Book Reviews

The Menopause Manifesto by Dr. Jen Gunter

I didn’t expect this book to make me cry, but it did. Specifically, I got teary when I was reading the introduction and came across this sentence: “It shouldn’t require an act of feminism to know how your body works, but it does.” I felt equal parts furious, seen, and relieved when I read that.

When The Vagina Bible was released a couple of years ago, I devoured it, paying special attention to the section about menopause. That was just after I’d turned 40, and I’d recently started getting night sweats with my PMS. I was craving information and my mom was no help, since she didn’t notice menopause at all. Me? I was NOTICING and wondered what fresh hell was up next. But even The Vagina Bible, amazing as it is, didn’t offer enough information to help me feel like I knew what to do about my menopause transition (the time between symptoms first showing up and the one-year anniversary of the final menstrual period). I was thrilled when The Menopause Manifesto was announced. It’s everything I wanted and, even better, it’s exactly what I needed.

The Menopause Manifesto is equal parts medical guide and manifesto. Alongside evidence-based information about what menopause does to the body and about current interventions, we also learn about the many ways misogyny and the patriarchy have been harming women and those who were assigned female at birth.

For example, did you know that menstrual cramps can be more painful for some women than a heart attack? I sure did not. Because mainstream understanding of heart attack presentation is based on men and people who were assigned male at birth, women too often have their heart attacks brushed aside as anxiety or hot flushes. I was screaming (in my heart, as we are still in the quarantimes) when I saw this comment: “It’s systemic gaslighting and it makes me want to scream.”

The no-bullshit approach to delivering information worked very well for me. For example, that chapter about heart disease? Its opening line says:

One woman dies every minute from cardiovascular disease.

Do I have your attention? Good.

YES, DR. JEN, YOU HAVE MY ATTENTION. But also, I agree that that’s a good thing. Before reading The Menopause Manifesto, I’d had no idea that cardiovascular disease was the number one cause of death in women or what I can do about it. Now I know that I need to go for those regular, recommended blood tests instead of letting my bloodwork slide like I sometimes do.

Similarly, the chapter called “Bone Health: The Basics of Bone Biology, Osteoporosis, and Preventing Fractures” opens with:

“I am here to scare you about osteoporosis,” was the opening line from a lecture I attended in 2019. I couldn’t have put it better, so I, too, am here to scare you about your bone health and osteoporosis.

And guess what? That was exactly correct too! Not only was I scared about osteoporosis, but I now understand exactly WHY I should be scared about it (mainly because it’s dangerous, it’s preventable, and hip fractures past the age of 65 can be disastrous). Dr. Jen shares that her own mother’s osteoporosis was so bad when she was alive that she fractured her kneecap by simply brushing her knee against a wall. I haven’t been able to stop thinking about that story and, since reading it, have been more diligent about including strength training alongside the cardiovascular exercise I’d already been doing.

While those two chapters grabbed me by the face and made me take notice, they never felt disproportionately alarmist, nor abusive or shaming of the reader. These are massive problems and too many of us don’t know what, if anything, we can do about them—and that’s only if we’re aware that they’re problems in the first place. I walked away from The Menopause Manifesto feeling empowered because I had several new choices I was able to put into action right away.

I also appreciated the approach to interrogating the various interventions that are available now. Menopausal hormonal therapy is explained thoroughly, but not pushed as a cure-all (although we learn about time periods when they were). I learned about the available hormonal options, when it makes sense to consider them, and what the tradeoffs might be for patches vs rings vs pills. I actually feel equipped to have a conversation with my doctor if/when the bother factor on my night sweats get too high. And when it comes to “menoceuticals” (i.e. supplements), I’ll avoid black cohosh, now that I know it can cause liver damage.

I was also pleasantly surprised to learn how effective cognitive behavioural therapy can be for things like hot flushes and have since adopted a mantra for whenever mine show up: this is just my superpower manifesting and it will pass in a few minutes. Is that mantra silly? A bit. But it works and it’s taken my stress around hot flushes away, so I’ll keep saying it to myself while stripping off my hoodie.

One of the most fun aspects of The Menopause Manifesto is the history of menopause, how it was understood, and how it was described in historical texts. For example, the menopause transition was known in the 18th and 19th centuries in England as “the dodge”, because women were perceived to be dodging between irregular periods. I’d challenge you to tell me that that isn’t the best, but I know you can’t, because it’s objectively awesome. Or how about the 16th century term for hot flushes, “hot bloom”? Also excellent and a really lovely expression for a super annoying experience.

If your field of fucks is completely barren and you just want some straightforward, evidence-based information served with a healthy dose of snark and the occasional jab at pseudoscience and Gwyneth Paltrow, this will be the book for you. It’s comprehensive and empowering without being overwhelming, and explains so much of the WTF? that is confusing and mysterious about menopause.

Remember that line that made me cry from the introduction? Well, it’s immediately followed by this:

And it seems there is no greater act of feminism than speaking up about a menopasual body in a patriarchal society.

So let’s make some noise.

Since reading The Menopause Manifesto, I’ve been making a whole lot of noise. Come join me.

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