The Menopause Manifesto: Own Your Health with Facts and Feminism

by Jen Gunter

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.

Feminism can help women see the biases that may have informed previous beliefs and reframe their menopause not as a terminal event, but as another phase of life.

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

When menopause is discussed in Western society, it’s often viewed negatively, as a cruel joke or even as a disease. This stems from the harmful belief that women lose value once they are no long 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.

Despite the universal nature of menopause, many women aren’t well informed about the symptoms, the physical changes, the medical concerns, or their treatment options. This information vacuum has been created by a toxic combination of medical providers being unable to meet the educational needs of their patients (medicine has some serious communication issues) and medical misogyny, meaning medicine’s long history of neglecting women.

Quality of life concerns aren’t trite; it’s medicine.

Trauma literally rewires the brain and the body.

Women are so much more than just their ovaries, so it’s important to sit back and look at the whole picture for perspective.

most physicians of the day were hampered by their belief that women were an inferior version of men as well as by their lack of knowledge of female anatomy and a complete lack of understanding of menstruation.

If you see women as inferior or weak or dirty or damaged, it’s easy to make the medical knowledge, such as it was, fit your world order.

It is a very important lesson that we in medicine should never forget.

(As an aside, I dislike the term “hot flashes,” which is used interchangeably with hot flushes, because a flash evokes a sensation that lasts for a second or two, and that isn’t accurate—and for me that can downgrade the severity of the experience.)

As most of what women experienced was passed down by oral tradition, it’s hard to know how many words in how many cultures have been lost due to disinterest or medical mansplaining—meaning let me listen to you, interpret your experience with my narrow view and the biases of society and religious beliefs, and explain it back to you in my medical textbook.

Many medical textbooks from the time of De Gardanne were like his—short on medicine, but dripping with patriarchy.

It’s a fascinating look at how language isn’t a passive descriptor; rather, it’s an active participant. Words influence our thoughts.

Now imagine a world where we said men were in erectopause?

The term menopause came to be before science knew hormones existed. It was never meant to signify a pause. It was invented by a man who felt women should cover their arms and not wear blush—whose book on the subject contributed nothing valuable to the body of knowledge except it left a term that ties women forever to menstruation. The word menopause was then weaponized by the pharmaceutical industry and transformed from troublesome phase of life into a lifelong disease that affected every woman. And not just any disease, the worst kind of disease—one that made women undesirable to men. It’s not a great origin story. The word menopause is due for an update.

At this point the fetal ovaries and testicles (also called testes) are identical structures. If there’s a Y chromosome the tissue receives signaling to develop into a testicle, and without the Y chromosome the tissue becomes an ovary. Yes, the ovary is the default.

There is a lot of irony here as many “origin of man” stories, whether it is Eve or Pandora (the first woman in Greek mythology), have women coming after men and/or being made from man.

There are likely many factors that contributed to this American oophorectomy epidemic at the time of hysterectomy including out-of-date practices, a patriarchal “doctors know best” attitude, a cavalier approach regarding MHT fixing everything, racism, and fear of litigation regarding missed ovarian cancer.

Surgical removal of the ovaries under the age of sixty-five is associated with an increased risk of mortality, and the younger the age the greater the risk.

Sometimes it can seem as if your body is a car with a new and completely different warning light that appears each day. An unwelcome exercise in, “Oh what now? ”

At times it feels like the essence of being a woman is to be in a constant state of apologizing for your body.

Many women have had their health concerns dismissed because they were overweight. Not only is that cruel, it leads to substandard and inadequate medical care and disenfranchisement with the health care system, which turns women away from medical care.

This progressive loss of muscle mass is responsible for what many call the slowing of the metabolism with age. Muscles are a major source of energy consumption, so the calories in/out equation becomes imbalanced when muscle mass decreases if the same amount of calories are consumed. Loss of muscle mass is also associated with insulin resistance, a condition where the body doesn’t respond appropriately to insulin. This causes the body to produce more insulin to compensate, increasing hunger and also leading to weight gain. The combination of insulin resistance and weight gain due to loss of muscle mass is one of the reasons menopause increases a woman’s risk of type 2 diabetes.

The best way to slow the decline of muscle mass, and even reverse some of the loss, is through physical activity.

Physical activity doesn’t just preserve muscle mass, it’s linked with a myriad of other positive health outcomes, such as lower rates of heart disease and stroke, reduced rates of type 2 diabetes, improvement of glucose control for people with diabetes, reduction in many cancers, a lower risk of dementia, as well as benefits to the immune system.

exercise is like free money. Even a little is good.

According to the National Institutes of Health (NIH) a waist circumference of ≥88 centimeters (35 inches) for a woman is abdominal obesity. Each 1 cm (0.4 inch) increase in waist circumference over 88 cm (35 inches) increases the risk of cardiovascular disease by 2 percent.

Common themes with successful weight loss plans:

ATTENTION TO FOOD CONSUMPTION:

COOKING AT HOME:

LITTLE TO NO ULTRA-PROCESSED FOODS:

Women who developed diabetes during pregnancy (gestational diabetes), or high blood pressure during pregnancy, are also at increased risk for CVD.

Unfortunately women typically receive less counseling than men about risk factors for CVD and what they can do preventative-health wise, only further compounding CVD risks for women.

Normal results for lipid screening tests are as follows: • Cholesterol 125–200 mg/dL • HDL ≥40 mg/dL • LDL <100 mg/dL • Triglycerides: < 150 mg/dL (normal), 150–199 mg/dL (borderline high)

42 percent of women die within one year of a heart attack versus 24 percent of men.

But often it’s death by misogyny.

Almost two of every three physicians don’t recognize these symptoms that are more typically experienced by women as a potential sign of a heart attack.

For example, for many women the pain of menstrual cramps is worse than the pain of a heart attack—after all, the force generated by the uterus during menstrual cramps is the same as the force generated during the second stage of labor.

Yet, women with menstrual cramps are somehow viewed as weak and complainers. It’s systemic gaslighting

when women are excluded from studies we don’t learn about these differences and we miss crucial and potentially life-saving information.

The standard angiogram is better suited to evaluating large arteries, but for women the smaller arteries are a frequent cause of heart attacks (this is called microvascular heart disease).

So a woman with chest pain may erroneously get the all-clear because her larger arteries checked out when really there is a major concern with her small arteries that has been missed.

Women with persistent chest pain or other symptoms of a heart attack and a negative angiogram may wish to make sure their cardiologist has expertise treating women so microvascu...

“If you’d just lose weight” isn’t appropriate medical therapy nor is it compassionate, and the horrible implication is some women deserve their symptoms.

Every person who downplays the ongoing mental wear and tear of irregular bleeding should be required to wear a contraption attached to their pelvis for a couple of years that intermittently leaks blood, and then they can get back with me about whether it’s really that bad.

Hysterectomy rates are higher in the United States versus other industrialized countries. While some of this is driven by some gynecologists who recommend surgery over medical therapies and even racism, some women simply want a hysterectomy because they want to be “done with it” bleeding-wise.

Given the bizarre American system, the copayments to treat the bleeding with medication could be higher than the copayment for a hysterectomy, so some women are financially incentivized for surgery.