Perimenopause in Black Women: What the SWAN Study Found

DEFINITION

SWAN study (Study of Women's Health Across the Nation)

A large multi-site US longitudinal study that followed over 3,000 women of diverse racial and ethnic backgrounds through the menopause transition starting in the late 1990s. SWAN is the primary source of population-level data on racial and ethnic differences in perimenopause experience.

DEFINITION

Vasomotor symptom burden

The combined frequency, severity, and duration of hot flashes and night sweats. SWAN data found that Black women reported higher vasomotor symptom burden than white, Chinese, and Japanese women across all perimenopause stages, with longer total duration.

What SWAN Found

The Study of Women’s Health Across the Nation (SWAN) is the most comprehensive longitudinal study of the US menopause transition. It enrolled over 3,000 women from five racial and ethnic groups — white, Black, Hispanic, Chinese, and Japanese Americans — and followed them for over two decades.

Among its consistent findings: significant racial and ethnic differences in perimenopause experience that persist after controlling for many confounding factors.

For Black women specifically, SWAN found:

• Higher reported frequency and severity of hot flashes and night sweats
• Earlier onset of vasomotor symptoms in the perimenopause transition
• Longer duration of bothersome vasomotor symptoms (median over 10 years in some analyses)
• Earlier average age at final menstrual period compared to white women

The Stress-Symptoms Connection

SWAN researchers investigated multiple potential explanations for these differences. One significant contributor identified is allostatic load — the cumulative physiological toll of chronic stress. Black women in the SWAN cohort had higher average allostatic load measures, which are associated with lower thermoregulatory set points (making hot flash triggering more likely at smaller temperature changes).

Structural racism, chronic stress from racial discrimination, and lower average healthcare access all contribute to allostatic load. These are not simply “lifestyle factors” — they are social determinants of health that produce measurable physiological differences.

Clinical Implications

The research has a clear clinical implication: Black women are more likely to have significant perimenopause symptoms and are more likely to have those symptoms untreated. Healthcare providers should be aware of this pattern. Black women experiencing perimenopause symptoms — particularly vasomotor symptoms — should not have to justify the severity of what they are experiencing.

Advocating for Appropriate Care

If perimenopause symptoms are not being adequately assessed or treated, specific questions are worth raising:

• What symptom management options are available to me?
• Am I eligible for HRT? If not, what is the specific reason?
• Are there non-hormonal alternatives for vasomotor symptoms?

Organizations including the Menopause Society and Black Women’s Health Imperative provide resources specifically addressing health disparities in menopause care.