Onset of natural menopause in African American women Original paper

What was studied?

This large prospective cohort study investigated predictors of the onset of natural menopause among African American women, with particular attention to the potential role of perceived experiences of racism. The researchers aimed to clarify how demographic, reproductive, lifestyle, and psychosocial factors, including experiences of racism, affect the timing of natural menopause. Data were drawn from the Black Women’s Health Study, with baseline and follow-up information (including exposures and outcomes) collected by mailed questionnaires between 1995 and 1999. Using Cox proportional hazards regression, the study evaluated associations between various risk factors (smoking, body mass index [BMI], oral contraceptive use, parity, education, physical activity, age at menarche, unilateral oophorectomy, and perceived racism) and the incidence of natural menopause over a four-year period.

Who was studied?

The analytic sample included 17,070 African American women in the United States who were aged 35 to 55 years and premenopausal at baseline in 1995. Participants were drawn from the broader Black Women’s Health Study, which initially enrolled 64,500 women via mailed questionnaires. Inclusion criteria for this analysis required premenopausal status at baseline and completion of at least one follow-up questionnaire in 1997 or 1999. The cohort was well-educated, with the majority having completed high school or higher education, making the results particularly applicable to similarly educated African American women in the U.S. Generalizability to women with less education or lower socioeconomic status may be limited.

Most important findings

The study found that current smoking was the strongest predictor of earlier natural menopause, with a hazard ratio of 1.43 for current smokers and 1.21 for ex-smokers compared to never smokers. There was a clear dose-response relationship between smoking intensity (pack years) and risk of earlier menopause. Higher BMI was inversely associated with risk: women with a BMI ≥30 had a 22% lower risk compared to those with a BMI of 20–24. Use of oral contraceptives for at least one year also delayed menopause. Other reproductive factors and education were not significantly associated with menopause onset. Unilateral oophorectomy was associated with earlier menopause only among younger women. For perceived racism, most hazard ratios were elevated, but few reached statistical significance. The most notable was a 32% increased risk for women who experienced being treated as “not intelligent” monthly and a 23% increased risk for those thinking about their race daily.

Key implications

This study underscores that similar to White women, smoking is the most consistent and modifiable risk factor for earlier menopause among African American women, with implications for counseling and preventive health. Higher BMI and oral contraceptive use appear protective against early menopause. The findings regarding racism are suggestive but not definitive; while some associations were present, they were generally modest and inconsistent, indicating a need for further research on psychosocial stressors and reproductive aging in this population. Clinicians should be aware of these factors when discussing reproductive health and menopause timing with African American women but should recognize that current evidence does not support strong, actionable links between perceived racism and menopause onset.