Dr. Kudzai Dombo is a board certified OBGYN, educator, and one of the leading voices in elevating conversations around women of color and their healthcare journey.
We start with the SWAN study, a 25-year longitudinal multiracial, multi-ethnic cohort study that enrolled over 3,300 women between the ages of 42 and 52. It remains one of the most important sources of information we have on how menopause affects women differently across racial and ethnic groups. What it found is striking: Black women are more likely to experience worse vasomotor symptoms, their hot flashes last on average 10 years compared to 6.5 for white women, and they tend to enter menopause about 1.2 years earlier. Hispanic women also enter the menopausal transition earlier, with symptoms lasting on average about 9 years. These are not small differences.
We talk about why these disparities exist, including the concept of weathering, the chronic stress load carried by Black women navigating systemic racism that accelerates biological aging, and what allostatic load actually means in the body. We get into social determinants of health, what they are, how they shape who gets equitable care and who does not, and why implicit bias is not a character flaw but a phenomenon every clinician needs to examine continuously.
We also get personal. Dr. Dombo shares what it felt like to be on the other side of the system she works within, and we talk honestly about what patients can do when they feel dismissed, and what clinicians can do before they even walk into the room.
This is a conversation about science, equity, and advocacy. And it is one every woman and every clinician needs to hear.
Key Takeaways
The SWAN study, established in 1996, followed over 3,300 women for 25 years and remains the most comprehensive source of data on racial and ethnic differences in the menopause experience.
The SWAN study found that Black women slept on average 30 minutes less per night than white women, even though they were less likely to report sleep disturbances — a gap that has significant implications for cardiometabolic health.
Weathering is the concept that chronic stress from navigating systemic racism accelerates biological aging in Black women, contributing to earlier and more severe menopause symptoms and higher cardiometabolic disease burden.
Social determinants of health include economic stability, access to quality care, food environments, green spaces, and the chronic stress of racial discrimination — all of which shape health outcomes.
Only 6.8 percent of US residents felt prepared to prescribe hormone therapy at graduation a statistic that explains a great deal about the care gap women experience.
Hot flashes are not benign; the intensity and duration of vasomotor symptoms is linked to cardiovascular risk and brain health, which makes treating them a priority not a preference.
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