Everything is Political - Menopause at the Margins

The typical menstruating individual experiences a menstrual cycle for approximately 2,535 days throughout their lifetime. Reflecting back, it's evident how my menstrual cycle journey and menopause experiences were interwoven with these life events, underscoring the importance of bodily autonomy, body sovereignty, access to quality healthcare and support, as well as employment protections.  My menstrual cycle stuck around for a solid 34 years, kicking off at the age of 12 and bowing out at 46. During this marathon, my period had a big say in my well-being each month, what I did for fun, my relationships, and how I thought about having kids. As I mapped my journey through perimenopause and menopause, I faced significant shifts—experiencing the loss of a pregnancy, navigating a "geriatric/advanced maternal age" pregnancy, going through a divorce, battling depression, and dealing with job loss. This introspection is magnified by my identity as a Black woman deeply engaged in social justice movements in the South, now I would like to look at how menopause affects humans on a global scale. 

By 2025, over a billion individuals globally will have experienced menopause, and in the United States alone, approximately 6,000 people from the GenX generation enter menopause each day. There has been a considerable uptick in women, femmes, transgender, and nonbinary people who menstruate talking about their relationship with their menstrual cycles, from menarche on through to menopause. At Black Girl’s Guide to Surviving Menopause, we offer that menopause is a physical, cultural, and political experience. It’s essential to recognize that menopause isn't a monolithic experience but rather a highly personalized and evolving transformation. Menopause encompasses physical changes, and cultural, social, and political factors also influence it. Expanding our inclusive understanding of those undergoing menopause and the diverse ways and timings in which it occurs is crucial for addressing a variety of needs and potential health and economic disparities. Likewise, understanding the specific context of an individual's menopausal journey— including family background, culture, and systemic challenges— is a significant factor in promoting health equity overall, further impacted by various intersecting identities. 

Cultural Bias  

In the growing menopause ecosystem, many advocates, culture critics, physicians, researchers, and journalists speak of the need and opportunity to normalize the menopause experience. This is the crux of culture and narrative shift work that is a pathway to improvements in provider preparedness, menopause care by healthcare providers, and policy change. The call to normalize an experience that will impact more than a billion people worldwide is critical to improving the menopause experience and health outcomes for all. It is equally critical to not further marginalize the menopause experiences and needs of Black, indigenous, and other people of color, as well as LGBTQIA+ people, through the invisibilization of their needs as policies developed or transformed to be more equitable and just.  It is also vital to acknowledge that our societal and cultural perspectives on aging are intertwined with how we perceive menopause, impacting our overall attitudes toward this life stage and the associated transition.  

The Need for a Collective Shift 

Regrettably, the menopausal journey is frequently misrepresented or portrayed negatively, lacking appreciation as a meaningful life transition encompassing diverse stages and expressions. Furthermore, a considerable number of menopausal experiences, requirements, and difficulties are often overlooked, especially at the intersections of race, ethnicity, gender identity, sexual orientation, and socioeconomic status. There are several arenas where policies and initiatives focused on menopause are gaining momentum and driving change: intersectional research of the marginalized experiences of menopausal people, improving provider training and disrupting implicit bias in the medical field, ensuring access to high-quality, affordable healthcare and strengthening workplace protections. When we speak of normalizing menopause as a life-transforming experience for human beings with uteri and ovaries, we also get to clarify that what a typical or “normal” menopause experience looks like is entirely dependent on the individual navigating it. Recognizing and bridging the linkages between diverse menopausal experiences goes beyond merely acknowledging medical disparities. Terminology such as 'normal' carries significant policy implications.  
 
As we approach an era of increased cultural awareness, reforms for menopause in workplaces, heightened research, and legislative attention, it's crucial to ensure that historical and contemporary inequities are not entrenched within the administrative and legal frameworks. Let’s look at provider preparedness and menopause care for a moment. When we think about changing the way we think about menopause we must look at menopause in the workplace, research, the healthcare we receive and healthcare policy, academia, one's family history, public policy, in addition to the historical context of Menopause. 

Drawing attention to the insights from the SWAN study, it becomes evident that individuals identifying as Black, Latinx, Asian, and other people of color, including genderqueer and gender-expansive individuals, encounter an earlier onset of menopause and often contend with more prolonged and intensified symptoms than their white counterparts. If a BIPOC individual begins to experience perimenopause in their late 30s, the importance of having a healthcare provider well-versed in the diverse spectrum of menopausal experiences cannot be overstated. Such awareness significantly shapes the quality of care provided at the onset and throughout their menopausal journey.  

In BIPOC communities menopause symptoms can be heightened by the cumulative burden of chronic stress and life events impacted structural racism within the U.S. according to Tené T. Lewis, PhD, associate professor of epidemiology at Emory University’s Rollins School of Public Health in Atlanta. This cumulative burden of chronic stress and life events is called allostatic load according to Tené T. Lewis, PhD, associate professor of epidemiology at Emory. Menopause, like most public health experiences, is affected by a range of factors. These include poor access to healthcare, toxic work environments, unsafe neighborhoods, socioeconomic hardships, and more. These stressors strain the body considerably, disrupting hormonal and biological processes and contributing to chronic inflammation. As a result, menopausal experiences can become more challenging and occur earlier for individuals exposed to these systemic injustices. Finding a provider who is well-versed in menopause care and whose care is influenced by an understanding of these societal factors can be a necessary challenge.  

There exists a presumption that all individuals undergoing menopause will exclusively identify as women, white, heterosexual, desire or have the ability to bear children, already have children, and will be in their 40s or 50s. Based on data from the Association of American Medical Colleges, over 50% of practicing physicians identify as white, 17.1% as of Asian heritage, 5.8% as Hispanic, and 5% as Black.

A recent survey from the Menopause Society found that only 31.3% of obstetrics and gynecology program directors reported inclusion of menopause education in their residents' training, and almost 20% indicated limited exposure to menopause curriculum confined to a rotation period. Shockingly, less than 10% of OB-GYNs expressed confidence in being adequately trained to support menopausal individuals in their practices. Moreover, in a 2017 survey involving LGBTQIA+ individuals, 8% disclosed that they had encountered situations where a healthcare provider, due to their actual or perceived sexual orientation, had declined to provide services. Furthermore, among transgender participants in the survey, a significant 29% reported experiencing outright refusals from healthcare providers.  Survey participants also recounted instances of verbal abuse and unwelcome physical interactions with healthcare providers. The sociopolitical realities of systemic oppression in the medical establishment profoundly impact these experiences. Instead of being embraced as a potentially transformative journey encompassing diverse stages and expressions, menopause often becomes shrouded in fear and solitude. This is why creating spaces for the diversity of individual stories, experiences, and cultural/political contexts to be held, respected, and affirmed is vital to generational change.  

When communities of people navigate the world with identities that challenge the constructs imposed by white supremacy and patriarchy, they often face marginalization and systemic oppression, erasing and dismissing their experiences and needs. This act of invisibility goes beyond measure; it is dehumanizing and violent. Unfortunately, within the realms of the reproductive and gender justice movement, initiatives focused on menopause and aging are severely lacking. A significant opportunity exists to fill this void by actively promoting a cultural shift in the perception of menopause and aging, centering BIPOC and QPOC voices and narratives. This work is political with a capital “P.” Doing so can pave the way for more intersectional research, advocacy, and policy changes, improving the menopause experience for all human beings.  

As Toni Morrison reminds us, “The function of freedom is to free someone else.”