Jen Gunter says menopause is a heck of a lot less scary when we talk about it
In her new book, the gynecologist aims to help people reclaim their health 'with facts and feminism'
This story was originally published on May 27, 2021.
If Dr. Jen Gunter hadn't become a gynecologist, she would have had plenty of cause to dread menopause.
"My mother's menopause was volcanic," she writes in her new book The Menopause Manifesto. "If that was all I had to go on, I would have been quite frightened."
Fortunately, she had a lot more than that to go on — including a small alphabet's worth of degrees and qualifications. And as she told As It Happens host Carol Off, that wealth of experience has only made her more determined to ensure that others aren't left relying on anecdotal accounts.
"It was a very, very frightening time in my house," she said of her mother's menopausal transition. "It was like the wheels came off ... you just never knew when something was going to enrage her."
But by the time her own menopause was approaching, Gunter said she knew that what was true for her mother wouldn't necessarily be true for her.
"Knowing about all the things that can happen doesn't mean they're all going to happen to you," she said. "But if you know that that's a possibility, then you can be prepared."
In her own case, being prepared also meant something else crucial. "I was never once dismissed," she said.
A history of medical misogyny
Known as Twitter's resident gynecologist, the Winnipeg-born doctor isn't new to writing about vaginal and reproductive health — or the pervasive misconceptions surrounding it. Her 2019 book The Vagina Bible promised to separate "the myth from the medicine" and The Menopause Manifesto picks up where it left off, dismantling menopausal misbeliefs with surgical precision.
"For too long we have been sold this story of weakness, of frailty, of lack of worth, of ovarian failure," Gunter said.
She argues that a lot of the falsehoods that exist around menopause come from the vocabulary that has traditionally been used to describe it.
"Who wants to tell their partner that they've got vaginal atrophy?" she said, referring to one of many historical terms for menopause. "Women are [already] told to be quiet and they're sort of assigned this societal irrelevance with age. So anything that ... reinforces that idea of shrinkage or getting smaller is really doubly harmful here."
Gunter says doctors who questioned wrongheaded wisdom about menopause have likely always existed, but have been dismissed themselves.
"There were some people who believed … menopause wasn't a death and that it was just another phase of life. And it's interesting to me that those physicians, you know, their narrative didn't become the dominant one because it wasn't the belief of the day."
Scientists have begun to address these medical misunderstandings, but Gunter says many of the stereotypes that historically accompanied them endure — even in doctors' offices.
"The patriarchy is writing the narrative," she said. "If you're a menopausal woman and you have shoulder pain, well, it's your uterus. But if you're a man who's 55 and has shoulder pain, well, obviously you worked too hard and injured your shoulder."
Her prescription? Better information
At the same time, Gunter acknowledges that disentangling the medical consequences of menopause from aging is an impossibility for anyone with ovaries.
"You can't have a study of 55-year-old women who are aging and have a control group that have menopause," she said. But knowing what might be a symptom of menopause, specifically — as opposed to aging more broadly — can be extraordinarily helpful.
"So, for example, many women are terrified when they develop brain fog … but knowing that it's [likely] temporary and not a sign of dementia hopefully will be reassuring to a lot of people."
Gunter says it's also important to know which treatments can help address symptoms of menopause and which therapies might, in fact, do harm.
"There are a lot of predatory products, because whenever there's gaps in medicine, predators move in. And there are gaps here."
Gunter is particularly concerned about specialized vitamin cocktails, potentially risky supplements like black cohosh, and compounded hormone therapies that rely on unproven blood and salivary tests.
"When I use my estradiol patch, I know exactly how much is getting into my bloodstream. I know if this dose can protect me from osteoporosis [and] what percentage of hot flashes or flushes will be reduced by this dose. I know exactly what it can do for my body," she said. "If you use a compounded estrogen product … you have none of that data."
Ultimately, Gunter says she believes part of the problem is that general practitioners are expected to complete physicals at breakneck speed.
"Many things can be mitigated," she said. "But you simply cannot sort it out in 15 or 20 minutes."
In praise of post-menopausal life
Despite the many conflicting narratives around menopause throughout its history, there's consensus on one thing: the experience is relatively unique to humans.
Gunter says this is often explained using something called 'The Grandmother Hypothesis.'
"Living beyond your ability to reproduce is helpful to the collective," she said. "A grandmother can forage for food. A grandmother can help with shelter. A grandmother can look after the three-year-old while you're breastfeeding the newborn.
"Obviously I don't want to distil a woman's worth to being a grandmother. But it's important to show us how useful grandmothers were [historically]. They weren't in their dotage. ... They were active, vibrant members of society."
Gunter says explanations like these are one of many reasons the menopause transition is worth celebrating, however uncomfortable it can be at times.
Final copies of The Menopause Manifesto have arrived! <a href="https://t.co/n30fYvPrFL">pic.twitter.com/n30fYvPrFL</a>—@DrJenGunter
Sex may be another.
"For some people, libido can absolutely go down in menopause, but it doesn't for everybody," she said. "Some people actually report a higher libido. Some women who are afraid of their periods and their cramps are like, 'This is awesome.'"
Gunter says she hopes that by helping readers understand their experiences, she might even help them enjoy aspects of their own menopause transitions. But she says The Menopause Manifesto isn't just a book for people experiencing menopause.
"I actually believe every person should read it because the way we are treated in menopause is a reflection of society and we need to change that narrative," she said.
"I hope it helps [readers] see where menopause fits in history. I hope it makes them see that menopause is a sign of strength. The fact that we evolved to live beyond our ovarian function and other animals didn't says something about our strength."
Written and produced by Chloe Shantz-Hilkes