Ask the expert Series:

Menopause and Perimenopause with Dr Tonye Wokoma


Menopause and Perimenopause with Dr Tonye Wokoma

Around 15.5 million women in the UK today are at some stage of the menopause transition (perimenopause, menopause, or postmenopause) – that’s almost half of the UK’s female population.

Many women don’t realise that they’re entering the perimenopause, and if they do feel worried or embarrassed to talk about it. This needs to change.

We spoke to Dr Tonye Wokoma, Menopause Specialist and Consultant in Sexual and Reproductive Health at My Menopause Centre to find out more about the menopause and perimenopause along with what it means for women of colour.

CB: People tend to have heard of the menopause, but not necessairly the perimenopause. What’s the difference between the two?

The perimenopause and menopause is a completely normal and natural part of a woman’s life. It’s a time when your hormones are changing, and your body is shifting towards the end of fertility. There are three stages in the menopause transition – the perimenopause, menopause and postmenopause.

The perimenopause is the time leading up to the menopause when your ovaries start to run out of eggs. Periods can be irregular, less frequent, heavier or lighter, and generally unpredictable (although for some women, periods don’t change).  

The menopause is said to occur after 12 consecutive months of no bleeding because your ovaries have stopped producing hormones. This isn’t always just caused by natural hormonal changes, surgical or medical menopause exists too. You then move into being postmenopausal.

CB: What are the symptoms to look out for/what age are they most common?

A woman’s experience of menopause – from the range of symptoms to their intensity and duration - is individual to her. Eight in 10 women experience symptoms of the menopause, and more than 25% suffer them severely. Women experience an average of 7 symptoms over time. For most women, symptoms start in the perimenopause and last around eight years. However, it can be shorter for some women and longer for others – it’s different for everybody.

Take hot flushes for example: while women can experience these, on average, for about seven years, over 40% of women aged between 60-65 years will continue to experience hot flushes and night sweats and some will experience them for up to 20 years following menopause. I have women in my clinic in their 70s and 80s still experiencing hot flushes.We cover 40 symptoms of menopause on our website and you can find out more about menopause symptoms here.


Many women don’t realise they are in the perimenopause because symptoms can creep up on them. They may be subtle, such as joint aches and pains, or feeling a little more anxious, or mood swings can dip lower than usual. Symptoms can come and go and change in intensity. Symptoms may be also associated with other medical conditions or just put down to ‘ageing’ rather than being recognised as being due to the menopause.

Older research from the USA found that Black women experience a longer menopause transition duration than white women. Unfortunately, we don’t have enough data in the UK on the experience of women of colour to know if these findings also apply here.

CB: What can women do to help with the symptoms of the perimenopause and menopause?

 There are a range of things that women can do to help them take control of their menopause symptoms. This could be lifestyle changes like diet and exercise, yoga and meditation or cutting down on alcohol. Some women choose to take hormone replacement therapy (HRT) to help manage their symptoms and for longer term benefits like bone and heart health.

Then there are vaginal oestrogen creams, lubricants or moisturisers which can help with vaginal dryness, and testosterone which can help with loss of sex drive.


Talking therapies, such as cognitive behavioural therapy (CBT) can also really help, especially in dealing with low mood and anxiety as well as hot flushes. Yoga, meditation and mindfulness can help you deal with a frazzled mind. There are lots of apps and online resources for everyone, from novices to experts.

 Sex and relationship therapy can also help, as the menopause can significantly impact your sex drive and relationships. As well as HRT (including testosterone and vaginal oestrogens within this), you may need support in getting your relationship back on track.

CB: What are the challenges that women of colour face during perimenopause and menopause?

From my years of experience as a menopause specialist, Black women are less likely to seek help and treatment for the menopause. There are several reasons for this: low awareness of the help and support available to them as they go through the menopause transition, reluctance to take medication – including HRT and cultural opinions about the menopause.

 In my experience, Black women often keep private their needs around health and personal issues in general. To compound this, the menopause may be seen as a taboo topic. Symptoms such as tiredness, changes in mood, depression or anxiety are seen as too sensitive for women to raise with their partner, family or friends.

Other symptoms, such as loss of sex drive and vaginal dryness (which are easy to treat) are considered so embarrassing, that they’re unlikely to be ever mentioned to anyone and certainly not their doctor.

 Another reason for not discussing these symptoms is that in many families, culturally, the woman is seen as a matriarchal figure which stems from outdated perceptions of the role of Black women in society.

For many women, speaking up about symptoms and asking for support can carry unhelpful cultural stigmas of weakness and vulnerability. As a result, Black women are not getting the support they need – whether from the medical profession or their friends, family and workplaces. The menopause isn’t discussed with their daughters or younger generations of women.

This in turn perpetuates the cycle of women entering the menopause transition unprepared as well as underestimating of the impact of their symptoms which can have negative consequences on their family life, work life and within their community and friends.

CB: What advice would you give to women of colour who are worried about the perimenopause/menopause?

Women today feel proud of everything that their bodies have achieved, so it’s important they feel comfortable speaking about any concerns or changes that are troubling them. Often when I am speaking with faith groups and within the Black community, I notice that women are happy to talk about the menopause within this environment.

Empower yourself - talk to your GP about your symptoms and seek out community education from reliable sources like My Menopause Centre where you can read about menopause and the treatment options available.

 But it’s not just on women to do the work - developing a culture of empathy, understanding and support around the menopause works both ways in friendships, families and within our culture. Feeling accepted and listened to by a partner, family, friends or a colleague can create powerful change.

 Knowledge is power, and there are all sorts of things you can do to manage this period of life, not just with medicine, but with your whole lifestyle. Then there’s (the knowledge you need about) hormone treatments you can have and, also, about the non-hormonal treatments available for those who don’t want hormone treatments. It’s about finding the right support wherever you are on this journey because every woman is an individual. But the most important thing is to start talking about the menopause.

If you’re experiencing vaginal dryness (one of the most common perimenopausal or menopausal symptoms), then try the award-winning YES lubricants and moisturisers - the world’s first and only range of intimacy products certified as organic by the Soil Association - for the most natural-feeling lubrication out there.

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