She’s a physician with access to great care. No one recognized her perimenopause.

Kudzai Dombo was tired, but she couldn’t sleep. She felt irritable and kept losing her patience with her new husband.

She tried turmeric, melatonin, magnesium. Then she made an appointment with a psychiatrist. Her eyes were so dry she went to the emergency room. She had blamed her exhaustion and irritability on her 24-hour shifts as an obstetrician and gynecologist.

Instead, she learned at 48, she was in perimenopause, the years leading up to menopause when a woman still has her menstrual period but often is consumed by symptoms such as fatigue and joint pain.

“I didn’t even see this in myself,” says Dombo, three years later.

Black women often start perimenopause early, go through it longer and often have more severe symptoms. While about 5% of women are on hormone replacement therapy to treat perimenopause or menopause symptoms, just 1% of Black women are, according to the Journal of the American Medical Association.

It’s not just that symptoms can be uncomfortable, they can be dangerous. Unmanaged hot flashes can lead to worse cardiac health including more strokes and heart attacks, leaving Black women at higher risk, according to a 2021 study.

“Black women have been left behind,” says Dombo, the director of advocacy and outreach for Alloy, a telehealth company for women. “How can I make it easier for women who look like me to get help?”

How Black women experience menopause differently

On average, Black women begin menopause two years earlier than White women, according to the Study of Women’s Health Across the Nation, a landmark study which followed midlife women for more than 30 years.

This can mean that doctors often miss that a Black woman has started perimenopause, says Sharon Malone, an obstetrician and gynecologist, and the chief medical adviser for Alloy. Malone also works to help educate other doctors.

“They have their symptoms dismissed,” Dombo says. “'Oh it’s just stress,' or 'oh, it’s just your weight.'”

Malone, 67, grew up in the South at a time she said it was difficult for Black women to find a trusted doctor. “Much of our information came from the community,” she says.

Malone and Dombo started Alloy’s initiative for Black women’s wellness to address it. In Malone’s role, she shifts from talking menopause with her good friend former first lady Michelle Obama to meeting with nine Black women in a support group via video asking about vaginal estrogen and if they should be taking testosterone.

Malone says hearing from another Black woman who has gone through menopause treatment can validate the experience, and be as important as meeting with a physician for many women.

Dombo understands that not all women will recognize their symptoms as perimenopause, so she brings the conversation to them, including a recent talk at the First AME Church in Los Angeles.

Vickie Franklin, a nurse and the church’s health program coordinator, says the church has hosted vaccine drives and sessions on heart disease and dementia. But she says Black women in particular need more information on menopause after decades of feeling shut out of the medical system.

“These are not things talked about in church. Women blame themselves,” Dombo, 51, says.

“In the church, you can turn on the air conditioner, but you’re still going to get hot. Women are still fanning,” Franklin says. “So we are talking about it, letting women know they don’t need to suffer and if they want help, they can get it.”

After Dombo’s first session, they asked for more.

Next month the church will host: “Still hot, still holy and fellows you’re invited too!”

The sessions provide a safe space for women to ask questions, and Franklin says it’s important their partners join them.

“Men get frustrated, ‘Why are you this and why are you so that?’ They can come and ask questions, too,” says Franklin, 77. “They’ll come to understand why you’re taking a shower in the middle of the night. You don’t have the patience to sit there and explain it.”

Why Black women experience menopause differently

To discuss women’s health and menopause, you cannot ignore the overall state of Black women’s health, which trails behind White women due to health care inequalities as well as discrimination and economic disparities. The health of a woman when she starts menopause may affect her experience.

While Black women get breast cancer at the same rate as White women, their mortality rate is higher. So, it’s been even more difficult for Black women to accept taking estrogen, which for years the Food and Drug Administration warned could lead to a higher risk of breast cancer, heart attack and stroke in postmenopausal women. The label was a result of a flawed 2002 Women’s Health Initiative study. It was removed from estrogen products in fall 2025.

“But you have women who think, should I endure this, or should I get cancer,” Malone says. “And that just isn’t true anymore. Black women now are saying that they aren’t going to let outdated information affect their overall health and wellbeing.”

Malone, who wrote “Grown Woman Talk: Your Guide to Getting and Staying Healthy," sees telehealth as one way to close the care gap and overcome disparities faced by Black women.

Because Black women’s life expectancy is shorter than White women (77 vs. 81), it is more difficult for them to see healthy aging role models, Malone says.

“I want women to expect more. I want them to see what it looks like on the other side of menopause,” says Malone. “There is a path forward.”

Laura Trujillo is a national columnist focusing on health and wellness. She is the author of "Stepping Back from the Ledge: A Daughter's Search for Truth and Renewal" and can be reached at [email protected].