Dr. Jen Gunter - Own Your Health with Facts and Feminism

The Manifesto

I F MENOPAUSE WERE ON Y ELP it would have one star.

This establishment has temperature control issues. Drenching heat followed by terrible chills. Defies the laws of thermodynamics. Would not recommend.

Awful, awful, awful! Bleeding was scheduled, but was rebooked without notification so arrived 3 weeks later than expected while I was in an Uber and I flooded the car. The driver gave me a terrible review!

The sex was dry.

And its no surprise. Most women have no idea what to expect when they are no longer expecting a period, and its uniquely awful and disempowering to not understand what is happening to your body and why. Menopause is like being sent on a canoe trip with no guide book and only a vague idea where you are headedalthough the expectation is its awful. There will be no advice on how to get there or how to manage any of the obstacles, such as rapids. That is if any exist. Who knows? Have fun figuring it out! Good times. Oh, and dont write. No one wants to hear about your journey or what it is like when you arrive.

Fear? Check. Uncertainty? Check. Medical ramifications? Check. Unpleasant symptoms? Check. Societal irrelevance? Check.

No wonder menopause receives such awful reviews.

The culture of silence about menopause in our patriarchal society is something to behold. Menopause doesnt even rate the shame that society gives to the vulva and vagina. Apparently there is nothing of lower value than an aging womans body, and many in our society treat menopause not as a phase of life, but rather as a phase of death. Sort of a predeath.

What little that is spoken about menopause is often viewed through the lens of ovarian failurethe assertion that menopause is a disease that exists because women and their ovaries are weak. The only grounds for this claim are that men dont experience menopause. But comparing women and men in this way is the same as comparing the liver with the heart. The liver isnt weak or diseased because it doesnt beat like the heart, and women arent diseased because the ovaries stop making estrogen.

The absence of menopause from our discourse leaves women uninformed, which can be disempowering, frightening, and makes it difficult to self-advocate. Consequently, many suffer with symptoms or dont receive important health screenings or therapies because they have been dismissed with platitudes like This is just part of being a woman or Its not that bad. But the issues with menopause even go beyond these knowledge gaps and the medical neglect. Women tell me that menopause is lonely; that there are no stories or culture. And so there is no whisper network to take up the slack from medicine. Nothing to offer comfort.

But many women are desperate to know more about menopause so they can understand how and why their body is changing, and they want information so they can make decisions that work for them. They also want to talk about what is happening to their body.

I contrast these experiences with my own. Having started medical school when I was twenty years old and my OB/GYN training when I was twenty-four, I cant remember back to a time when I didnt have a detailed understanding of the hormonal changes of both the menstrual cycle and menopause. And not just the biology, but how to apply it practically to my own body. I never once thought, Wow, that is unexpected, or Why am I sweating so much at the age of forty-five? or WHAT IS GOING ONWHY AM I BLEEDING EVERYWHERE!?

My medical knowledge didnt prevent me from having menopause acne, hot flushes, or those special heavy periods that are all typical of the menopause transition. But because I knew exactly what was happening and when to seek care, it made the whole process feel routine. Because I knew the tests that were indicated and those that were not, and because I understood the medicine, it was much easier for me to navigate the treatment options and choose the safest most effective therapy and avoid the snake oil. By the time I entered my own menopause transition, I had spent over twenty years speaking with women about their menopause and helping them manage their symptoms and any health concerns, so I had heard many stories and had knowledge of the range of experiences as well as the treatment options. It was fortunate that my view of the subject wasnt confined to what I saw at home. My mothers menopause was volcanic, and if that was all I had to go on, I would have been quite frightened.

Online, on book tour for The Vagina Bible, and during many interviews with reporters I often heard (and still hear today) What do I do? and Where do I turn? from women about menopause. I remember one interview in particular that had nothing to do with menopause or even menstruation and when for some reason I tangentially mentioned I was using an estrogen patch the conversation derailed and all the reporter wanted to discuss was menopause. Hearing over and over again from women from many countries about this need for knowledge made me obsessed with the idea that every woman should know about menopause like a well-informed gynecologist and so that is what I have set out to do in these pages.

For women to navigate menopause, they need facts because empowerment requires accurate informationbut they also need feminism because our bodies, our medical care, and even our thoughts have been colonized by the patriarchy. The cultural absence of menopause from our discussions isnt because thats what women want. The often pejorative language about menopause and the medical neglect also arent up there on the meno wish list.