Making menopause more inclusive : The global majority experience

The experience of menopause amongst minority ethnic women is substantially worse than for white women. Yasmin Alibhai-Brown explores the cultural and societal background to why this is, and calls for more recognition and support for women in diverse communities.

This series of articles has been commissioned by Eleanor Mills, Editor in Chief at Noon about the inequalities facing Queenagers in health care. This series of articles has been edited by her and reflect her editorial judgement. The articles have been paid for by Theramex.

This article is sponsored by Stella.

Karen Arthur’s words and pics make me feel, at once, uplifted and sad. If you’ve never heard of her, check out her website or her posts on Instagram  She’s a sixty year old black British woman with pizazz, a mum and gran who has never let age wither her exuberant personality or unique style, through good times and bad. In her  stunning kaleidoscopic clothes – which she designs or finds in vintage or charity shops- and flamboyant earrings, she walks tall, talks bold. ‘Wear your Happy!’, is her slogan. Her designs have been featured in Vogue, the Telegraph and Channel4.  

The talented seamstress and stylist trained and performed as a dancer and then became a teacher, a job she loved and had to abandon. On her website she explains why: ‘I left teaching behind after 28 years when the onset of the menopause brought with it a diagnosis of anxiety and depression which threatened to floor me.’ Arthur being Arthur, got therapy, found her mojo again and used her own experiences to agitate on behalf of menopausal black women in Britain. More on that anon.  

So, why does Arthur make me feel sad? Her irrepressible life force brings back memories of my mum, Jena,  and her close friends, all feisty and fun women too, until they reached menopause. As they crossed that biological border, they slowed down, walked heavily – if they walked at all- became inert and morose. Some turned fierce, at times violent, matriarchs, while others seemed to give up on life. Jena’s sunny personality dimmed; though only fifty, she began to contemplate death. Sadly, these close mates never discussed what was happening to them. It was like a dirty secret, shame that could not be verbalised.  None of our Asian languages have a word for this normal female experience. ( No words for vagina, clitoris, breasts, vulva or anus either) Perimenopausal and menopausal women are invisible within the culture and mostly unseen and unheard outside. In this country, I know of husbands taking second wives after the first ones became menopausal. One of the rejected women killed herself. The pity of it all.  

Black British women face their own plethora of menopause issues. Karen Arthur found- to her shock- that the only research evidence collated and published in this country involved 22 respondents, of whom 15 identified as black.  This was for the Nursing Times in 2007. The lack of menopausal diversity got her blood up. So she set up her ‘Menopause Whilst Black’ Instagram feed and devised her own survey. Scores of women have responded to this callout, she says: ‘No woman should be frightened of this natural transition… I’m creating this space for black UK women who want to hear menopause stories from women just like us. And for my own daughters. And for our youngers.” She’s taking on patriarchal power and cultural expectations too, in particular, the idea that black women are all, always strong and supportive, and must never show signs of weakness or dependency.  Agencies and doctors could learn much from this accidental activist. I have.  

Marina, 43, a British-Jamaican, took care of our little girl, twenty five years ago. The first year went well, then we noticed the nanny was getting vague,  lethargic, distracted and putting on weight. She brought in bags of chocolates and cakes and scoffed them with our three year old child. It never occurred to me that these were signs of early menopause. After forgetting to pick my child up from nursery twice, we decided she had to go. I rang her when researching this article. Yes, she said, it was ‘ because of the change. I couldn’t tell you. How could I tell you? ‘  I will carry this guilt forever.     

Despite the 2018 census showing that 13.8% (1) of the UK population is from ethnic minority backgrounds, there is little [UK]research dedicated to the experience of the menopause in diverse communities, writes GP Dr Nighat Arif in an article for the website  ‘Because of this, these women have come to believe that the menopause is a “white, middle class” problem or a “Western phenomenon”’.   

In the USA, The  Study of Women’s Health Across the Nation (SWAN) and other investigations show that women of colour experience perimenopause and menopause at earlier ages than their white peers, have longer transition periods, and suffer some symptoms more acutely and for more years. These include gastrointestinal problems, bone density decline, increase in fat mass, weak muscles and increase in cholesterol. 

Dr Arif is also concerned that black and Asian communities: …treat menopause with ambivalence- it is the endurance of being a woman – like menstruation, pregnancy and childbirth…the menopause is simply not viewed as a medical condition.’ Furthermore, ‘Many women from South Asian communities will not talk about menopause-related mood disorders, such as anxiety and depression, because of a shame of linking this with an incapability to cope or even madness.’  

Meera Bhogal, 52, ( , a British Asian woman in her early fifties, who looks far younger and fitter than she is , suffered so much and for so long that she decided to set up her own wellness platform to help others. Early menopause at 40– undiagnosed- left her debilitated for years:  In an interview with Danielle Hine for the online My Menopause Centre, Bhogal spoke about her journey: ‘ It was a very lonely place…As far as the [Asian] generation before us, it never happened. But perimenopause and menopause can go on for 20 or 30 years of your life and it’s just not talked about.’ White friends helped Bhogal ‘join the dots’, understand the state she was in. She decided to help herself and others, including mystified or unaware husbands. But there is still strong resistance from some in the communities. She’s been told not to talk about the subject, that menopause is a myth: ‘Getting factual information is important – many Asian women still believe HRT is made from horse urine… We need a whole cultural and healthcare  

Meera Soni ( not her real name), a female consultant gynaecologist I know, agrees: ‘ White women are now more confident about talking about the menopause and getting medical help, but most women of colour are wary of interventions. Some are fatalistic or superstitious. Most think that nature should take its course. Women with quite bad menopausal symptoms have told me they think drug companies or white scientists and doctors cannot be trusted because historically, black people have been used  in immoral experiments. They are also anti-vaxxers’ I despair.   

Anita Powell works for Samson’s Academy – an unusual gym which is also a charity. They reach out to, engage with disadvantaged people, provide skills training and help them deal with class and ethnic exclusion from services.  Powell’s role is to be a community advocate for the young and old of  all ethnicities and races. A menopause activist for years, Powell, now includes this life change in her paid advocacy work. I asked her if more black and Asian women are talking about this ‘private’ subject: ‘Yes, in their own menopause communities. In my experience, they do not engage much in the traditional menopause spaces – which tend to be white, and middle class. There the dialogues do not include narratives around the taboos, family/relationships, social structures, barriers, culture.’  Women she sees get little support; many are ‘dismissed or ignored by medical professionals: ‘We invite Menopause experts to do sessions on Zoom. They give women, who traditionally have no access to such experts, free advice’  

I met up with three black and three Asian pals – all of who have gone through the menopause and come out the other side. None of them had HRT. Four were nervous about its side effects and two were never given the option. Dianne is now 60. Her husband walked out on her ‘because the doctor never offered me HRT. I couldn’t give him sex all the time. It hurt too much’. But we all felt we knew more, had more power and still looked and felt womanly and attractive. Bina, a retired dentist, asked us to ’think about our mothers and grandmothers. Knowing nothing, the body punishing them, community sexism. My mother went through so much. My dad’s mother was so cruel. It was as if, I suffered so you suffer. We now refuse to suffer or to be silent. I had to educate my husband and he stepped up’. Dianne has a new man: ‘ My life is starting over again. Maybe I should thank the menopause for that’ Amen.

By Yasmin Alibhai-Brown

If you are fired up by watching this and would like to sign the Noon petition, backed by everyone on the panel, to make menopause a QOF then click here

Theramex is a leading global pharmaceutical company dedicated to supporting women’s health needs at every stage of their lives. We have a reputation for delivering  patient focused treatments and driving value for our partners.

Our exclusive commitment to women’s health and fertility reflects our passion to address unmet needs by women and their healthcare providers.

We offer a wide range of treatment options for women, addressing her specific needs, from both a medical as well as a lifestyle perspective.

Across our four therapy areas we offer therapy choices to both prescribers and our patients, women, who often take an active part in making a decision on their health care as they progress through the different stages of life.

Leave a Reply

Your email address will not be published. Required fields are marked *