One minute you’re a sassy 11-year-old, the next you’re a sullen teen, sitting in your bedroom hating your mother, then bang-bang-bang — your 20s, 30s and 40s gallop by in a blur of work, relationships and family. Before the dust has even begun to settle, you’re in your 50s and it all shifts again.
The end of one’s reproductive life has a tendency to sneak up on a person. And when menopause starts it can arrive as a bit of shock, like a frying pan to the back of the head.
Never fear, Dr. Jen Gunter is here to make some sense of it all with her new book, The Menopause Manifesto, an encompassing look at this season of change.
On the 200th anniversary of the creation of the word, Gunter argues that women need not only facts to have a good menopause, but they also need feminism. Hence the book’s subtitle Own Your Health with Facts and Feminism.
Part battle cry and part reference guide, with a heap of history and cultural critique thrown in, The Menopause Manifesto joins a long list of recent titles that parse and delineate the experience. Some are sad, others more polemical, in keeping with the thing itself.
In short, no two women are exactly alike, and so menopause is also very much a diasporic experience. One woman’s easy and benign transition is another person’s raging inferno. It’s both end and beginning, liberation and loss, up and down.
As a gynecologist, Gunter has a degree of access to this breadth of experience. Like many doctors, she’s blunt and no-nonsense with little patience for bullshit and blarney. And lord knows there’s lots of both when it comes to women’s bodies.
In a recent op-ed for the New York Times, Gunter laid out the most salient and far-reaching implications of her work — everything from how access to information shapes women’s health to the political ramifications of being liberated from biology.
The ringing edict throughout is that understanding your own body is the ultimate act of empowerment.
“Menopause isn’t a death sentence. We must dispel the misogynistic notion that a woman’s worth is tied to her estrogen and her age. Instead we should think of menopause as a new phase of life and the last period as just one landmark along the way. When women need help navigating their symptoms and the health implications of menopause, clear, non-sexist information and proven therapies should be available. At some point getting help for menopause won’t require an act of feminism, but that will never happen if we stay silent.”
Silence is another of the major reasons that Gunter decided to write The Menopause Manifesto. As she explains part of her motivation was to dispel the secrecy and shame that attends the longest, and arguably one of the most productive, period of women’s lives.
Even if you’re not currently menopausal or packing a uterus, there is a great deal of useful stuff, so prepare yourself with multi-coloured stickies and highlighters. The book takes an information-heavy approach, which isn’t a bad thing given how much misinformation has been perpetrated about women’s bodies. In marshalling all of this material, Gunter provides a summary at the end of each chapter winnowed into bullet points, as well as a compendium of charts and graphs.
One of the primary pleasures of the book is a deeper immersion in the odd twists and turns of culture and history when it comes to the change of life. Whether it’s the creation of the word itself, coined in 1812 by a French physician named Dr. Charles-Pierre-Louis de Gardanne, or the explosion of historical guides written to “help” women navigate their evolving bodies. As Gunter writes, some of these books should have been titled: “Being a woman, from bad to worse.”
The way that we treat women in menopause is a reflection of how we view women in larger society, she notes. This has changed over the centuries, again sometimes going from bad to worse, from the ancient Greek idea that women were overly moist (ugh, that word) and that menstruation was a means of shedding a toxic buildup of liquid, to the Freudian notion that menopausal women were just looking for a fight. “Quarrelsome, vexatious and overbearing,” as old Siggy F. put it.
While Freud’s description is questionable, at least he gets right the idea that many women in their later years have simply run out of fucks to give. Gunter is one of them.
The frustration and rage that runs through her book is like an electric current that occasionally shocks, but also illuminates. In shining a direct light on the ways in which women have been bullied, misled or conned, certain industries come in for a right kicking.
In the chapter about the business of supplements, entitled “Menoceuticals,” Gunter takes the gloves off to dispel the idea that pills, potions and homeopathic remedies will remedy hot flashes and insomnia. She doesn’t spare the medical system either, arguing that it is women being ignored or told to suck it up that drives them to the quackery of the wellness industry.
People pushing potions will happily take your money, and menopause with its insecurities makes women uniquely vulnerable to pitchmen and celebrities pushing CBD oils. But as Gunter explains, the supplement industry is largely unregulated, arguably predatory and driven by profit. She closes out this chapter on snake oil, both new and old, stating she expects to receive a lot of hate mail for her efforts.
Part of the mandate of Gunter’s book is to reframe the conversation in order to make menopause not only a natural part of life and human evolutionary biology, but also a source of strength and confidence.
Turns out that language plays a role as an indicator, or more correctly a constructor, of reality. In cultures that don’t have a word for menopause or use a term with a more positive meaning like konenki “renewal of life” in Japanese or overgang in Dutch — which essentially means switching lanes — the transition is perceived to be less onerous.
Other species can offer a different perspective of the evolutionary role of older females. In killer whale pods, menopausal females lead group members to food sources, care for the young and help ensure the survival of the species as a whole. In short: the more grandmothers, the more grandchildren. This holds true for human societies as well.
There are some schools of thought that argue menopause might be partly responsible for the overall success of the human race. Not only do hunter-gatherer grandmothers more than pull their weight in finding food, but they also do double duty with child care, allowing younger women to actually have more children.
The so-called Grandmother Hypothesis suggests another, perhaps even greater, role as older women serve a critical function as knowledge keepers, story tellers and leaders. As women age, a different kind of intelligence emerges. Psychologists term this “crystallized intelligence,” but it just as easily can be called wisdom.
But before we get to be wild, wise matriarchs swimming free, there are hurdles to leap over.
Gunter notes that although there is something of a menopause medical renaissance happening at the moment, many women still have trouble accessing information or effective therapies for a variety of different reasons.
The story of menopausal hormone therapy is a case in point.
The early 1990s was the heyday of hormone therapy, Gunter notes, but fears of increased risk of invasive breast cancer, heart disease and stroke brought on by a faulty study created a panic and curtailed the wider use of this treatment for years. She herself is in favour of MHT treatment if it’s the best option for the woman taking it.
Other treatments like cognitive behavioural therapy can help mitigate some of the challenges of menopause by “creating new pathways in the brain,” Gunter says. “But how do you get this therapy and get the care you need?”
Access to effective treatment isn’t always readily available, and in the Canadian medical system, where dealing with nuanced, complex issues can take time, getting the help you need in a 15-minute appointment is often challenging. She argues that what’s really needed is systemic change as well as more conversations, greater education and more discourse around public health.
In spite of all the challenges, the most surprising aspect of menopause is that it can be great. Although Gunter admits that we hear a lot of horror stories, for many women the experience is liberating. “Imagine if we only heard the worst things about giving birth?” she asks. Many of the symptoms that are most difficult to bear, like hot flashes, brain fog and insomnia, are usually temporary.
Like puberty, menopause can be understood as one system replacing another. It takes time for the new system to come fully online, but when it does, hallelujah. “No more heavy periods, no more packing pads and tampons when you go on a trip. No more menstrual cramps,” she enthuses. While the spectre of sexual irrelevance is, for many women, one of the more awful things, as Gunter explains often it can go the other direction. Without the misery of periods and fear of pregnancy, sexuality can flourish.
Even in casual conversation, many women relate that the menopausal years are some of the most liberated and free. The biological shackles fall away, and you’re left with time and energy to dedicate to other things.
But here is where it gets political. In a period of their lives when they are most unencumbered, keeping women from raising hell takes some doing. The idea that menopause was a period of weakness, fragility and decline chipped away at the idea of women using their newfound liberty to take on larger problems like inequality and misogyny.
Gunter is plainspoken about the indignities that women have been subjected to — lower pay, inequality, lack of child care — and the greater burden of biology that they carry in the face of all this. As she takes pains to note, the continuation of the human race is predicated on women’s ability to give birth and care for children. The final chapter of her book is a clarion, clanging reminder of this fact, as she locates the source of her own simmering rage around this reproductive reckoning.
The final edict throughout her work is that understanding your own body is the ultimate act of empowerment, both personal and political.
“Many women have been conditioned to fear menopause as an expiration date for relevance and as a sign of weakness only because that’s what men thought. In fact, we have this amazing data that tells us menopause is the opposite — a time when historically women contributed great things to society because of their knowledge and their age.”
Old women, your time is now.
Read more: Gender + Sexuality