Dr. Jennifer Gunter, an obstetrician/gynecologist, bestselling author and force of nature on social media, where she advocates for women’s health while taking down trolls with her razor-sharp commentary, has heard it all from her patients. Now, she is reshaping the menopause conversation with her groundbreaking book, The Menopause Manifesto. Here’s what she has to say about where the negative cultural attitudes about menopause come from, and how we can empower ourselves and take charge of our health.
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In your book, you make an interesting comparison of menopause to puberty — how are the two life passages treated differently?
Dr. Jen: Entering the transition into menopause is in many ways like puberty in reverse — a transition from one biological phase of ovarian function to another, but the way we view these two events couldn’t be more different. Puberty is frequently a subject, or at least a costar, in teen novels (thank God for Judy Blume!). It’s often covered, the basics at least, in school biology curriculums and sex education. A coming of age — transitioning from childhood to teen or adult — is commonly celebrated or at least acknowledged in multiple cultures and/or religions.
In contrast, there are no coming-of-age stories for women in menopause, and the rare times when menopause is alluded to it seems ubiquitously negative. Even though menopause is a universal experience for every woman with ovaries who lives long enough, unlike puberty, menopause is shrouded in secrecy. There is no menopause curriculum in schools, and providers rarely discuss it in advance. When menopause is discussed in Western society, it’s often viewed negatively, as a cruel joke or even a disease. Menopause deserves at least the same attention as puberty (I’d even argue more), and menopause is no more a disease than being a man is a disease.
Sheesh! Where do you think all this negativity comes from?
Dr. Jen: I believe it stems from the harmful belief that women lose value once they are no longer able to reproduce, and the false hypothesis that menopause is a biological flaw as there is no equivalent for men who can make sperm into their old age. But if you look at that argument from another angle, we might as well say that cisgender men are biologically flawed because they can’t get pregnant, or because they develop heart disease earlier than women. Comparing the ovaries with the testicles is as valuable as comparing the heart with the liver. They are different organs! Just as the liver isn’t diseased or weak because it doesn’t beat like the heart, ovaries aren’t diseased or weak because they stop making estrogen.
In describing menopause it’s not uncommon for textbooks and articles to use the word “exhausted” when there are no more follicles capable of ovulating, but the ovaries aren’t exhausted, tired or used up. It’s not as if they started a race and had to stop due to injury or inadequate training. Ovulation ends when it ends because that’s the plan. If we applied that same tone to erectile dysfunction, we’d expect textbooks to declare that the penis is worn out. In medicine, men get to age with gentle euphemisms and women get exiled to Not Hotsville. Generations of medical professionals were trained with this language, and many have likely used these same words when talking to their patients — and that needs to change.
You always hear, “no one talks about menopause.” Why are women hesitant to ask their health care providers about it, or even discuss it among themselves? Is it because they don’t want to own it?
Dr. Jen: Possibly they are unsure of the facts, so are less likely to share with friends. Some may falsely assume most of the therapies are ineffective or unsafe, or even that there are no treatments available. There has been a lot of destructive messaging about therapies for menopause in the press and from so-called influencers, but it’s also very important to acknowledge that many women have been inappropriately dismissed by their medical providers when they have sought help for symptoms of menopause. So, you can see how people get to the point of thinking: why should I even bother.
In addition, unlike your first period, the final menstrual period feels like a dotage date —and who wants to be 48 and making plans for either graduating to a plucky lady detective who is forced to pass off her competence as a series of fortunate breaks, a vindictive matriarch exacting retribution for her societal impotence on all who cross her path, or a recluse with an ever-increasing assortment of cats with questionable litter box skills? Our society makes menopause sound so awful, and who wants to talk about joining Team Failed Ovaries?
Why is it so important to help women view menopause differently?
Dr. Jen: 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 don’t receive important health screenings or therapies because they have been dismissed with platitudes like “This is just part of being a woman,” or “It’s not that bad.” So it’s vital to break this taboo and get everyone educated, doctors and the public alike, so people can get help if they are suffering, and they can avail themselves of the right preventative care.
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. Not only is there no whisper network to take up the slack from medicine, but there are few spaces to offer comfort, kinship and opportunities to talk about what is happening to their body.
It’s so important to talk about menopause, so women can understand how and why their body is changing. We need to be done with that false narrative of “ovarian failure” and “menopause as a disease.” Knowing that menopause is likely an evolutionary adaptation that helped with human evolution and that our ancestral grandmothers were productive members of society makes menopause look very different from the patriarchal narrative we are saddled with today.
What do you wish women knew about menopause and getting older in general?
Dr. Jen: Women often only hear the awful stories about menopause, but the truth is the menopause experience is diverse. Many women have mild symptoms, some moderate, and others severe. Often these symptoms are temporary, and for many they are the most bothersome or problematic during the menopause transition, but occasionally they’re long-lasting. And if you are someone with symptoms, there are therapies to help.
Women also need to know that menopause does start a series of biological events that increase a woman’s risk of several medical conditions, such as cardiovascular disease and osteoporosis. But menopause isn’t the only paint on a woman’s canvas. Age, other medical conditions, diet, exercise, and even adverse childhood events are also adding color to her portrait. So, when a woman wants to consider what she should do, it’s important to step back and look at the whole picture. Managing menopause is the ultimate exercise in whole body or holistic medicine. One of the most helpful things a woman can do for her menopause, besides getting educated, is weight-bearing exercise and resistance training. Exercise is good for your bones, muscles, heart and brain!
And finally, menopause is not a disease. It is an evolutionary adaptation that is part of our survival and success as a species, like opposable thumbs or the ability to walk upright. It’s vital that women know this about menopause, but also about everything that’s menopause adjacent, so they can understand what is happening to their own bodies, put that in perspective and advocate for care when needed.
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