Whole Person Wellness

That is the story.

The Study of Women's Health Across the Nation — SWAN — is the longest-running clinical study of the menopause transition in the United States. It tracked 3,302 women at seven sites from 1996 through 2013. African American women had, by every measure the researchers used, the most persistent vasomotor symptoms in the cohort. That category — vasomotor symptoms, or VMS — covers the hot flashes, the night sweats, the temperature dysregulation that wakes a woman up at 3 a.m. soaked through her sheets. The clinical term is dry. The lived experience is not.

In April 2026, researchers presenting at the American College of Obstetricians and Gynecologists annual meeting reported what happens when Black women with these symptoms walk into a doctor's office. Drawing from Epic Cosmos data on women aged 45 to 60 with a menopause diagnosis between 2020 and 2025, the analysis found that 5.4% of Black patients were prescribed hormone replacement therapy. White patients were prescribed it at 10.8%. Half the rate.

It is not because Black women refuse the treatment. The same analysis found Black patients were significantly more likely to be prescribed selective serotonin reuptake inhibitors — antidepressants — at an odds ratio of 1.85, fezolinetant at 1.82, and gabapentin at 1.42. The prescription pad is not empty. It is full. It is full of the second-line options.

A short note on what these drugs do. Hormone replacement therapy replaces the estrogen the ovaries stop producing. It treats the cause. SSRIs and gabapentin treat the symptoms downstream. Fezolinetant is a non-hormonal hot flash drug approved in 2023. All four can be appropriate. Only one addresses the underlying hormonal transition. The decision to prescribe one over another is supposed to be made with the patient. The data suggests it is not always being made with her.

The economic question is who benefits. Hormone replacement therapy is generic. A monthly supply of generic estradiol costs less than a generic SSRI in many cases. The disparity is not a pricing scheme. It is a prescribing pattern, and prescribing patterns reflect what clinicians were taught, what clinicians are comfortable with, and which patients the clinical literature was written about. The clinical literature was largely not written about Black women. The Women's Health Initiative, the 2002 study that scared a generation of providers off hormone therapy, enrolled overwhelmingly white participants. Twenty-four years later, the conservatism is still there, and Black women are still inheriting it.

The compounding factor is cardiovascular. In a longitudinal SWAN analysis published in the Journal of the American Heart Association in February 2021, women with frequent, persistent vasomotor symptoms had a 77% higher risk of incident cardiovascular events than women without. Hazard ratio 1.77. The confidence interval is 1.33 to 2.35. The p-value is less than 0.0001. In English: hot flashes are not just a quality-of-life issue. They are a cardiovascular signal. Black women already carry the highest baseline cardiovascular risk of any racial group in the United States. The two risks stack.

So the equation, plainly stated. Ten more years of symptoms. Half the appropriate prescription rate. A cardiovascular risk multiplier on top of an already-elevated baseline. And a clinical conversation that, when it happens at all, treats the whole thing as ordinary aging.

It is not ordinary. It is not happening to ordinary women. It is happening to the women in their late thirties and forties carrying the household, the parents, the children, and the job. The women whose fatigue gets read as overwork. Whose brain fog gets read as stress. Whose rage gets read as a personality problem and prescribed an SSRI.

Louisiana does not have many providers who treat this transition correctly. There is no Midi clinic in Lafayette. There is no Evernow franchise on Johnston Street. There is no Alloy Health office in Opelousas. The mainstream menopause telehealth companies that opened over the last five years built their clinics around an upper-middle white market in major coastal metros. The Acadiana market — where Black professional women in their forties are the actual demographic experiencing the longest, most severe perimenopause documented in the United States — has been left to whoever is in the room.

The room, increasingly, is a Black-owned primary care practice in Lafayette called DAB Health Innovations. The clinic is led by Dawn P. Arceneaux, MSN, APRN, FNP-C — a family nurse practitioner who can prescribe hormone replacement therapy, order the labs that confirm a perimenopausal hormonal profile, screen cardiovascular risk, and refer for bone density and sleep workups. The clinic is taking new clients. The first visit is virtual. The booking page is dabhealthinnovations.janeapp.com.

That is one provider. In one parish. For a population that, by SWAN's count, runs into the tens of thousands across South Louisiana alone. The math does not work yet. The math will not work until enough Black women in this state understand that what they have been told to live with is, in clinical terms, a treatable medical transition with a documented disparity in how it is treated.

The information has been in the journals for a decade. It has not been in the conversation. That is the gap. The gap is the story.

Originally published in blacklouisiana.guide · The Ledger.