Menopause is Different for Black Women. We Talked About it With Dr. Jayne Morgan

By now, we know that menopause is different for women of color. It happens earlier, the symptoms are more severe, and they last longer. Additionally, Black women are less likely to seek treatment than white women, and when they do seek it, they’re less likely to walk out of the doctor’s office with a prescription than white women. This Juneteenth, our Chief Medical Advisor Dr. Sharon Malone hosted a webinar with Dr. Jayne Morgan, a cardiologist and the Executive Director of Health and Community Education at the Piedmont Healthcare Corporation in Atlanta, GA, the largest healthcare system in Georgia, where she works to address health literacy and information both internally to the 35,000 employee system, as well as to external stakeholders. She’s won several awards for her work, including from the NAACP, is a medical expert on CNN, is published in the areas of Congenital Heart Disease, Interventional Cardiology, and Covid19, and serves as Health Equity Advisor for Moderna. And that’s not even all of it.

We’ve transcribed the webinar below, which has been edited for clarity and shortened for brevity. To watch the entire webinar (highly recommended!), head over to our YouTube. 

Dr. Sharon Malone:

First, I want to say Happy Juneteenth to everyone. For those of you who don't know me, my name is Dr. Sharon Malone. I'm an OB-GYN and the Chief Medical Advisor of Alloy Women's Health. I am joined today by my dear friend Dr. Jayne Morgan. I know that many of you have questions today, and we are here to talk about the menopause disparities as they relate to African American women. For those of you who may not be familiar, here is a rundown: When I say menopause, I mean you’ve had your last period more than a year ago. The average for that is about 51.5. For African American women, menopause tends to start almost a full year earlier than for white women. African American also have more symptoms, the symptoms are more severe, and they last longer. What’s most disturbing, however, is that even though Black women are often more symptomatic, they are least likely to complain about these symptoms, and when they do complain, they’re only half as likely to get a prescription and get relief. 

Dr. Jayne Morgan is a cardiologist. It’s also important to talk about the fact that once you’re in menopause, your cardiovascular risk goes up. Prior to menopause, women have about half the risk of heart disease that men do, but that changes at menopause. So, Dr. Morgan, let’s talk about some of the risk factors and what happens.

Dr. Jayne Morgan:

First, thanks so much for having me today. This is such a sage and timely conversation, not just for Juneteenth, but for us to really understand how our hormones and our hearts interact, because we don’t often think about it. And that goes for all women, not just Black women. When we look at the heart and we look at the progression of heart disease, we are beginning to understand that a lot of that has to do with inflammation.

Inflammatory processes can occur inside of your arteries, and we are now beginning to understand that estrogen has anti-inflammatory properties. So, during menopause, your estrogen levels decrease, and your risk of a heart attack or some type of heart event goes up, and actually becomes equal to that of men.

Dr. Sharon Malone:

And I think that is a big misconception that people have to be aware of, because I don't think that women realize how high their risk is after menopause. 

Dr. Jayne Morgan:

Correct. And taking Menopausal Hormone Treatment can lower that risk. So when we’re thinking about Menopausal Hormone Treatment, it’s important that we talk about it as not just something that helps us feel healthier. It’s something that actually helps us be healthier. 

Dr. Sharon Malone:

That’s right.

But it’s hard, because when you look at the amount of money that comes from the NIH research budget that goes to women’s health issues, it’s a fraction of their $45 billion budget. And when you look at how much of that is dedicated to women of color, it’s a fraction of a fraction. So the messaging isn’t always there. And women don’t learn these things, even from their doctors.

And that has to change. We need more research, we need more doctors, and we need to figure out how to create a groundswell and how to advocate and how to make sure that our health needs are being met.

Dr. Jayne Morgan:

Just to add to that, when we look at the population here in the United States, 80% of African Americans are seen by African American physicians, and yet 98% of clinical trials are led by white males. The number one reason that someone enrolls in a clinical trial is that you’re approached by a trusted physician. So if your trusted physician isn’t connected to research, or clinical trials, or a major medical center, you can see where that chasm comes from. But the majority of the world is not white. 

Dr. Sharon Malone:

Another point I'd really like to make about women of color in menopause is that we don't really recognize the symptoms of menopause as such. And even when we do, we don't seek help. And I think that this is really, really, really important. I say this all the time: We have to stop normalizing suffering. We’ve gotten into this mindset where we think suffering is just part of growing old. And it’s not. And Black women especially need to advocate for themselves.

This is particularly important at menopause because as I said, these things are not just bothersome. I mentioned that severe hot flashes come with an increased risk of cardiovascular disease. Sleep disturbances also are a risk factor. But women don’t complain about it, or even report it. When we wake up in the middle of the night, we think it’s just normal, and a part of growing old.

Dr. Jayne Morgan:

Absolutely. I mean, we are drawing an absolute hard line between menopause and cardiovascular outcomes. This is not a dotted line. We have to be able to step up and advocate. And we have to look at our tolerance for suffering for women and populations of color. And we can’t normalize that. 

Dr. Sharon Malone:

The other problem is that even when women do complain, they’re more than likely not going to get their symptoms addressed.

Dr. Jayne Morgan:

That's right. Not only do we minimize our symptoms, your doctors will also minimize our symptoms.

Dr. Sharon Malone:

That is exactly right. 

Before we get to questions from our audience, I have one. I’m sure people are wondering: What can you do to minimize your risk of heart disease? 

Dr. Jayne Morgan:

You hit on a big one when you mentioned sleep. We don’t think about our sleep. And it’s not just duration of sleep, it’s the quality of sleep you’re getting. Constant interruptions of your sleep can lead to inflammation. There’s that word again. You need to be getting enough sleep. You also should try to not carry around a lot of extra weight. Exercise helps, walking helps, addressing cholesterol and blood pressure. But, don’t be overwhelmed by that list. Pick one thing, start there, and then start having these conversations with your doctor.

Dr. Sharon Malone:

Now we’ll have Kristin from Alloy join us, and we’ll answer some questions.

Kristin Lynem:

Thank you Dr. Sharon. We actually have a ton of questions. One is, “What are some safe non-hormonal medications?

Dr. Sharon Malone:

I want to just say this: According to the North American Menopause Society’s guidelines, if you are symptomatic, there is nothing more effective than Menopausal Hormone Treatment. The American College of Obstetricians and Gynecologists agrees. There are over-the-counter supplements, but there’s no data on them. If they work for you, they work for you. But you won’t get the long-term benefits you’ll get with hormone replacement. There are supplements out there, and they’re largely safe, but they may not be effective. 

Dr. Jayne Morgan:

And, and to add to that is, these supplements don’t give you health outcomes that reduce your risk of a heart attack or cardiac event later.

Kristin Lynem: 

I keep hearing you talk about inflammation. What do I need to know about inflammation when it comes to estrogen and heart disease?

Dr. Jayne Morgan:

Well, to reduce inflammation in general, we need to first talk about what we eat, because food is medicine. You should eat a healthy diet with minimal (if any) processed food, and lots of fruits and vegetables. And during menopause, the same rules apply.

Dr. Sharon:

I tell this to my adult children all the time. Eat a healthy diet, and cook at home when you can!

Kristin Lynem:

This next question is for both of you. How do micro and macroaggressions intensify the symptoms of menopause? 

Dr. Jayne Morgan:

I'll start, and I'll just give the cardiovascular perspective. In all 50 states, Black people have a lower life expectancy. And that’s every single state. And when you look at Black women, the chronic, unrelenting stress of microaggressions, macroaggressions, and just navigating the environment, there’s a weathering that occurs. This is especially true for mothers of Black sons. They report even higher levels of chronic stress. Stress increases the inflammatory process, which increases the risk of cardiovascular disease and also the amount of heart attacks we will see. So, these microaggressions and macroaggressions are not innocuous. And this high tolerance for injustice and suffering is so appropriate to talk about today on Juneteenth, and it’s absolutely correlated with poor outcomes from a cardiovascular perspective. 

Dr. Sharon Malone:

I could not agree more. Human beings are not built for chronic stress. It affects your blood pressure, it affects your risk of getting cancer. 

So, what are we going to do about it? First, do not minimize it. Know when you need to get help, and figure out the things you can do, be it exercise, be it prayer, yoga, talking to your friends. Don’t internalize that stress, because you are doing yourself no good by doing so. 

Kristin Lynem:

Thank you so much. Dr. Morgan and Dr. Sharon, is there anything else you all would like to add before we wrap up here?

Dr. Sharon Malone:

Happy Juneteenth.

Dr. Jayne Morgan:

Happy Juneteenth. It was a pleasure.

To watch the whole interview, check out our YouTube. And, follow us on Instagram to learn about our upcoming events!