By Dr. Lisa Saul, Chief Medical Officer of Women's Health at UnitedHealth Group
Black women know what it means to keep going, even when something feels off.
We push through work, caregiving, family responsibilities and the pressure to be strong for everyone else. We explain away exhaustion as stress. Poor sleep as a busy season. Mood changes as having too much on our plate. Trouble focusing as just another part of life.
The challenge is that perimenopause doesn't always look the way we were taught to expect. Many women are told to watch for hot flashes or changes in their periods, yet some first notice they are waking up at 3 a.m., struggling to concentrate, feeling unusually anxious or simply feeling unlike themselves.
For Black women, getting answers can be even more difficult. Research shows Black women are more likely to enter the menopause transition earlier and experience some symptoms longer or more intensely. At the same time, many encounter barriers that can make it harder to get clear answers, including limited access to menopause-informed care and having symptoms minimized or dismissed.
That combination matters. When symptoms are explained away as stress or treated as unrelated issues, women may spend months or years pushing through instead of getting support.
Why the dots aren't always easy to connect
Perimenopause can be confusing because it doesn't always look the same for everyone.
Anxiety may be treated only as anxiety. Concentration issues may be written off as burnout. Sleep problems and fatigue may be blamed on work, parenting, caregiving or simply doing too much.
And many women are doing a lot. This stage of life often arrives while we're building careers, managing households, caring for children, supporting aging parents or carrying several of those responsibilities at once.
So the question is not always, "Why didn't I recognize this sooner?"
Sometimes the better question is, "Was anyone looking at the full picture?"
As a physician, I believe symptoms deserve context. Sleep, stress, mental health, chronic conditions, access to care and life experiences all shape how someone moves through a health transition. That matters even more when we're talking about a transition that can affect so many parts of daily life at once.
The body keeps score
By the time a woman reaches her 40s, her body has already lived through decades of stress, caregiving, work, family responsibilities and health challenges. For many Black women, those experiences can also include navigating systems that have not always listened to or responded to their concerns.
Perimenopause doesn't happen in a vacuum. It happens within the context of everything the body has already carried.
That context matters because symptoms can overlap. Sleep disruption can amplify anxiety. Poor sleep can make concentration harder. Stress can make fatigue feel heavier. When several things are happening at once, it becomes easier to attribute what we're experiencing to stress, aging or simply having too much on our plate.
Looking at the whole picture matters because context deserves to be part of the conversation.
When symptoms follow you into daily life
Perimenopause can affect more than the body. It can affect how we show up in our daily lives.
Brain fog may be annoying when you forget why you walked into a room. It can feel very different when you lose your train of thought in a meeting or when a task that once felt simple suddenly takes far more energy than expected.
Mood changes, anxiety, disrupted sleep and fatigue can also affect relationships, work, caregiving and confidence. That doesn't mean women are less capable. It means this stage can be disruptive, especially when we're expected to keep performing, supporting and managing everything around us without missing a beat.
Nearly 3 in 4 women ages 40 to 49 say menopause symptoms have negatively affected some aspect of their work life, and 1 in 5 say those symptoms have affected their income.
What better support can look like
There is no single menopause experience, and there is no one right path for every woman.
Some women have mild symptoms they can manage with lifestyle adjustments and support. Others experience changes that significantly affect their quality of life. Depending on symptoms, health history and individual needs, support may include lifestyle changes, mental health resources, hormone therapy, nonhormonal treatments or care from a clinician with experience in perimenopause and menopause.
The goal is not to self-diagnose. It is to walk into the conversation prepared to describe the full picture.
That may mean telling your doctor:
I'm not sleeping through the night, and it's affecting my workday.
My mood feels different, and I don't feel like myself.
I'm having trouble focusing in ways that are new for me.
My symptoms are affecting my quality of life.
I want to know whether this could be perimenopause and what options may be appropriate for me.
Women should not have to connect every dot on their own. But being prepared with examples, patterns and questions can help make the conversation more productive.
Why this is a good time to rethink what support looks like
Open enrollment may not be the first thing people connect to perimenopause. But it can be a practical moment to ask whether your health coverage still fits the stage of life you're in now.
As women, we often spend so much time making sure everyone else has what they need that our own health gets pushed down the list.
As you review your coverage, consider whether you have access to clinicians with experience in perimenopause and menopause, behavioral health support and other resources that can help you navigate changes that affect daily life. Some health plans, including UnitedHealthcare, may offer resources to help eligible members better understand their benefits, find care and seek support.
You deserve answers
Perimenopause is natural, but that doesn't mean women should be expected to simply endure it.
For Black women, this conversation is about more than symptoms. It's about being heard. It's about having access to care that considers the whole person. It's about knowing that changes in sleep, mood, focus, energy or daily functioning deserve a fuller conversation, not a quick dismissal.
If something feels different, that matters.
If you feel like your concerns are being reduced to stress or aging without a fuller conversation, it's okay to keep asking questions.
Black women deserve better answers about perimenopause. We deserve care that listens, providers who look at the whole picture and conversations that make room for the full truth of our lives. The more we understand what is happening in our bodies, the better prepared we are to ask for the support, answers and care we deserve.
