Vital Signs February 2025 Edition: Written by Dr. Laura Berghahn, OB-GYN
I am indebted to Loretta Ross and other African American women who, in 1994, coined the phrase “reproductive justice.” It’s been a guiding principle during my career as an Ob/Gyn. As I enter the “M Factor” phase of life, it occurs to me that Ross’ framework of reproductive justice, in which bodily autonomy is inextricably linked to social justice, not only applies to the reproductive years but also the years that follow.
Research on menopause consistently demonstrates health inequities. Patients of color have higher rates of primary ovarian insufficiency (impaired ovarian function before age 40) and early menopause (before age 45). They report more severe vasomotor symptoms, worse sleep disturbances and on average experience these symptoms for 3.5 years longer than white patients. Despite this, African Americans are less likely to receive prescriptions for hormone therapy or other effective treatments. Just as they are less likely to receive treatment for depression or hypertension. Menopausal patients of color score worse on scales that assess quality of life and health status and are much more likely to die from diabetes, breast cancer and gynecologic cancers, compared to white patients. Research informs us that structural racism is the cause. Not race. No wonder that focus-groups tell us that African Americans feel like the health care system and clinicians “do not care about them.”
The average person will spend one-third of their life in menopause. All of us deserve access to preventive health screenings and treatments and the freedom to choose how to live our best and healthiest life. As physicians, we need to raise awareness about health and menopause and do everything we can so that all patients feel comfortable talking about these issues and feel heard. Regarding menopause and more specifically hormone therapy, our professional societies need to publish updated standardized guidelines that will help providers with clinical decision-making and close the gaps in equity. We need to encourage and support more people of color to enter health care professions. We need to support organizations that are fighting for health equity including SisterSong (which was cofounded by Loretta Ross) as well as local organizations, like Embolden Wisconsin. (Amber Joshway, our Diversity, Equity and Inclusion Manager here at Associated Physicians is on this great organization’s board of directors). When we uplift the voices and follow the actions of giants like Loretta Ross and rising star Amber Joshway, we will do better.
TotALLY yours,
Laura Berghahn, MD