A manifesto is a public declaration or proclamation and we are well past due for a manifesto on menopause as 2021 is the 200th anniversary of the introduction of the word. My manifesto is for every woman to have the knowledge that I had to help them with their own menopause. I demand that the era of silence and shame about menopause yield to facts and feminism. I proclaim that we must stop viewing menopause as a disease, because that means being a woman is a disease and I reject that shoddily constructed hypothesis. I also declare that what the patriarchy thinks of menopause is irrelevant. Men do not get to define the value of women at any age.
Dr Jen Gunter (OB-GYN, women’s health advocate, and internationally renowned author of The Vagina Bible) states in her introduction to The Menopause Manifesto that most women will approach menopause woefully unprepared for the changes they will encounter; societal shame dissuading women from even talking about their experiences among themselves. And as Western medicine has traditionally put most of its focus on men’s bodies and their care, women entering the menopause transition tend to not even get good information from their primary care providers: life-disrupting symptoms are dismissed as “normal” and “inevitable”; treatments offered are one size fit all; and in the US, ongoing cost and duration of medical care can be a deterrent for access. Gunter makes it very clear throughout this book that this lack of information and adequate care can be tied to the patriarchy, and she concludes the introduction with, “It shouldn’t require an act of feminism to know how your body works, but it does. And it seems there is no greater act of feminism than speaking up about a menopausal body in a patriarchal society.” The information that follows is clear and comprehensive, Gunter’s tone is generally informal and engaging, and although I picked this up on a bit of a whim, I’m very glad that I did: all information is power and I learned quite a lot. (Note: I read an ARC through NetGalley and passages quoted may not be in their final forms.)
There’s a common fallacy that women were never “meant” to experience menopause. This assertion claims that menopause is an accidental state that resulted from longer life expectancies from modern sanitation and medicine, allowing women to live beyond their ovarian function. A benevolent patriarchal society allowed the failings of women — menopause — to be uncovered. The tenacity of this myth is testament to the impact of patriarchal dogma. Erasing menopausal women from history is literally reducing women to the functioning of their uterus and ovaries. When something feels off balance I replace the word “women” with “men” to see how it sounds. If it sounds reasonable I’m more likely to consider the hypothesis worthy of further evaluation, but if we would never speak about men that way, then there’s going to be a lot of side eye on my part. Has anyone ever in the history of medicine ever uttered these words? “Through good sanitation and health care, men are now living long enough to develop erectile dysfunction?” Doubtful.
I knew so little about menopause that I didn’t even realise that only humans and toothed whales experience it (and for killer whales, it seems to confer some kind of an advantage: female orcas usually live to be around ninety, and males just to fifty), so that does beg the question: why menopause? Dr Gunter proposes the “grandmother hypothesis” — that human women (evolutionarily speaking) stop reproducing in order to help their daughters raise their own children, sharing their hard won knowledge and wisdom (this seems to be true for the whales, too) to the benefit of the species — and I suppose this shifting role is better than being consigned outright to the rubbish heap. Whatever the reason for the menopause transition, women’s bodies will go through a range of unpleasant experiences (from hot flashes and irregular periods to insomnia and incontinence) and Gunter stresses that a doctor should describe such experiences as “typical” instead of “normal” (where “normal” implies that these are just things women need to deal with instead of addressing). In some cases, women suffering from life-altering symptoms may be prescribed MHT (menopausal hormone replacement) and Gunter goes into interesting detail about the history of hormonal treatments — including an explanation for why it’s no longer pejoratively called “HRT” (hormone replacement treatment; nothing is being replaced because nothing is failing) — and I appreciated that she explained why the small increase of risk for breast cancer can be offset by estrogen’s role in preventing the more likely onset of cardiovascular disease or osteoporosis. I also appreciated the information she shared about so-called natural alternatives (hardly natural and never effective), the uselessness of a daily multivitamin, and the danger of pharmacist-compounded, rather than pharmaceutically manufactured, hormone creams (why do these even exist? Even the so-called libido-enhancing “scream creams” sound like snake oil.)
The best way to approach menopause is to be informed so women can understand if what is happening is menopause-related; what diseases she may face due to her combination of genetics, health, and menopausal status; and what is the best way to achieve quality of life and health and how to best balance those goals against any risks. This can only happen with accurate information and without the prejudice of the patriarchy.
There is a lot of good, specific information in The Menopause Manifesto, far beyond what I took away as general interest, and I can totally see how it could be a useful resource for a woman to consult before seeking medical advice. I’m glad this exists and that I read it.
