(122) Silent Symptoms, Missed Opportunities: Exploring Menopause Care-Seeking, SRH Experiences, and Mental Health Among Black Women in Maryland

Abstract Introduction Black women in the U.S. experience menopause symptoms earlier, more intensely, and often without adequate care or validation. Despite the documented disparities in sexual and reproductive health (SRH) access, little is known about how prior SRH experiences or mental health symptoms influence menopause-related healthcare-seeking among Black women. This study explores the intersection of menopause symptoms, SRH care experiences, and anxiety/depression in care utilization patterns. Objective To examine how prior SRH experiences and mental health symptoms influence the likelihood of Black women seeking menopause-related healthcare, within the broader context of racial disparities in midlife care access. This study aims to uncover relational and systemic factors that shape care-seeking behaviors during the menopausal transition among Black women, a population often underrepresented in sexual medicine research. Methods We analyzed cross-sectional data from the SHINE Black Women Study, which surveyed 158 Black women in Maryland. Analyses were restricted to participants aged ≥35 to align with earlier symptom onset patterns. Key measures included self-reported menopause symptoms, use of healthcare services for those symptoms, prior positive or negative SRH experiences, and mental health symptom severity (GAD-7 and PHQ-8 derived items). Descriptive statistics and logistic regression models were used to examine predictors of menopause-related care use. Results While 28% (n = 44) of participants reported experiencing menopause symptoms, only 14% (n = 22) reported seeking healthcare for those symptoms, indicating that only half of symptomatic women accessed care. In adjusted models, having a prior positive SRH experience significantly increased the odds of menopause care use (OR = 4.84, 95% CI: 1.05–22.34, p = 0.043), while perceived availability of SRH services was paradoxically associated with lower odds of care-seeking (OR = 0.17, 95% CI: 0.04–0.65, p = 0.010). Anxiety symptoms trended toward significance as a driver of care use (p = 0.071). Conclusions Disparities exist with menopause-related care utilization among Black women despite symptom presence. Positive SRH provider experiences appear to be a critical enabler, while availability alone does not guarantee engagement, highlighting a disconnect between presence and usability of services. These findings underscore the need to move beyond access alone and toward system-optimized SRH models that are responsive to the unique needs of Black women across their lifespan. Efforts to improve equity must prioritize relational quality, provider accountability, and service integration to ensure that midlife and menopause care is not an afterthought but a core component of reproductive health equity. Disclosure No.