Managing Perimenopause as a Woman of Color with Diabetes
- Lillian Simon, BSN, RN, NBC-HWC
- Jun 16
- 9 min read
Written by: Lillian Simon, BSN, RN, NBC-HWC
Perimenopause—the transitional phase before menopause—brings drastic hormonal fluctuations that can significantly affect women living with diabetes. For women of color, this transition is further influenced by cultural norms and expectations. Research consistently shows that women of color experience earlier symptoms of perimenopause, more intense symptoms, and greater barriers to treatment, all of which can complicate diabetes management. Understanding these intersections is essential for protecting long‑term metabolic, cardiovascular, and skeletal integrity.
Benefits of Hormones
Hormones are the body's essential chemical messengers that regulate vital bodily functions. Female sexual hormones mainly consist of estrogen and progesterone with smaller yet essential amounts of testosterone. These receptors are found throughout the body, from the head to the toes. Estrogen, specifically, provides multifaceted protective functions, including skin hydration, bone density, heart and blood vessel protection, cognitive function, and more. Progesterone's main function is to keep estrogen balanced. When estrogen and progesterone drastically fluctuate during perimenopause, women experience a wide range of symptoms, which might appear unrelated to the untrained eye.
Recent research indicates that there are over 103 symptoms of perimenopause affecting all areas of the body, including psychological, physical, digestive, and genitourinary (genital and urinary area) health (1). These symptoms last anywhere from a few months to 10+ years. Some may have mild symptoms while others may have prolonged, unbearable experiences. Each person’s journey through this transitional phase varies based on their family history and ethnicity. In fact, each race and culture experiences different perimenopausal symptoms, which will be discussed shortly.
Insulin Resistance
As estrogen levels fluctuate during perimenopause and eventually decline in postmenopause, visceral (belly) fat accumulates, which leads to insulin resistance and increased glucose variability. This then increases a woman’s risk for type 2 diabetes (T2D). Vasomotor symptoms (hot flashes and night sweats), stress, and sleep disturbances can further affect glucose levels. These changes are especially important for women of color, who already face higher rates of T2D.
Ethnicity‑Specific Symptoms & Patterns
While the average menopausal age is 51, the normal age range for menopause can occur any time from 40 to 60 years of age (2). Technically, menopause is just one day, the 366th day without menstruation. The transitional phase before menopause is called perimenopause, which can last about 10 years before menses ceases. This means perimenopausal symptoms can start in your 30s. The years after menopause are called postmenopause and last for the remainder of a woman's life.
Women of color, however, typically start menopause and perimenopausal symptoms earlier. Multiple studies, including the SWAN study, which analyzed over 3,000 women, show differences in perimenopausal symptoms across racial and ethnic groups (3-7). Let’s look at those differences.
Black Women
Most Common Symptoms
Vasomotor symptoms
Sleep disturbances
Fatigue/Low energy
Most Severe
Vasomotor symptoms (more frequent, longer‑lasting, and more intense than other races/ethnicities)
Distinctive Patterns
Enters perimenopause 1–2 years earlier
Symptoms often last 10+ years and are more severe
Higher chronic stress burden intensifies vasomotor symptoms
More likely to have symptoms dismissed or undertreated due to racial bias
Average menopause age: 48-50
Hispanic/Latina Women
Most Common Symptoms
Fatigue/Low energy
Sleep disturbances
Weight changes
Most Severe
Skin and hair changes
o Mood swings
o Irregular periods
Distinctive Patterns
Enters menopause 2 years earlier (average age 49)
Highest rates of metabolic syndrome of any race/ethnicity
2x more likely of having depressive symptoms
Vasomotor symptoms lasting up to 9 years
More hot flashes and vaginal dryness than other races/ethnicities
West Asian Women
Most Common Symptoms
Musculoskeletal pain
Physical and mental exhaustion
Weight changes
Most Severe
Fatigue
Weight changes
Distinctive Patterns
Enters menopause earlier (average age: 48-49)
Much fewer vasomotor symptoms than white women
South Asian Women
Most Common Symptoms
Musculoskeletal pain
Sleep disturbances
Fatigue/Low energy
Weight gain, especially visceral fat
Most Severe
Weight gain, 3x more than white women
Distinctive Patterns
Average menopause age: 46-47
Enters perimenopause earlier, often in late 30s to early 40s
Higher rates of T2D at lower BMIs and cardiovascular disease due to visceral fat
Vitamin D deficiency common, which worsens fatigue and bone pain
Increased risk for osteoporosis due to entering menopause earlier
Cultural stigma may delay seeking care
East Asian Women
Most Common Symptoms
Musculoskeletal pain
Sleep disturbances
Fatigue/Low energy
Weight changes
Most Severe
Heart discomfort (palpitations, rapid heartbeat)
Distinctive Patterns
Average menopause age: 48-50
Higher prevalence of musculoskeletal pain
Fewer vasomotor symptoms
Cultural norms may reduce symptom reporting
Indigenous Women
Most Common Symptoms
Fatigue/Low energy
Brain fog
Sleep issues
Most Severe
Painful sex
Weight changes
Body aches
Distinctive Patterns
Limited research, but emerging studies highlight underdiagnosis and undertreatment
Symptoms often interpreted through spiritual or community frameworks
Higher severity of anxiety, depression, and fatigue than in whites
Most intense and most frequent number of vasomotor symptoms amongst all races/ethnicities
Average menopause age: not certain, but likely earlier than 51
Compounded Risk Factors for Women with Diabetes
Women with diabetes are more likely to start perimenopause earlier than someone without diabetes (7). Also, women of color with diabetes face overlapping risks, which may compound those risk factors. Let's discuss three of them.
Cardiovascular Disease (CVD): Heart disease is the leading cause of death for women nationally and internationally (4, 9). Black, South Asian, and Hispanic people have a higher risk for CVD (10-12). Estrogen is cardioprotective; when it declines, so does its protection, creating increased risk for CVD (4, 13). Many times, people with diabetes (PWD) also have CVD. PWDs are two times more likely to have some type of CVD than those without it (14).
Sleep Disruption: Decreased and fluctuating estrogen affects sleep quality and quantity (4, 13). Diabetes technology (alarms, CGMs, insulin pumps, etc.) also affects sleep. Together, they can compound this issue, thereby increasing glucose levels.
Osteoporosis: Women could lose up to 20% of their bone density during perimenopause because of fluctuating and declining estrogen levels (13). Post-menopausal Asian women aged 50 or more have the highest risk of osteoporosis of all women of color (15-16). Recent evidence suggests that those on GLP1 medications who experience rapid weight loss and decreased nutritional intake can negatively affect their bone health (17). So, for an Asian perimenopausal woman taking GLP1, the risk for osteoporosis could increase much more due to multiple risk factors. Menopause specialist and expert, Dr. Mary Claire Haver, encourages women to start getting DEXA scans (which determine bone strength) much earlier than age 65, ideally during perimenopause (13). This is especially vital for those with multiple risk factors.
Menopause Specialists
Find a provider who specializes in menopause; ideally, someone who’s certified in it. Unfortunately, most gynecologists did not receive adequate training or knowledge to manage the transitional phase of midlife (4, 13). Menopause is considered a subspecialty of women's health. Look for providers who specialize in this niche by searching in their bio, website, or Google reviews. However, sometimes finding providers with this specialty is like trying to find a needle in a haystack. Thankfully, the Menopause Society has created an online provider directory.
If you’re still having trouble finding a local menopause specialist, try an online clinic. Virtual menopause clinics are now becoming more available, with some of them accepting insurance. Some examples include Midi Health, Allara Health, or Alloy Health. These specialty virtual clinics, however, do not replace your current gynecologist for wellness exams and pap smears.
Once you find a menopause specialist, they will want to know your complete medical and gynecological history, current perimenopausal symptoms, and family history. Be prepared for your visit by writing it down beforehand, especially if you’re dealing with brain fog, and take it with you to your appointment. Ideally, providers will give you treatment options, and together you’ll decide how to best manage your symptoms.
Treatment Options
There are three general ways that women manage perimenopausal symptoms: making lifestyle changes, taking medications, and/or taking supplements.
Lifestyle Interventions
Making lifestyle changes is beneficial for all perimenopausal women. These approaches may improve both perimenopausal symptoms and glycemic control. Here are some effective ways:
Consistent sleep hygiene practices
Eating fiber-rich foods regularly
Strength, flexibility, and endurance exercises
Culturally adapted heart‑healthy, balanced eating patterns
Eating an adequate amount of protein, unless medically restricted
Incorporating stress-reducing practices (i.e. mindfulness, meditation, emotional support)
Medications: MHT
For over twenty years, misinterpretation from the Women’s Health Initiative study introduced intense fear in using Menopausal Hormone Therapy (MHT – sometimes referred to as hormone replacement therapy). Last year, they finally admitted that they interpreted the data incorrectly, and the FDA removed the black box warning from the medication (4, 13, 18-20).
Women can safely start taking MHT before age 60, within ten years of menopause, or ideally during their perimenopausal years. They can continue taking it for as long as they want as a protective measure. Those with a uterus will need both estrogen and progesterone. Otherwise, only estrogen will be needed (4, 13, 18-20).
There are essentially two types of MHT: systemic or localized medications. Systemic means the medication will travel to every organ system in your body, whereas localized means it stays in the area where you applied it. Multiple menopause specialists agree that local vaginal estrogen is safe for all women (4, 13, 18-19).
Opt for bioidentical hormones, which are hormones that mimic your body’s natural hormones. They have a lower hormonal dosage, which is adequate for managing perimenopausal symptoms and safer for long-term use. Synthetic hormones tend to have a higher hormonal dosage, are usually prescribed to prevent pregnancy, have more serious side effects, and might be animal-derived, like Premarin (4, 13).
Some providers may initially and periodically check hormone levels when adjusting medication dosages and determining personalized optimal hormonal levels. They should not determine treatment or dosage by labs only; it should be based on a woman’s symptoms (21).
MHT should not be used in women with (13):
Estrogen‑ or progesterone-sensitive cancers
Undiagnosed abnormal vaginal bleeding
Current or recent clotting disorders i.e. heart attack, stroke, embolism
Currently pregnant or planning to be
Severe liver disease or impairment
Allergic to any of the ingredients in the medication
Supplements
Certain women may not be eligible to take MHT or may prefer supplements. Some women of color may have grown up using botanical or herbal remedies, such as Chinese, Ayurvedic, or Indigenous medicine.
Before starting supplements, talk with your healthcare team. They may request blood work to check for potential deficiencies and to rule out other potential health conditions. Certain supplements may interfere with your current medications and affect your health, especially if you have other chronic health conditions besides diabetes. So, it's safer to check with your healthcare team first before starting anything new.
However, some providers may not be as knowledgeable about supplements and botanicals. If so, consider finding a functional medicine provider, naturopathic doctor, or similar provider who also specializes in menopause. With the emergence of numerous virtual menopause specialty clinics, some of them offer supplements and botanicals to manage perimenopausal symptoms, including their own proprietary blend. Many times, however, these supplements are not covered by insurance.
The Bottom Line
Perimenopause is a pivotal health transition for women of color living with diabetes. Symptom patterns vary across ethnic/racial groups. Certain risk factors increase and compound as estrogen fluctuates and eventually declines in post-menopause. Combined with structural inequities, these differences make proactive, culturally informed care essential. With the right support, symptom tracking, and individualized treatment, women of color living with diabetes can navigate perimenopause with clarity, confidence, and better long‑term health.
References
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7. Allen KP. Menopause in South Asian Communities and the Diaspora: a Complete Guide. The Women’s Health Clinic. Published August 21, 2025. https://thewomenshealth.clinic/menopause-in-south-asian-communities-and-the-diaspora-a-complete-uk-guide/
8. ADA. Diabetes and Early Menopause. American Diabetes Association. Published 2024. https://diabetes.org/health-wellness/sexual-health/early-menopause-diabetes
9. CDC. Leading Causes of Death in Females. Centers for Disease Control & Prevention: Women’s Health. Published December 12, 2024. https://www.cdc.gov/womens-health/lcod/females.html
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11. Borkowski P, Borkowska N, Mangeshkar S, Adal BH, Singh N. Racial and Socioeconomic Determinants of Cardiovascular Health: a Comprehensive Review. Cureus. 2024;16(5). https://doi.org/10.7759/cureus.59497
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13. Haver MC. The New Perimenopause: An Evidence-Based Guide to Navigating Your Body, Mind, and Hormones. Random House; 2026.
14. ADA. Diabetes Can Affect Your Heart. American Diabetes Association. https://diabetes.org/health-wellness/diabetes-and-your-heart/diabetes-affect-your-heart
15. QuickStats: Percentage of Adults Aged ≥50 Years with Osteoporosis, by Race and Hispanic Origin — United States, 2017–2018. MMWR Morbidity and Mortality Weekly Report. 2021;70(19):731. https://doi.org/10.15585/mmwr.mm7019a5
16. UC San Diego Health. Osteoporosis Risk Factors. UCSD Health. Published 2024. https://health.ucsd.edu/care/endocrinology-diabetes/osteoporosis/risk-factors/
17. UC Davis Health. UC Davis Health Examines Systemic Impact of GLP-1–based Therapies. UC Davis Health News. Published December 5, 2025. https://health.ucdavis.edu/news/headlines/uc-davis-health-examines-systemic-impact-of-glp-1based-therapies/2025/12
18. Clarke H. Experts Urge FDA to Remove Black Box Warning on low-dose Vaginal Estrogen. Urology Times. Published July 18, 2025. https://www.urologytimes.com/view/experts-urge-fda-to-remove-black-box-warning-on-low-dose-vaginal-estrogen
19. The Truth About Estrogen: What the Women’s Health Initiative Got Wrong with Dr. Avrum Bluming & Dr. Carol Tavris. unPAUSED Podcast with Dr. Mary Claire Haver. Published October 21, 2025. https://thepauselife.com/blogs/the-unpaused-podcast/the-truth-about-estrogen-what-the-womens-health-initiative-got-wrong-with-dr-avrum-bluming-dr-carol-tavris
20. HHS. Fact Sheet: FDA Initiates Removal of “Black Box” Warnings from Menopausal Hormone Replacement Therapy Products. U.S. Department of Health and Human Services. Published November 10, 2025. https://www.hhs.gov/press-room/fact-sheet-fda-initiates-removal-of-black-box-warnings-from-menopausal-hormone-replacement-therapy-products.html
21. Lumsden MA, Dekkers OM, Faubion SS, et al. European Society of Endocrinology Clinical Practice Guideline for Evaluation and Management of Menopause and the Perimenopause. European Journal of Endocrinology. 2025;193(4):G49-G81. https://doi.org/10.1093/ejendo/lvaf206
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