A survey to understand the experience, perceptions, and stigma around menopause among African American women

Abstract

Objective

This survey (September–October 2022) sought deeper understanding of menopause experiences, perceptions, and unmet needs among African American women.

Methods

Participants were perimenopausal or had transitioned through menopause, resided in the United States, assigned female at birth, aged 40–69 years, African American, and reported menopause symptoms in the past 30 days.

Results

The survey was completed by 334 African American women (mean age 55 years). Common symptoms were night sweats (94%, n = 314), hot flashes (93%, n = 310), and vaginal dryness (87%, n = 291). Most reported symptoms lasting ≥9 years (81%, n = 270) and occurring daily (69%, n = 230). Participants believed African American women experience more frequent hot flashes over more years compared with other racial/ethnic groups. Participants believed society discriminates against menopause (82%, n = 274); 87% (n = 290) did not feel supported, with 85% (n = 285) seeking more healthcare provider support and 89% (n = 296) reporting prayer helped cope with symptoms. Solutions to reduce discrimination included seeing everyday women share experiences (87%, n = 263) and educating younger women (77%, n = 233) and men (76%, n = 231).

Conclusions

African American women experience bothersome menopause symptoms and societal stigma. Education and greater access to trusted, female, African American healthcare providers may improve health status and help overcome health disparities in menopause.

Highlights

• •African American women lack the support needed from their doctors during menopause
• •Increase access to trusted female African American healthcare providers
• •Encourage sharing experiences of menopause and educating younger women and men
• •It is of great importance to overcome the health disparities in menopause

1. Introduction

Menopause is a significant period of transition in a woman's life, accompanied by a range of physical and psychological symptoms (Panay et al., 2021; Santoro et al., 2021). Existing literature suggests that many women may have an optimistic view of menopause (Dillaway et al., 2008; Im et al., 2010a; Im et al., 2010b; Nosek et al., 2010); however, across racial and ethnic groups (Im et al., 2010a), and specifically for African American women (Im et al., 2010b; Sampselle et al., 2002), menopause is often perceived as a part of life with unavoidable and unstoppable symptoms.

African American women have an earlier onset and increased burden of menopause symptoms, including vasomotor symptoms (VMS) and depression (Bromberger et al., 2004; Gold et al., 2006; Harlow et al., 2022; Kochersberger et al., 2024; Reeves et al., 2024). Most women between 40 and 64 years of age experience VMS (i.e., hot flashes and night sweats – feelings of warmth in the face, neck, and chest, or sudden intense feelings of heat and sweating) (Bansal and Aggarwal, 2019; Makara-Studzińśka et al., 2014), with notable effects on sleep, concentration, mood, energy level, and overall quality of life (Williams et al., 2009). The Study of Women's Health Across the Nation (SWAN) established that African American women experienced VMS for an average of 3.5 years longer (Avis et al., 2015) and were three times more likely to consistently report VMS (Tepper et al., 2016) than White women. Despite this, African American women may be less likely to receive treatment for VMS compared with White women (Crawford et al., 2018; Gold et al., 2013; Harlow et al., 2022). To better understand the reasons behind this, it is crucial to gather greater insight into the support systems and unmet needs of African American women experiencing menopause.

This survey sought to build on the existing literature in this area and gather insights into the symptom experience of African American women, the impact menopausal symptoms have on daily life, support systems available, barriers to healthcare, and trigger points for seeking menopause treatment. The overall objective was to gain a deeper understanding of the menopause experience and perceptions among African American women and to identify unmet needs and healthcare disparities.

2. Materials and methods

2.1. Study design

Astellas Pharma Inc., in partnership with The Balm in Gilead Inc., conducted a survey that was available for 4 weeks from mid-September to mid-October 2022. This cross-sectional, 44-item survey explored key themes relating to menopause including symptoms and impacts; perceptions, beliefs, and stigma; support and access to care; and menopause management. The survey was developed for the purpose of this study.

The Balm in Gilead Inc. is an organization that aims to prevent diseases and improve health status for African Americans and contribute to the elimination of health disparities. Before conducting the survey, The Balm in Gilead held an informational session with the female leadership of the African American Denominational Leadership Health Institute, a national faith network established by The Balm in Gilead in 2010. An official letter of invitation to participate in the study was sent to denominational partners of The Balm in Gilead on official letterhead. Eligible participants were invited to participate via existing partnerships and networks with advocacy groups in addition to boosted/targeted advertisements on social media platforms. Compensation was provided to all eligible survey participants who completed the survey during the recruitment and engagement period. The survey, consisting of screening questions and the questionnaire, was distributed electronically using Qualtrics CoreXM via a dedicated online portal and via email. Introductory explanations and definitions of medical terms were included for each section of the survey.

All participants included in the study were perimenopausal (defined as irregular menstrual bleeding, including irregular menstrual periods that started more than 1 week before or after expected within the last 2–12 months) or had transitioned through menopause (defined as last menstrual period 12 or more months ago), resided in the United States of America (USA), were assigned female at birth, were aged 40–69 years, identified as African American, and reported having symptoms of menopause in the past 30 days. Participants were excluded if they were pregnant, trying to get pregnant, had cancer, or had received treatment for cancer within the past 2 years.

This study was granted institutional review board (IRB) exemption by WCG™ IRB because the research only includes interactions involving survey procedures and any disclosure of the participants' responses outside the research would not reasonably place the subjects at risk of criminal or civil liability or be damaging to the subjects' financial standing, employability, educational advancement, or reputation.

2.2. Data analysis

Data were collated from survey responses and analyzed descriptively. All data were de-identified. All measures, including demographics, health characteristics, and symptoms, were self-reported.

A descriptive analysis approach was used to stratify selected data elements in an effort to understand the impacts of menopause among study participants and any correlation to the factors such as age and socioeconomic status. Raw numbers and scores for questions using scales or rank-order were analyzed and reported as percentiles to better illustrate the significance of key findings. This allowed for a more in-depth analysis of the data to find out how study participants were experiencing menopause and identify gaps in awareness, education, healthcare, and support.

The survey findings were retrospectively grouped into the following themes: menopause symptoms and impacts; perceptions, beliefs, and stigma; support and access during menopause; and menopause management.

3. Results

3.1. Participant demographics and health characteristics

A total of 334 African American women across 28 states in the USA completed the survey. Approximately 27% resided in the Southeast, 22% in the Northeast, 20% in the Southwest, 16% in the West, and 15% in the Midwest. Participants were from both rural and urban regions. Mean age (SD) was 54.9 (7.5) years, with mean age of menopausal symptom onset of 41.5 (3.3) years. Forty-seven percent (n = 156) had a bachelor's or graduate degree and 29% (n = 97) of participants were employed full-time.

Many participants had hypertension, diabetes, or heart disease (69%; n = 229), and more than one third reported anxiety or depression (36%; n = 119). While most participants reported exercising at least three days in the last week (73%, n = 244), over a quarter of participants exercised less than this (27%, n = 90). Further participant demographics and health characteristics are reported in Supplementary Table 1.

3.2. Menopause symptoms and impacts

Forty-five percent (n = 150) of participants shared that their menopause symptoms lasted for 9–12 years and 36% (n = 120) for ≥13 years. For most, menopause symptoms occurred every day in the past week (69%, n = 230; Table 1).

Table 1.

Menopause symptom experience: onset, duration, frequency, and bothersomeness – survey responses from African American women in the United States, September–October 2022.

	Responses, n (%)
Mean age of onset of menopausal symptoms
Years (SD)	41.5 (3.3)
Duration of menopause symptoms	N = 334
1–4 years	43 (13)
5–8 years	21 (6)
9–12 years	150 (45)
≥13 years	120 (36)
Frequency of menopause symptoms (in the last week)	N = 334
1 day	0 (0)
2 days	0 (0)
3 days	17 (5)
4 days	46 (14)
5 days	20 (6)
6 days	21 (6)
7 days	230 (69)
Most bothersome symptoms (top 3)	N = 334
Hot flashes	194 (58)
Night sweats	99 (30)
Vaginal dryness	89 (27)
Difficulty staying asleep	64 (19)
Weight gain or slowed metabolism	59 (18)
Bloating	56 (17)
Painful intercourse	53 (16)
Frequent urination and/or leaking urine	51 (15)
Abnormal vaginal discharge	43 (13)
Headaches	42 (13)
Heart palpitations	39 (12)
Breast tenderness	38 (11)
Joint pain	36 (11)
Chills	30 (9)
Sweating during the day, including cold sweats	25 (7)
Thinning hair	23 (7)
Difficulty falling asleep	22 (7)
Dry skin	22 (7)
Irregular periods	13 (4)
I have not experienced symptoms	0 (0)
Other symptom(s) not listed	0 (0)

Hot flashes and night sweats are feelings of warmth in the face, neck, and chest, or sudden intense feelings of heat and sweating.

The menopause symptoms most commonly experienced in the past week were night sweats (94%, n = 314), hot flashes (93%, n = 310), vaginal dryness (87%, n = 291), and sweating during the day (87%, n = 290; Fig. 1). Participants rated their top three most bothersome symptoms as hot flashes (58%, n = 194), night sweats (30%, n = 99), and vaginal dryness (27%, n = 89; Table 1). When considering these top three symptoms on a scale of 1–5 (5 = most bothersome, 1 = least bothersome), 83% (n = 277) selected 5 (most bothersome), 10% (n = 33) ranked their symptoms as a 4, 7% (n = 24) as a 3, and no participants selected a 1 or 2.

Fig. 1.

Menopause symptoms experienced in the past 7 days (n = 334), African American women survey respondents in the United States, September–October 2022.

No participants selected “other” or “I have not experienced symptoms.” Participants were asked the question: “In the past 7 days, which of the following menopausal symptoms have you experienced?” Participants were asked to select all options that applied. Hot flashes and night sweats are feelings of warmth in the face, neck, and chest, or sudden intense feelings of heat and sweating.

The most commonly experienced impacts of menopause reported in the past week were lack of desire or interest in sex (88%, n = 295); having little interest or pleasure in doing things (83%, n = 278); feeling tired or lacking energy (80%, n = 266); feeling nervous, anxious, or worried (74%, n = 247); and feeling down, depressed, or hopeless (73%, n = 243; Fig. 2).

Fig. 2.

Impacts experienced in the past 7 days due to menopause (n = 334), African American women survey respondents in the United States, September–October 2022.

No participants selected “other” or “I have not experienced any impacts.” Participants were asked the question: “In the past 7 days, which of the following impacts have you experienced due to your menopausal transition?” Participants were asked to select all options that applied.

3.3. Perceptions, beliefs, and stigma

When asked about their own perceptions on menopause, participants generally believed that African American women experience more frequent hot flashes over a longer time period (more years) than other racial or ethnic groups, with 83% (n = 277) responding that ≥20 hot flashes per week is typical for African American women while only 54% (n = 179) shared that this is typical for women of other racial or ethnic groups. More than half of participants (56%; n = 186) reported that menopause is a natural part of life. Only 19% (n = 65) reported that menopause is a medical condition that may need treatment. Forty-one percent (n = 138) believed that it is important to be strong and not let menopause affect daily life (Table 2).

Table 2.

Menopause perceptions, beliefs, and stigma – survey responses from African American women in the United States, September–October 2022.

	Responses, n (%)
What does menopause mean to you?	N = 334
A natural part of life	186 (56)
Associated with aging	124 (37)
A time of personal growth and greater self-awareness	108 (32)
A life transition that is meaningful	97 (29)
A life transition that is upsetting	76 (23)
A medical condition that may need treatment	65 (19)
How do you feel about menopause?	N = 334
I feel it is important to be strong and not let menopause affect my day-to-day life	138 (41)
I feel it is important to take time to care for myself during this phase of my life	115 (34)
I am embarrassed and hide my symptoms	94 (28)
Overall, I view menopause positively	76 (23)
I am not embarrassed and am comfortable with my symptoms	66 (20)
Overall, I view menopause negatively	29 (9)
How do you feel about the reproductive or fertility changes as a result of menopause?	N = 334
I am relieved that I will no longer get my period	216 (65)
I am excited about sex without the chance of pregnancy	139 (42)
I am relieved that I can no longer have children	55 (16)
I am upset that I can no longer have children	17 (5)
I am afraid that my partner will see me differently now that I can no longer have children	11 (3)
In your opinion, do African American women experience menopausal symptoms differently than women of other ethnic and racial groups?	N = 334
Yes	189 (57)
No	101 (30)
I don't know	44 (13)
In your opinion, how long do the symptoms of menopause typically last for African American women?	N = 334
<1 year	15 (4)
1–4 years	43 (13)
5–8 years	76 (23)
9–12 years	120 (36)
≥13 years	80 (24)
In your opinion, how long do the symptoms of menopause typically last for other racial or ethnic groups?	N = 334
<1 year	24 (7)
1–4 years	60 (18)
5–8 years	106 (32)
9–12 years	94 (28)
≥13 years	50 (15)
In your opinion, how frequently do African American women experience hot flashes due to menopause?	N = 334
0–4 hot flashes weekly	0 (0)
5–9 hot flashes weekly	0 (0)
10–14 hot flashes weekly	24 (7)
15–19 hot flashes weekly	33 (10)
≥20 hot flashes weekly	277 (83)
In your opinion, how frequently do women of other racial or ethnic groups experience hot flashes due to menopause?	N = 334
0–4 hot flashes weekly	0 (0)
5–9 hot flashes weekly	0 (0)
10–14 hot flashes weekly	125 (37)
15–19 hot flashes weekly	30 (9)
≥20 hot flashes weekly	179 (54)
In your opinion, how severe do you think the symptoms of menopause are for African American women?	N = 334
1 (not at all severe)	0 (0)
2	0 (0)
3	23 (7)
4	71 (21)
5 (extremely severe)	240 (72)
In your opinion, how severe do you think the symptoms of menopause are for other racial or ethnic groups?	N = 334
1 (not at all severe)	0 (0)
2	0 (0)
3	80 (24)
4	170 (51)
5 (extremely severe)	84 (25)
Based on your experience and opinion,society viewsmenopause as:	N = 334
A time when women are not able to control their emotions	252 (75)
A time when women are less attractive	246 (74)
Something that is not okay to openly talk about	242 (72)
A negative life change for women	219 (66)
Shameful	196 (59)
A positive life change for women	98 (29)
Something that is okay to openly talk about	92 (28)
A time when women are more attractive	88 (26)
A time of independence, clarity, and wisdom for women	88 (26)
A time when women are in control of their emotions	82 (25)
Do you believe there is stigma in society around menopause?	N = 334
Yes	291 (87)
No	43 (13)
I am not sure	0 (0)
Do you believe society discriminates against menopausal women?	N = 334
Yes	274 (82)
No	60 (18)
I am not sure	0 (0)
Have you been discriminated against because of menopause?	N = 334
Yes	214 (64)
No	73 (22)
I am not sure	47 (14)
What do you think would help in reducing discrimination against menopause in your community?	N = 303
Seeing everyday women share their experiences	263 (87)
Educating younger women about menopause	233 (77)
Educating men about menopause	231 (76)
An influential person (entertainer, celebrity figure, social influencer) sharing their menopause experience	189 (62)
Menopause education and awareness in the workplace	186 (61)
Menopause education in schools as part of general reproductive education	176 (58)
Menopause education and awareness through social media websites	175 (58)
Menopause education and awareness to people in leadership roles	157 (52)
I do not think there is any discrimination within my community	0 (0)
Free-text responses	96 (32)
Free-text responses to do with peer-led education and support groups (n = 96)	58 (60)

Hot flashes and night sweats are feelings of warmth in the face, neck, and chest, or sudden intense feelings of heat and sweating.

Participants reported that societal views of menopause were generally negative; 75% (n = 252) reported that society views menopause as a time when women are not in control of their emotions and 74% (n = 246) reported that it is a time when women are less attractive. Eighty-two percent (n = 274) of participants believed that there is discrimination against menopause in society, with 64% (n = 214) reporting that they have been discriminated against due to menopause. Participants were asked what they thought would help in reducing discrimination against menopause in their community; the most common response was “seeing everyday women share their experiences” (87%, n = 263) followed by “educating younger women about menopause” and “educating men about menopause” (77%, n = 233 and 76%, n = 231, respectively). Other frequently selected options were “an influential person (entertainer, celebrity figure, social influencer) sharing their menopause experience” (62%, n = 189) and “menopause education and awareness in the workplace” (61%, n = 186). Thirty-two percent (n = 96) provided written responses to this question with 60% (n = 58) of these including suggestions for peer-led education or support groups. None of the participants selected the option “I do not think there is any discrimination within my community” (Table 2).

3.4. Support and access during menopause

Eighty-seven percent (n = 290) of participants did not feel supported in their menopause transition. Most wanted more support from healthcare providers and their partner or spouse (85%, n = 285 and 83%, n = 278, respectively). One fifth (19%, n = 64) wanted more support from female family members (Table 3).

Table 3.

Menopause support, access, and management – survey responses from African American women in the United States, September–October 2022.

	Responses, n (%)
From whom would you likemoresupport?	N = 334
My healthcare provider(s)	285 (85)
My partner or spouse	278 (83)
My family members	105 (31)
My female family members	64 (19)
My coworkers	49 (15)
My friends	9 (3)
My faith-based group	0 (0)
My in-person group	0 (0)
My online group	0 (0)
I don’t need more support	0 (0)
What made you seek care for your menopause-related symptoms from a healthcare provider?	N = 129
Disruption to my family life	107 (83)
Disruption to my work	102 (79)
Other option not listed	82 (64)
Disruption to my social activities	34 (26)
Cost for self-care, such as over-the-counter treatments, supplements, or wholistic care, got too expensive	29 (22)
Disruption to my hobbies	13 (10)
I did not seek care; my healthcare provider asked me about menopause	0 (0)
Other option not listed	82 (64)
Health concern	25 (30)
Weight gain	22 (27)
My family, healthcare provider, friend	11 (13)
Mood swings	9 (11)
Hot flashes	8 (10)
Irregular bleeding	6 (7)
Night sweats	5 (6)
Depression	2 (2)
Online article, wellness event	2 (2)
Treatment options offered by a healthcare provider (women who had seen their healthcare provider for menopause)	N = 129
Dietary management	42 (33)
Breathing or relaxation exercises	38 (29)
Change in exercise routine	36 (28)
Prescription hormone therapy (example: estrogen)	34 (26)
Yoga or meditation	30 (23)
Nothing was offered to me during my visit	23 (18)
Prescription therapy for anxiety or depression	20 (16)
Supplements, including herbals	19 (15)
Cooling techniques	18 (14)
Over-the-counter treatments	16 (12)
Cognitive behavioral therapy	15 (12)
Hypnosis	13 (10)
Acupuncture	6 (5)
Reported prescription medications (women who had seen their healthcare provider for menopause)	N = 129
I do not use any prescription medications or products	87 (67)
An anti-depressant medication (examples: paroxetine, venlafaxine, escitalopram)	24 (19)
Estrogen alone in patch, pill, or vaginal ring	12 (9)
Estrogen and progesterone in pill or patch	12 (9)
Estrogen with a selective estrogen receptor modulator	8 (6)
Local estrogen alone in vaginal cream	3 (2)
Progesterone only	1 (1)
Birth control pill	1 (1)
Selective estrogen receptor modulator (example: ospemifene)	1 (1)
Other non-hormonal medication (examples: gabapentin, clonidine)	0 (0)
Compounded bioidentical hormones in pill, patch, injectable, or pellet	0 (0)
I don’t know what type of medication that I am taking	0 (0)
Something not listed here	0 (0)
Reported lifestyle strategies	N = 334
Prayer	296 (89)
Cooling techniques (such as fans, ice packs, cooling devices)	283 (85)
Yoga or meditation	269 (81)
Exercise	207 (62)
Home remedies	190 (57)
Social support from friends/family	88 (26)
Dietary management	56 (17)
Breathing or relaxation exercises	44 (13)
Cognitive behavioral therapy	8 (2)
Acupuncture	5 (1)
Laughter	5 (1)
Hypnosis	4 (1)
Technologies to track symptoms (apps or wearable devices)	0 (0)
I do not use any lifestyle strategies	0 (0)
Something not listed here	0 (0)
Reported dietary supplements	N = 334
Something not listed here	121 (36)
Black cohosh	100 (30)
Ginseng	51 (15)
Evening primrose oil	43 (13)
Chasteberry	39 (12)
Relizen	36 (11)
Flaxseed or flaxseed oil	35 (10)
Red clover	35 (10)
Dehydroepiandrosterone	34 (10)
Soy	33 (10)
Wild yam	31 (9)
Revaree	25 (7)
Ristela	23 (7)
Dong quai	22 (7)
St. John’s wort	0 (0)
I do not use any supplements	0 (0)

Hot flashes and night sweats are feelings of warmth in the face, neck, and chest, or sudden intense feelings of heat and sweating.

Relizen is the brand name of a plant-based dietary supplement blend. Revaree is the brand name of a non-hormonal vaginal moisturizer. Ristela is the brand name of a plant-based blend to increase blood flow to the vagina.

Participants were asked about where they access information on menopause symptoms and treatment, with the main source being from healthcare providers (48%, n = 161) followed by social media platforms (33%, n = 111), medical websites (28%, n = 95), internet searches or other websites (24%, n = 80), friends (23%, n = 77), and female family members (23%, n = 76; Supplementary Fig. 1).

The top reasons leading participants to seek care for menopause symptoms from a healthcare provider were disruption to family life (83%, n = 107) and disruption to work (79%, n = 102). None of the participants reported that their healthcare provider proactively asked them about menopause (Table 3). When asked what would make them more likely to seek support from their healthcare provider, participants reported “having access to healthcare providers” (75%, n = 153), “having access to healthcare providers that I can trust to provide good care” (48%, n = 98), and “having access to a female African American healthcare provider” (47%, n = 96; Supplementary Fig. 2). Seventy-six percent (n = 155) of participants who reported that they did not seek care from their healthcare provider stated this was because their healthcare provider does not seem concerned about menopause, with 63% (n = 130) waiting for their healthcare provider to discuss it with them (Supplementary Fig. 3).

3.5. Menopause management

Only 38% (n = 129) of participants had discussed menopause with a healthcare provider. Among those who had spoken to their healthcare provider, more than a quarter were offered dietary management (33%, n = 42), breathing or relaxation exercises (29%, n = 38), changes in exercise routine (28%, n = 36), and/or prescription hormone therapy (26%, n = 34) by their healthcare provider. Eighteen percent (n = 23) reported that they were offered no treatment during their visit. Most participants who had spoken with their healthcare provider reported that they did not use any prescription medications or products to treat menopause symptoms (67%, n = 87). Nineteen percent (n = 24) used anti-depressants, 9% (n = 12) used estrogen alone, 9% (n = 12) used estrogen and progesterone, and 6% (n = 8) used estrogen with a selective estrogen receptor modulator. All participants (100%, n = 334) used lifestyle strategies, dietary supplements, and over-the-counter medications to treat their menopause symptoms, and 13% (n = 42) used prescription medication. The top lifestyle strategies were prayer (89%, n = 296), cooling techniques (85%, n = 283), and yoga or meditation (81%, n = 269; Table 1). Fifty-eight percent (n = 194) of participants were satisfied with lifestyle strategies for improving their menopause symptoms, 49% (n = 164) were satisfied with dietary supplements, 31% (n = 103) with over-the-counter medications, and 17% (n = 7) with prescription medication (Fig. 3A–D).

Fig. 3.

Satisfaction with treatments for menopause symptoms, African American women survey respondents in the United States, September–October 2022.

Only participants who stated that they took prescription medication (n = 42) responded to Part A. Participants were asked the question: “How do you feel about the treatment you are taking for your menopause symptoms?”

4. Discussion

This survey gathers an array of key insights into the menopause experience and perceptions among African American women and identifies a number of unmet needs and healthcare disparities. The results provide suggestions into how these needs may be addressed. Notably, this research was conducted across rural regions of the USA as well as urban regions.

In alignment with existing literature including the SWAN study (Avis et al., 2015; Harlow et al., 2022; Im et al., 2010b; Tepper et al., 2016), most participants in our survey perceived that African American women endure more frequent and longer lasting menopause symptoms than other ethnic and racial groups; most participants reported that they experienced symptoms every day of the past week and that they had been experiencing symptoms for 9 years or more. Despite the protracted duration of symptoms, African American women often self-manage their treatment because healthcare providers do not offer the support required, leaving many to conclude that menopause is not a priority or concern for healthcare providers. This notion is supported by reports that no respondent's healthcare provider initiated a conversation about menopause or any symptoms they were experiencing. Less than half of our survey participants received information on menopause from their healthcare providers; African American women are likely to utilize other sources such as social media, websites, and friends or family, as reflected in our survey and other literature (Dillaway et al., 2008; Im et al., 2010a; Im et al., 2010b; Richard-Davis and Wellons, 2013). However, in rural communities, they may be more likely to suffer increased social isolation as they age, thus reducing this support even further (Mathunjwa-Dlamini et al., 2011). The insights gathered in our survey also suggest that many African American women experience relationship issues as a daily life impact of menopause, that they require more support from their partners, and that they are concerned about the impact of menopause on their family life.

Concerningly, most participants had experienced societal stigma toward menopause and believed that society views menopause negatively. They generally did not feel they could speak openly about what they were going through, with three in five participants stating menopause was shameful. Previous studies have suggested that silence may be a way of coping with symptoms and health worries, particularly in the African American community, and that negative connotations of menopause may be a generational habit for African American women, likely exacerbated by a mistrust of the healthcare system (Aririguzo et al., 2022; Im et al., 2010a; Im et al., 2010b). The insights gathered in our study support this notion.

Such mistrust of the healthcare system and mismatched expectations from their healthcare providers may be contributing factors toward most participants not taking prescription medications. In our survey, one in five participants who gave information on treatment options they discussed with their healthcare provider were not offered any treatment or symptom management at all. The results of our survey align with other studies suggesting that African American women instead often use spirituality and nonmedical ways to manage symptoms (Aririguzo et al., 2022; Bair et al., 2008; Im et al., 2010a; Jones et al., 2016). Of note, our survey found that nine in ten participants turned to prayer for support through their menopause experiences.

4.1. Implications for practice and/or policy

African American women experiencing menopause symptoms are unlikely to seek support from their healthcare providers and, when support is given, it is generally unsatisfactory; thus, many are left to conclude that menopause is not a priority or concern for their healthcare provider and must manage their treatment without support. This may be overcome by greater access to trusted female African American healthcare providers as well as providers initiating conversations about menopause during regular visits. To reduce discrimination against menopause in the community, sharing experiences of menopause should be encouraged and education provided for younger women and for men.

4.2. Limitations

Recruitment was limited to women connected with The Balm in Gilead and within the USA, and thus may not be representative of the full experiences of African American women. The results of the survey were analyzed using descriptive statistics only. Future efforts should be made to parse out differences between participants' age groups and the different regions that they lived in.

5. Conclusions

Despite enduring frequent and bothersome menopause symptoms, African American women experience stigma in their communities and lack the support needed from their healthcare providers. Further efforts and education, such as those provided by the African American women included in our survey, are needed to improve health status for African American women and overcome health disparities in menopause.

CRediT authorship contribution statement

Meaghan Krohe: Writing – review & editing, Writing – original draft, Project administration, Funding acquisition, Formal analysis, Conceptualization. Pamela D. Price: Writing – review & editing, Writing – original draft, Formal analysis, Data curation, Conceptualization. Danielle Simeone: Writing – review & editing, Writing – original draft, Project administration, Funding acquisition, Formal analysis, Conceptualization. Liv Gagne: Writing – review & editing, Writing – original draft, Formal analysis, Conceptualization. Deanna D. King: Writing – review & editing, Writing – original draft, Formal analysis, Conceptualization. Pernessa C. Seele: Writing – review & editing, Writing – original draft, Supervision, Formal analysis, Data curation, Conceptualization.

Funding

This study was funded by Astellas Pharma Inc. As employees of Astellas Pharma, Meaghan Krohe, Danielle Simeone, Liv Gagne, and Deanna D. King provided substantial contributions to the conception or design of the study or the acquisition, analysis, or interpretation of data for the study; drafted the manuscript or reviewed it critically for important intellectual content; and provided final approval of the version to be submitted.

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Meaghan Krohe, Danielle Simeone, Liv Gagne, and Deanna D. King are employees of Astellas Pharma Inc. Pamela D. Price and Pernessa C. Seele are employees of The Balm in Gilead Inc.

Data availability

Researchers may request access to the data used to support this article by contacting the corresponding author.