michigan. 

“It’s a reflection of decades of growth in women's health research and the movement towards understanding women’s health needs.”

Yet practical support, treatment and government action lag behind the needs of midlife women — especially low-income women and women of color, who are less likely to find their experiences reflected in the national conversation about menopause or receive the most effective therapies.

Brandy Harris Wallace and Tamara Baker, Black scholars who study health disparities and gerontology, described their own experiences navigating menopause in an essay in The Lancet last fall. While they credited social media for bringing visibility to the subject, they noted that white middle- and upper-middle-class women dominate these spaces.

“While understanding the menopause landscape is uncharted territory for most women, regardless of race, it is daunting to see so few women of color talking about their menopause journey,” Wallace and Baker wrote.

The gap in representation is emblematic of deeper disparities.

Research shows that women of color suffer more intense hot flashes, and endure symptoms longer — up to 10 years for Black women, compared with seven years for white women. And on average Black women reach menopause at age 49, two years younger than the national median.

For some Native American women, symptoms begin in the late 30s, said Genevieve Neal-Perry, chair of obstetrics and gynecology at the University of North Carolina School of Medicine. “And they're often dismissed because the assumption is they're too young. You can imagine just going from one provider to the next and spending a lot of time trying to figure out what’s going on before someone actually recognizes it and helps them.”

Earlier onset of menopause is associated with a higher risk of cardiovascular disease, cognitive decline and other age-related conditions, so treatment — or missed treatment — can have lifelong consequences.

It’s also becoming clear that menopause and the years of symptoms before and after aren’t shaped by hormones alone or even, more broadly, by individual biology. “Chronic stress, health care access, and the cumulative effects of social and economic conditions, to name a few things, play important roles,” said Wallace, an associate professor of sociology at the University of Maryland Baltimore County. 

Research has shown, for example, that living in high-poverty neighborhoods is associated with earlier menopause. And women living in communities with less green space experience menopause 1.4 years earlier, on average, than women living near parks, which tend to be more affluent, have less pollution and offer a lush respite from stress.

“The larger takeaway is that there is no single ‘menopause experience,’” Wallace said.

All this means every woman should get sound information and appropriate support and care. 

Yet in a study of Latinas in their mid-40s to mid-50s, 55% said they knew little about menopause. And a study presented at the annual meeting of the American College of Obstetricians and Gynecologists last month found that only about 11% of white patients, 8% of Native American patients, and 6% of Asian patients use hormone therapy, the most effective treatment for hot flashes and other menopausal symptoms. 

Black women were more likely to be prescribed antidepressants and gabapentin, an anti-seizure drug that is not FDA-approved for menopause. For reasons that aren’t clear, Neal-Perry said, insurers sometimes require a patient to try an off-label treatment before they’ll cover one that research has shown to work.

Studies have yet to tease out the reasons for treatment disparities, but researchers point to geographic barriers, systemic racism, implicit bias of clinicians, and patient distrust of medicine — “well-founded,” Neal-Perry said, given the history of racist abuses such as forced sterilization and the Tuskegee experiments.

Inadequate physician training is also an obstacle to good care. A survey of OB-GYN residency programs found that fewer than one-third had a menopause curriculum. It’s an astonishing blind spot considering that 75 million women in the United States are in some stage of this profound physical, biochemical and metabolic transition.

No wonder so many people go online for guidance. But rampant misinformation, Neal-Perry said, “keeps me up at night.”

For example, hormone therapy is safe and effective when started before age 60 or within 10 years of a woman’s final period. But spurred by influencer advice, patients sometimes ask her to prescribe it long after they’re candidates or before they’ve experienced menopause.

“What worries me is the women don't make it to me,” Neal-Perry said. “They may just go to someone local or online who will give them a prescription when, in fact, it isn’t safe.”

Government action could go a long way toward making sure that the different needs of diverse women are met. But at the federal level, two major Congressional bills — one introduced in 2023 to address equity in menopause research and treatment,  and the other introduced in 2024 to improve menopause awareness and workforce training — stalled in committees. 

And by throwing millions of people off health insurance, the massive cuts to Medicaid and the Affordable Care Act under the 2025 Republican megabill will make it harder than ever for low-income women and women of color to get care.

The good news is that states are stepping up. Menopause-related bills are advancing through 19 state legislatures, and seven states passed groundbreaking laws in 2024-2025. 

For instance, Rhode Island became the first state to enact workplace protections and accommodations for women experiencing menopause. The Philadelphia City Council approved a similar ordinance. Illinois, Louisiana, New Jersey, and Oregon have expanded or now require insurance coverage of FDA-approved treatments for menopause relief.

Journalists can track policy developments in their states and municipalities — and dig into the lobbying that causes some bills to languish. Journalists can also investigate the menopause education and treatment resources in their communities. Are they adequate? Are care and support delivered equitably? What are the gaps? Where do women find help when they don’t have access to knowledgeable clinicians — or to health care at all?

In any coverage, it’s important to feature voices that too often go unheard. 

“What I think needs to change and what my colleagues … and I are looking to explore with our work is Black women telling their own stories about menopause,” Wallace said.