What Black Women Actually Need to Know About Perimenopause (That Nobody's Telling Us)

Listen.

If you're in your late 30s or early 40s and your period suddenly has a mind of its own, you're tired ALL the time for no good reason, and every doctor you see hits you with "it's probably just stress" I need you to know something. You're not crazy or dramatic, and it's not just stress.

Welcome to perimenopause. And if you're a Black woman? Yeah, it's hitting you earlier and way harder than anyone bothered to tell us.

Here's what they don't say: Black women don't just experience perimenopause a little differently. We get the worst of it. We start earlier. Our symptoms last LONGER. And somehow we still get less help than everybody else.

The Reality: Black Women Get the Short End of the Stick

The numbers don't lie. Black women experience perimenopause and menopause very differently than white women, and most of it comes down to structural racism, not genetics.

Real talk? Perimenopause is that whole stretch of years before menopause when your hormones start packing their bags. It's not menopause that's literally just one day (the day you hit 12 months with no period). Perimenopause is everything BEFORE that. The hot flashes. The mood swings. The "why am I crying at this commercial" moments. The brain fog. All of it.

And it can last 4 to 10 years. YEARS.

For us? The ride is rougher. The symptoms hit harder. And the medical system? Not built for us. At all.

So let me break down what you actually need to know.

We Start Earlier

Black women reach menopause about 8.5 months earlier than white women. That might not sound like much, but here's the thing: some of us are starting perimenopause in our late 30s or early 40s. And we're three times more likely to experience premature menopause (before age 40).

When your hormones start declining earlier, you're dealing with symptoms longer and facing health risks sooner.

Our Symptoms Last Longer

The average woman experiences perimenopause symptoms for about 4 to 7 years. Black women? We're looking at 7 to 10 years. In a recent survey of Black women going through perimenopause:

• 81% reported symptoms lasting 9 years or more

• 69% said symptoms happen daily

• Most didn't even realize it was perimenopause at first

The Symptoms Hit Harder

Here's where it gets real. Black women don't just deal with symptoms longer we deal with them more intensely.

At the start of perimenopause:

• 46% of Black women report hot flashes and night sweats vs. 37% of white women

• 27% experience clinical depression vs. 22% of white women

By the time we're in the thick of it, the numbers are even worse:

• 94% experience night sweats

• 93% have hot flashes

• 87% deal with vaginal dryness

And that's not even counting the sleep issues, anxiety, brain fog, joint pain, and weight changes.

SIDEBAR: Common Perimenopause Symptoms Hot flashes and night sweats Irregular periods (longer, shorter, heavier, lighter, skipped) Mood swings, anxiety, or depression Brain fog and memory issues Fatigue that doesn't go away with sleep Sleep disturbances and insomnia Weight gain (especially around the midsection) Joint and muscle pain Vaginal dryness and painful sex Low libido Headaches or migraines Hair thinning or loss Skin changes

The Treatment Gap (This Part Right Here Will Make You MAD)

Okay, so we've established that Black women get hit harder with perimenopause symptoms. More intense. Longer duration. Starting earlier.

You'd think that would mean we'd get MORE help, right?

Wrong.

We get LESS.

Let that sink in for a second.

Even though we're dealing with worse symptoms for a longer time, the healthcare system is out here acting like we don't exist. Check these numbers:

• Black women are 26% less likely to be prescribed hormone therapy than white women

• Hispanic women? 32% less likely

• Our symptoms don't even get written down in medical records half the time

• And here's the kicker: 80% of OB-GYNs didn't even get proper training on menopause because it's treated like an elective in medical school

AN ELECTIVE.

Like perimenopause is optional or something.

But wait, there's more. We're already walking into perimenopause with higher rates of hypertension, diabetes, and metabolic syndrome. You know what we're NOT getting? Treatment for those either.

So we're dealing with:

• Worse perimenopause symptoms

• More underlying health issues

• Less documentation

• Less treatment

• Less support

It's giving "the system was never built for us" because it literally wasn't.

Why This Happens: Structural Racism

This isn't about genetics. This is about racism.

The major study that gave us most of this data the Study of Women's Health Across the Nation (SWAN) followed over 3,000 women for 25+ years. The Black women in that study were born and raised during the Jim Crow era. That shaped everything:

• Their access to education

• Their access to quality healthcare

• Their access to safe housing and good jobs

• Their exposure to chronic stress and discrimination

Dr. Siobán Harlow, who led the research at the University of Michigan, put it this way: "The enduring influence of structural racism differential access to the goods, services and opportunities of society by race is a major contributor to the health disparities between Black and white women in the midlife."

Chronic stress and discrimination don't just affect your mental health. They affect your physical health. They change how your body ages. They accelerate the decline of hormones. They increase inflammation. They wear you down.

Researchers call it "weathering."

The Vitamin & Supplement Real Talk

Your body is already going through hormonal chaos during perimenopause. Add in vitamin deficiencies and you're running on empty.

This is especially critical for Black women because many of us are dealing with anemia, vitamin D deficiency, and B vitamin deficiencies and perimenopause makes it all worse.

Here's what you need to know and how to actually make your supplements work for you.

Iron & Anemia: The Silent Energy Thief

Y'all, let me tell you about anemia because I LIVE this.

Anemia is extremely common in Black women. I'm anemic. You probably know at least three other Black women who are anemic. And perimenopause? It makes the whole thing worse.

Here's what happens: You're already in perimenopause, so your periods might be getting heavier or lasting longer. More bleeding = more iron loss. THEN your estrogen starts dropping, which makes it harder for your body to actually absorb the iron you DO have. It's a setup.

And the thing about low iron is that it doesn't just make you "a little tired." It's a whole different level of exhausted. I'm talking:

• The kind of tired that sleep doesn't fix

• Brain fog so thick you forget what you walked into a room for

• Headaches that won't quit

• Getting dizzy when you stand up too fast

• Your heart racing for no reason

• Restless legs at night (the WORST)

• Looking in the mirror and thinking "why do I look so pale?"

• Getting winded just walking up the stairs

  
  

That's anemia. And if you're already dealing with perimenopause symptoms on top of that? You're running on fumes.

What you actually need to do:

First, get tested. Not just iron ask for your ferritin levels too. That's your stored iron. You need both numbers.

And please don't just start taking iron supplements without knowing your levels. Too little is a problem, but too much iron after menopause (when you're not losing blood every month anymore) can also cause issues.

If you DO need iron, here's how to actually make it work:

TAKE IT WITH:

• Vitamin C and I mean this. Vitamin C can boost your iron absorption by up to 60%.

• Take your iron with orange juice, throw some strawberries in your breakfast, eat bell peppers with lunch, or just take a vitamin C supplement with it

• Empty stomach is best if you can handle it. If it makes you nauseous, take it with a light snack

DON'T TAKE IT WITH:

• Calcium or anything with a lot of calcium (milk, cheese, leafy greens)

• Coffee or tea the tannins mess with absorption

• Green tea it literally binds to the iron so your body can't use it

• Your calcium, magnesium, or zinc supplements

You need to space iron and calcium at least 2 to 4 hours apart. I know that sounds like a lot, but if you're anemic and exhausted, you want that iron to actually WORK.

Other nutrients that help with iron:

• Vitamin D (helps absorption)

• Copper (helps move iron around your body but don't just take this on your own, get tested first because too much copper is toxic)

• B vitamins, especially B6, B9 (folate), and B12 (you need these to make healthy red blood cells)

• 
  

Real talk: If you're dragging yourself through the day and every doctor keeps saying "you're fine," push back. Ask for the full iron panel. Ask for ferritin. And if they blow you off, find someone else.

You deserve to have energy. You deserve to feel like yourself.

SIDEBAR: Red Flags Get Checked Immediately Bleeding lasting more than 7 days Extremely heavy bleeding (soaking through a pad or tampon in under an hour) Severe fatigue that doesn't improve with rest Dizziness, lightheadedness, or fainting Pale skin with a rapid or irregular heartbeat Shortness of breath during normal activities These could signal severe anemia or other serious conditions. Don't wait.

Vitamin D: The Deficiency Almost All of Us Have

Here's a stat that should alarm you: only 8 to 10% of perimenopausal women have optimal vitamin D levels. About 50% have moderate to high deficiency.

For Black women, it's even worse because melanin reduces the skin's ability to produce vitamin D from sunlight. We need more sun exposure to make the same amount of vitamin D as lighter-skinned women.

Why does this matter during perimenopause?

• Vitamin D deficiency makes iron absorption worse

• It's linked to bone loss (a major risk after menopause)

• It contributes to depression, mood issues, and fatigue

• It affects immune function

Studies show that women with vitamin D deficiency have lower hemoglobin, fewer red blood cells, and lower ferritin levels.

How to take Vitamin D properly:

TAKE WITH:

• Healthy fats (vitamin D is fat-soluble, so it needs fat to be absorbed)

• Eat it with avocado, nuts, olive oil, fatty fish, or a meal with healthy fats

• Magnesium (magnesium activates vitamin D in your body without enough magnesium, vitamin D just sits there)

• Vitamin K2 (helps calcium go to your bones instead of your arteries)

CAN TAKE WITH:

• Iron (they don't compete)

Vitamin D is best taken in the morning or with your largest meal of the day.

B Vitamins: The Energy & Mood Stabilizers

B vitamins especially B6, B9 (folate), and B12 are critical during perimenopause.

Here's why:

• They're needed to produce red blood cells

• B12 deficiency creates misshapen red blood cells, which causes anemia

• B12 deficiency symptoms look just like perimenopause: fatigue, brain fog, mood swings, insomnia, depression

The problem? As we age, our stomach produces less acid, which makes it harder to absorb B12 from food. If you're vegan or vegetarian, you're at even higher risk because B12 comes mainly from animal products.

How to take B vitamins properly:

• B vitamins are water-soluble, so take them with water

• Can be taken on an empty stomach or with food

• DON'T take vitamin C within 2 hours of B12 (vitamin C can reduce B12 absorption)

• Best form of B12: methylcobalamin (NOT cyanocobalamin, which is derived from cyanide and has low biological activity)

If you're taking a B-complex, that's great all the B vitamins work together.

Magnesium: The Relaxation Mineral

Magnesium is one of those minerals most people are deficient in, especially if you're eating a lot of processed foods.

During perimenopause, magnesium is your friend. It:

• Helps activate vitamin D in your body

• Supports better sleep

• Reduces muscle cramps and restless legs

• Eases anxiety and irritability

• Supports bone health

How to take magnesium properly:

TAKE WITH:

• Vitamin D and B6 (they work together)

DON'T TAKE AT THE SAME TIME AS:

• Calcium (they compete for absorption)

• Iron or zinc (minerals compete)

Best taken at night because it promotes relaxation and sleep. Can be taken with food to reduce any stomach upset.

Forms: Magnesium glycinate is best for sleep and relaxation. Avoid magnesium oxide (cheap form, poorly absorbed).

Calcium: Important, But Don't Overdo It

Calcium is important for bone health, especially as estrogen drops during perimenopause. But you don't need to go crazy with it.

How to take calcium properly:

TAKE WITH:

• Vitamin D (helps your body absorb it)

• Vitamin K2 (directs calcium to bones instead of soft tissues)

DON'T TAKE WITH:

• Iron (blocks iron absorption)

• Magnesium, zinc (they compete)

Best taken between meals (about 2 hours after eating) if you're taking it solo.

Split large doses your body can only absorb about 500 mg at once.

SIDEBAR: What to Take Together (Boosts Absorption) Iron + Vitamin C Vitamin D + Magnesium + K2 Vitamin D + Calcium (but NOT with iron) B vitamins together (B-complex) Fat-soluble vitamins (A, D, E, K) + healthy fats

SIDEBAR: What to Separate (They Compete) Iron and Calcium 2 to 4 hours apart Calcium and Magnesium take at different meals Calcium and Zinc space them out Iron and Zinc space them out Vitamin C and B12 2 hours apart Don't take multiple minerals (calcium, iron, zinc, magnesium) at the same time

Sample Daily Supplement Schedule

Here's how you might actually structure your day:

Morning (with breakfast that includes healthy fats)

• Multivitamin (if it doesn't contain iron)

• Vitamin D + Magnesium + K2

Lunch (on empty stomach or with a light meal)

• Iron + Vitamin C

• Have it with orange juice, strawberries, or bell peppers

Dinner

• B-complex

Between meals (2 hours after eating)

• Calcium supplement (if needed)

Bedtime

• Magnesium glycinate (if taking separately for sleep support)

Remember: This is a general guide. Your needs might be different based on your labs and health conditions. Always check with your healthcare provider.

Getting the Care You Deserve

Let's talk about how to actually get help when the medical system isn't set up for you.

How to Advocate for Yourself

Dr. Maggie Ney, a naturopathic doctor who works with perimenopausal women, coaches her patients to say this to their doctors:

"I'm aware that Black women have more significant menopausal symptoms than white women, and that these symptoms can start earlier. I want to make sure we're checking my hormone levels and ruling out perimenopause."

Don't downplay your symptoms. Don't let anyone tell you "it's just stress" or "this is normal aging." Perimenopause symptoms are real, and they're treatable.

What to Ask For

When you see your doctor, request these tests:

• Full iron panel (serum iron + ferritin)

• Vitamin D levels (ask for 25-OH vitamin D)

• B12 and folate

• Thyroid panel (TSH, T3, T4 symptoms overlap with perimenopause)

• Hormone testing if appropriate (FSH, estradiol)

Track your symptoms for a few weeks before your appointment. Write down:

• Period changes (longer, shorter, heavier, lighter, skipped)

• Hot flashes and night sweats (how often, how severe)

• Sleep issues

• Mood changes

• Fatigue levels

• Any other symptoms

Bring this list to your appointment. Don't rely on memory.

If Your Doctor Dismisses You

Dr. Kudzai Dombo, an OB-GYN who specializes in menopause care, says: "If you see a healthcare practitioner and you feel dismissed, that is not the end of the story. There are people, there are doctors, there are places that really want to hear you."

Find another doctor. You deserve better.

And here's the truth: not all doctors are trained in menopause care. In fact, 80% of OB-GYN residents say they feel uncomfortable discussing menopause because it's treated as elective coursework in medical school.

You might need to find a menopause specialist.

Where to Find Help

The good news? More resources exist now than ever before. Here's where to start.

Telehealth Options (Insurance or Affordable Self-Pay)

Midi Health

• Available in all 50 states

• Accepts most major insurance plans

• All clinicians are menopause-trained

• $250 initial visit, $150 follow-ups if self-pay

• Offers virtual care for perimenopause, menopause, weight management, and more

• Website: joinmidi.com

Alloy

• Text-based care with menopause-trained doctors

• Unlimited messaging access to your doctor

• Chief Medical Advisor: Dr. Sharon Malone (Black woman, OB-GYN, 20+ years of menopause experience)

• Offers hormone therapy and other treatments

• Website: myalloy.com

Gennev

• Accepts insurance

• Board-certified, menopause-trained doctors

• Video appointments available within a week

• Also offers registered dietitian support

• Website: gennev.com

Evernow

• Insurance accepted for video visits (check your plan)

• $250 initial appointment, $150 follow-ups self-pay

• Focused on hormone therapy and menopause symptom management

• Website: evernow.com

Finding In-Person Care

North American Menopause Society (NAMS)

• Has a "Find a Menopause Practitioner" tool on their website

• Search by zip code to find certified menopause specialists near you

• Website: menopause.org

Black Doctor 24/7

• Directory specifically for finding Black healthcare providers

• Includes OB-GYNs and specialists

The Black Wellness Clinic (UCSF)

• Specializes in reproductive healthcare for Black-identifying patients

• Located in San Francisco but may offer virtual options

• Website: womenshealth.ucsf.edu

Community & Education

Let's Talk Menopause

• Nonprofit organization with educational resources

• Hosts panels specifically about Black women's menopause experiences

• Free symptom tracker in English and Spanish

• Website: letstalkmenopause.org

WisePause Wellness

• Founded by Denise Pines, a pro-aging platform

• Resources and community for women in midlife

Final Thoughts: You Deserve to Feel Good

Here's the bottom line: You're not imagining it. You're not being dramatic. Black women DO experience perimenopause differently, and the healthcare system IS failing us.

But now you know:

• What to look for

• What to ask for

• How to take your vitamins the right way so they actually work

• Where to find doctors who will listen

  
  

Get your levels checked. Advocate for yourself. Find a provider who takes you seriously. And don't suffer in silence.

Dr. Sharon Malone said it best: "If you live long enough, and you have two ovaries, you're going to go through menopause. And if you are suffering, please don't suffer. There's no reason for that. Don't walk around with a fan for your hot flashes. Go get some estrogen."

You deserve to feel good in your body. You deserve care that actually meets your needs. And you deserve to thrive through this transition not just survive it.

Period.

Sources & References

This blog post is based on research from:

• Study of Women's Health Across the Nation (SWAN), University of Michigan School of Public Health

• North American Menopause Society

• NIH Office of Dietary Supplements

• Peer-reviewed studies on racial disparities in menopause care

• Interviews and webinars with menopause specialists including Dr. Sharon Malone, Dr. Kudzai Dombo, Dr. Siobán Harlow, and Dr. Maggie Ney

  
  

For more detailed information, visit the resources listed throughout this post.

Disclaimer: This blog post is for educational purposes only and is not a substitute for professional medical advice. Always consult with your healthcare provider before starting any new supplements or treatments, especially if you have existing health conditions or take medications.