The Perimenopause Roadmap for Women of Color

What to Expect, What to Prevent, and What to Ask for—Before Menopause Hits

Introduction

Perimenopause is the hormonal transition that occurs before menopause and often begins in the late 30s or 40s. During this time, estrogen and progesterone fluctuate unpredictably, affecting menstrual cycles, sleep, mood, metabolism, cardiovascular health, bone density, and vaginal health.

For women of color—particularly Black women—perimenopause is often longer, more intense, and more disruptive, yet frequently under-recognized and under-treated. This roadmap centers prevention, advocacy, and culturally informed care.

 

Why Perimenopause Hits Black Women Differently: The SWAN Study

The Study of Women’s Health Across the Nation (SWAN) is a landmark, long-term U.S. study following racially and ethnically diverse women through midlife. SWAN data consistently demonstrate that Black women:

• Experience more frequent and more severe hot flashes and night sweats
• Have longer-lasting vasomotor symptoms, often persisting for many years
  
• Report worse sleep quality and shorter sleep duration
• Carry higher cardiometabolic risk during the menopause transition
  
• Are disproportionately impacted by chronic stress and structural inequities that worsen symptoms

These differences are not due to personal failure or biology alone—they reflect delayed diagnosis, gaps in care, and systemic stressors. Knowledge empowers earlier intervention.

 

Common Perimenopause Symptoms

•  Irregular, heavier, or skipped periods
• Hot flashes and night sweats
• Sleep disruption and insomnia
• Anxiety, irritability, or depressed mood
  
• Brain fog and memory changes
  
• Weight gain or body composition changes
  
• Vaginal dryness, irritation, or painful intercourse
  
• Low libido
  
• Fatigue and joint aches

Symptoms that disrupt quality of life deserve evaluation and treatment—even if menstruation continues.

 

A Prevention‑First Perimenopause Roadmap

Nutrition

Focus on stabilizing blood sugar, reducing inflammation, and protecting heart and bone health:

• Adequate protein at each meal
  
• High‑fiber foods (vegetables, beans, whole grains)
  
• Healthy fats (olive oil, nuts, seeds, fatty fish)
  
• Limit alcohol, which may worsen hot flashes and sleep

Exercise

• Strength training 2–3x weekly
  
• Weight‑bearing cardio (walking, dancing)
  
• Daily mobility and core/pelvic floor support

 

Preventive Screening & Health Maintenance

Bone Health

• Bone density (DEXA) screening when indicated
  
• Vitamin D level testing
  
• Vitamin D supplementation if deficient
  
• Adequate calcium intake; supplement only if dietary intake is insufficient

Cardiometabolic Health

• Cholesterol (lipid) panel
  
• Diabetes or prediabetes screening
  
• Blood pressure monitoring

Reproductive & Sexual Health

• Birth control counseling (pregnancy remains possible until menopause is confirmed)
  
• Evaluation of heavy or irregular bleeding
  
• Vaginal moisturizers for daily comfort
  
• Vaginal lubricants for sexual activity

Cancer Screening

• Mammography beginning at age 40 or individualized by risk
  
• Colorectal cancer screening beginning at age 45
  
• Annual well‑woman visit with pelvic exam when clinically indicated

Immunizations

• Influenza vaccine
  
• COVID‑19 vaccines/boosters as recommended
  
• Tdap/Td boosters
  
• Shingles vaccine when eligible
  
• Other vaccines based on age and medical history

Breast Health

Don't ignore your breast:

• Practice **breast awareness**
  
• Report changes promptly
  
• Maintain recommended mammography screening

Birth Control in Perimenopause

Ovulation can be unpredictable. Contraception is recommended until menopause is confirmed (12 months without a period). Birth control may also help regulate heavy bleeding and cycle irregularity.

Vaginal Health Is Essential Health

Vaginal dryness, burning, and pain with sex are common—and treatable.

• Vaginal moisturizers for routine use
  
• Vaginal lubricants during sexual activity
  
• Prescription therapies may be considered if symptoms persist

Pain is not normal, and silence is not required.

Appointment Advocacy Script

“I believe I am in perimenopause and would like to focus on both symptom relief and prevention. I want to review my bleeding changes, cardiovascular and diabetes risk, bone health plan, sexual health options, contraception, cancer screenings, and immunizations.”

 

Perimenopause Checklist for Women of Color

Symptoms to Notice

■ Irregular periods

■ Hot flashes/night sweats

■ Sleep disruption

■ Mood changes or anxiety

■ Brain fog

■ Vaginal dryness or discomfort

■ Low libido

■ Fatigue or low energy

Health Areas to Review

■ Cholesterol panel

■ Diabetes screening

■ Vitamin D level

■ Bone health discussion

■ Mammogram

■ Colorectal screening

■ Pelvic/well-woman exam

Daily Support

■ Balanced meals with protein and fiber

■ Strength and weight-bearing movement

■ Adequate sleep and stress management

■ Vaginal moisturizer or lubricant as needed

Appointment Prep

■ Track symptoms for 2–4 weeks

■ Write down top questions or concerns

 

 

Created by Dr. Cyn | www.BeautyBelowMD.com