I burned with heat that started at my neck and traveled to my scalp.

It came in waves, every ten minutes, whether I was in an exam room, at my desk, or sitting in traffic, grateful I could blast the air conditioning. My makeup melted. My glasses fogged up! I needed a fan. At night, I woke up reaching for the glass of ice I had started keeping on my nightstand because I was so hot.

Everything went dry, I became a living desert. My hair, my skin, and I mean everything. I got a strange rash on my left shin. My weight climbed by thirty pounds. My cholesterol and blood pressure went sky high.

I am a physician. I had been counseling patients about perimenopause for years. But when it arrived in my own body, I did not know what was happening. My periods had become heavy, then light, then off schedule. I was the right age. The pieces were there. But living inside something is different from reading about it, and when it finally became clear what was happening to me, I understood how many times I had probably not been compassionate enough with the women sitting across from me who had tried to describe this exact thing.

I remember sitting around the kitchen table with my Grandmom and her friend, Pearl, and Grandmom broke out in a sweat, and Pearl sucked her teeth and said, “Oh, it’s just the change.” And that was all I ever heard about perimenopause or menopause growing up. Maybe some of you can relate?

According to the SWAN study, the largest ongoing study of women and menopause, Black women reach menopause at 49, about two years earlier than the national median, and are three times more likely to experience premature menopause before age 40. This matters because if you are in your late thirties experiencing depression, sleep disruption, and hot flashes, your physician may not have perimenopause on their radar.

Black women’s symptoms tend to be more severe and last on average a decade. In one recent survey of Black women, 94% reported night sweats, 93% reported hot flashes, and 87% reported vaginal dryness, with most saying symptoms had lasted nine or more years and occurred daily. A personal yes to all this!

The full picture is wider than hot flashes: weight gain, hair changes, mood shifts, brain fog, joint pain, skin changes, heart palpitations, and changes in cholesterol and blood pressure. All of this can be perimenopause. And despite carrying a greater symptom burden, Black women are less likely to receive hormone therapy or mental health services during this transition.

What to Ask For

I saw my gynecologist and started something I never imagined I would use: HRT(hormone replacement therapy), in the form of a patch. Before perimenopause struck, I thought oh I can get through it’s natural, how bad can it be? BAD. I got relief, though not complete. Then a patch shortage hit. I tried oral hormone replacement and could not tolerate it. I stopped HRT entirely, and by then my body had adjusted; eight hot flashes an hour became eight a day. The night ones persisted. But I could manage.

There is no single right path. What I want you to know is that you have options. Ask specifically about the estradiol patch, vaginal estrogen for dryness, and non-hormonal options like cognitive behavioral therapy, which research shows meaningfully reduces hot flash severity. If your symptoms are dismissed, say this:

I am aware that Black women experience more severe perimenopause symptoms that begin earlier, and I need you to take this seriously.

Share

FROM THE WRITING DESK

There is a particular loneliness in not having language for what your body is doing. I had the medical terminology, but I still felt lost. Experience has a texture that knowledge alone cannot prepare you for.

I think about the women, like my Grandmom, who came before and moved through this transition without anyone naming it, without a doctor who took them seriously, in bodies worn down by decades of work and worry and holding everything together. They called it the change and kept moving. But we can have better, that is their legacy.

This week I’m recommending The Man Who Could Move Clouds by Ingrid Rojas Contreras, a memoir about the curanderos, the healers, in her Colombian family, and the women who carried that knowledge forward across generations. After suffering a brain injury that erased her memory, Rojas Contreras goes looking for what her body holds that her mind cannot. If you are a writer, it will change how you think about memoir.

Last week, I was in Baltimore for AWP, the Association of Writers and Writing Programs conference, surrounded by thousands of writers from across the country. It is equal parts overwhelming and electric. The kind of place where you turn a corner and find yourself in conversation with someone whose work you admire, or a new writer trying to figure it out. I left tired, inspired, and full of ideas.

ODDS & ENDS

And last night, with temperatures finally behaving like spring, I made a minestrone (a riff on this recipe) that matched the warm feeling in the air, with asparagus, spinach, orzo, all in a rich homemade broth. Simple, light, exactly right after all the cold and snow.

Clocks moved forward Sunday, and you know it. Melatonin may still be released on the old schedule, making it harder to fall asleep at night and wake up feeling rested. For the next few days, keep your wake time consistent and get outside in the morning because light exposure is one of the fastest ways to reset your internal clock. If you already have trouble with sleep, this week may feel rougher than usual. Be gentle with yourself. Take extra rest if you need to.

REFERENCES & FURTHER READING

Avis NE, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine. 2015;175(4):531–539.

Harlow SD, et al. SWAN: A multi-site longitudinal observational study of women at midlife. Women’s Midlife Health. 2022.

Study of Women’s Health Across the Nation (SWAN). swanstudy.org

Kochersberger A, et al. A survey to understand the experience, perceptions, and stigma around menopause among African American women. Clinical Nutrition Open Science. 2025;59:189–205.

Thurston RC, et al. Menopausal symptoms and cardiovascular disease risk in Black and white women. Menopause. 2023;30(2):121–129.

Black Women’s Health Imperative. bwhi.org

The Menopause Society. menopause.org