The Menopause Manifesto: Own Your Health with Facts and Feminism

by Jen Gunter

Estrogen is a major player in bone formation, so the time of most rapid bone loss starts approximately one year before the final menstrual period, lasting about three years.

If a woman aged sixty-five years or older is living independently and breaks her hip, one year later she has a 50 percent chance of being unable to live independently, a 40 percent risk of being unable to walk independently, and a 30 percent chance of no longer being able to get in and out of a bath. And the odds she will die by the time the year has passed are 17 percent.

A woman is far more likely to get her screening mammogram than her screening for osteoporosis, and most women who have a hip fracture—an event that should trigger therapy for osteoporosis—don’t get the right follow-up.

Perhaps society just expects women to get frail, so why be concerned about something that’s “normal”?

Maybe the needs of women as they age are irrelevant when society decides they’re no longer hot enough so they should just be quiet and accept their dotage?

Even if women have concerns or are aware of their risks, they may not feel a space has been created for discussion.

Making changes in your seventies and eighties is hard—being stubborn is probably one reason many people live that long.

Making your home safer in your seventies and eighties can feel as if you’re giving in to aging, while making these same changes in your fifties and sixties (or even earlier) can feel as if you are taking charge and being proactive.

Screening for osteoporosis with a DXA is recommended at least once for all women at age sixty-five, when a follow-up evaluation is needed depends on several factors. If at sixty-five a woman has a normal bone density (a T score of -1 or higher) or mild bone loss (a T score of -1.01 to -1.49) her chance of developing osteoporosis in the next 15 years is less than 10 percent. However, women with moderate bone loss (T score of -1.50 to -1.99) or advanced bone loss (-2.00 to -2.4) are at risk for developing osteoporosis within a few years and may need repeat testing in 1–5 years (this depends on a variety of factors and is beyond our scope here).

Women ages nineteen to fifty need 1,000 mg of calcium a day, and women fifty-one years and older should get 1,200 mg. For some women dairy may be that source, but fortified soy or almond milk, sardines, tofu, canned salmon with bones, turnip greens, chia seeds, kale, bok choi, and figs are also good sources.

The way society amplifies rare complications of life-saving therapies for women yet ignores complications when it’s about amplifying the glory of the penis is exhausting and harms women.

Judging women by their hormones is the ultimate ad hominem attack, or perhaps a better term is an “ad feminem” attack, and it’s this character assassination that is the core tenet of the patriarchy.

For example, estrogen increases blood flow to the brain, enhances brain metabolism (meaning how the brain receives and uses chemicals and nutrients), and improves brain connectivity (how the different regions of the brain communicate and coordinate with each other).

Estrogen even helps clear beta-amyloid deposits (proteins that contribute to the development of Alzheimer’s).

Estrogen also boosts activity of serotonin, an important neurotransmitter involved in mood and in the signaling required for some aspect...

Hormonal changes with delivery repurpose many functions to this new, all-important task—infant survival. This is why many mothers feel they have baby brain, and they’re not wrong. It’s not that they are less capable but rather the brain has shifted resources to become hyper-focused on one specific and evolutionarily vital task—survival of their baby.

These menopause transition changes in brain functioning are temporary and disappear once the menopause transition is over.

The way we think about menopause feels like an exercise in confirmation bias about the supposed ineptitude of older women.

Genetics also increase the risk of Alzheimer’s disease, specifically a gene called APOE4, which appears to raise the risk for women even more than men.

The APOE gene provides instructions for making a protein called apolipoprotein E. There are several versions of the APOE gene, and people who inherit the version called APOE4 are at higher risk of developing Alzheimer’s, and there appears to be an interaction between APOE4 and estrogen that increases the vulnerability of younger women to Alzheimer’s during the first few years of postmenopause.

amyloid plaques, which are seen with Alzheimer’s disease and show up on brain scan years before symptoms.

It’s a penis, not a magic wand.

If wipes were about genital hygiene and not oppressing women, then there would be shelves of these products for men with scents such as Dick’s Delight, Sunset Escape, and Puppy Paws.

Women deserve better. It’s shameful when you consider that women have borne a huge burden from undertested medical devices—from

a typical pathway for devices like these is low-quality studies (which don’t offer the kinds of conclusions we want to have before exposing women to this therapy) are generated from the off-label use.

Women are constantly expected to tolerate the consequences of their biology, and it’s unacceptable.

This backstory is important, because sexual difficulties are common, but a difficulty doesn’t make something dysfunctional or a disease.

The reality of women’s sexuality has been fictionalized to serve a patriarchal script and medicalized to support pharmaceutical industries.

A medical model doesn’t work well for desire because the reasons people engage in sex are complicated, numerous, individual, ...

This is a good place to add that the patriarchy hurts men as well as women, because men who don’t follow the always thinking about sex and always ready model are viewed as being lesser, when they are just following the sexual script that works for them.

Catchy science-ish phrases require constant vigilance, because they are most often hype that originated in a marketing department, not health.

This is a great example of how the word “natural” can be absurd because the least natural thing is for a woman in menopause to have a menstrual period. In Feminine Forever, Dr. Wilson wrote that a period was a “token of femininity.” Yes, a menstrual period was a curse until menopause—when it becomes a blessing and a sign of being desirable to men. This constant moving of the goal posts is enraging. A woman’s body can simply never be just right.

BEFORE WE GET TO THE hormone talk, it’s important to remember the three healthiest things a woman can do for her menopause have nothing to do with menopausal hormone therapy (MHT)—they are quitting smoking, getting the recommended amount of exercise, and eating a diet that meets nutritional needs. While MHT can help many women with quality of life and sometimes longevity, greater gains can be made with these other changes. This doesn’t mean women shouldn’t use MHT; rather, it’s important to put the benefits of MHT into perspective as it’s only one piece of the menopause puzzle.

Women don’t have to be postmenopausal to start; remember, symptoms of menopause can start years before the final menstrual period (FMP) during the menopause transition.

Women ages forty to fifty-nine have the highest rate of depression (12.3 percent).

phenomenon known as the first pass

Most of the medications absorbed through the intestine enter a specific group of blood vessels that head directly to the liver for processing and from there head to the bloodstream. So the liver gets the first pass at the medication. With transdermal delivery the estrogens enter directly into the bloodstream through the skin or from the vagina, so when the hormone reaches the liver it has been diluted by the greater volume of blood in the body.

The first pass effect means the liver sees a much larger dose of the hormone with oral therapy as comp...

When estradiol is taken by mouth the liver converts most of it to estrone.

While estrone is a weaker estrogen, it triggers the liver to make more proteins that cause the blood to clot, hence the increased risk of clots with oral estrogens.

It’s not the dietary conundrum that it first appears to be as there are some core similarities between these traditional diets—no processed foods, low in added sugar, lots of vegetables, and fish.

Humans are pretty efficient omnivores, and perhaps as long as the diet is balanced and has the core important elements, we can otherwise adapt to what is made locally.

it’s important to compare not just levels, but absorption and impact on tissues. It’s also important to know that some foods that don’t have any natural estrogen or activity could be contaminated with estrogenic mycotoxins.

when there are scary headlines about food, it’s important to step back from the panic and make sure there’s perspective.

Natural food is unchanged from its form in nature—think

Anything that changes the fundamental nature of the food, from freezing to pasteurization to adding sugar, is processing.

Ultra-processed foods are the health issue. Although the definition has changed slightly over the years, these foods are typically thought of as industrial formulations, meaning they have ingredients other than salt, sugar, and fats not typically used in home cooking.

Some definitions have also included food with five or more ingredients

Ultra-processed foods account for 58 percent of dietary energy consumed in America and 90 ...

Eliminating ultra-processed foods in America can be a privilege. Due to social determinants of health and structural racism, many people live in neighborhoods where access to fresh foods may be limited.