The Menopause Manifesto: Own Your Health with Facts and Feminism

by Jen Gunter

In medicine, men get to age with gentle euphemisms and women get exiled to Not Hotsville.

Life expectancy has increased significantly over the years for both women and men. This is primarily due to more children surviving the first year of life as the result of sanitation, basic medical care, and vaccines. Until relatively recently in human history, the death rate in the first year of life was very high—at times 50 percent.

Historically, if you made it past your first birthday your odds at living a long life jumped dramatically.

for much of our recorded history maternal mortality wasn’t likely higher than 1 percent or 2 percent.

We know women lived beyond the age of fifty, otherwise ancient Greek and Roman physicians wouldn’t have been able to accurately record the average age of menopause.

Before the advent of modern sanitation and medicine, women who lived to the age of forty-five likely had a life expectancy of sixty-five to seventy years, much like men.

What sanitation, improved nutrition, and medicine appear to have given women as well as men are more years beyond seventy.

Today in the United States a forty-five-year-old-woman can expect to live to almost eighty-three years, three years longer than a forty-five-year-old man.

But after menopause, women can still protect their genetic legacy by contributing to the survival of their grandchildren.

The evolutionary advantage of menopause is grandmothers.

Intelligence and being able to walk upright, freeing hands for other tasks, have both conferred huge evolutionary advantages. The problem? Fitting the large fetal head needed for intelligence through the small pelvis we require to be bipedal.

The most helpful grandmother hasn’t recently finished with her reproduction; she’s enough years from childbearing that she can leave her own offspring unattended.

the grandmother effect disappeared with distance. If a grandmother’s daughter or son lived close by, they had almost two more grandchildren compared with those who moved away.

For each decade a grandmother lived beyond the age of fifty, she had two additional grandchildren.

in hunter-gatherer societies most of the family nutrition was supplied by foraging, and grandmothers excelled at this task.

Fluid intelligence includes thinking quickly, rapid recall, and multitasking, and peaks in our twenties and thirties. As we approach middle age, crystallized intelligence develops, which is how we use what we have learned and the practical application of that knowledge.

So the question should not be why does ovarian function and consequently fertility have a hard stop around fifty? Instead the question we should consider is how did women become so physically successful that they began to live beyond their reproductive capacity?

What the grandmother hypothesis should do is give society a kick in the ass about the worth of women in menopause.

By the time a woman enters her menopause transition she has likely absorbed a lifetime of toxic messaging about her size and shape.

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

It fascinates me that we don’t think less of ourselves because we can’t play soccer like Megan Rapinoe or perform gravity-defying gymnastics like Simone Biles. I suspect many women are like me and marvel at what these women have accomplished with hard work and probably genetics. And yet if our bodies don’t look like Jennifer Lopez at fifty—who also looks the way she does because of hard work and genetics—we feel judged by society.

If exercise were a medication, every health care provider would be prescribing it and almost every patient would want it. After quitting smoking, exercise is the single greatest health intervention.

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

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.

many harmful cultural narratives tie a woman’s competence to her hormones.

When women are expected to be less competent with age there is no urgency to report troubling symptoms, so women may suffer in silence thinking what is happening is normal.

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

This doesn’t mean that women’s brains are unable to function without estrogen. Girls have amazing, capable brains before they enter puberty and many women who never take estrogen continue to achieve great things after their final menstrual period.

men with memory tasks before menopause, but during the menopause transition and afterward that advantage became less apparent. This point feels important enough to emphasize. Yes there is a temporary change, but even with that change women still out-performed men.

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

the normal sexual response of many women has been medicalized and turned into a disease and the only way to treat it is with medications.

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

Low sexual desire can’t use a medical model, like appendicitis. After all, whether your partner is attentive to your appendix, whether you can talk with your partner about your appendix, and how your partner speaks with you, and whether your partner does their fair share around the house don’t influence whether or not you get appendicitis.

Desire, it turns out, isn’t always spontaneous and it isn’t the only reason people engage in sex.

Spontaneous desire or libido may be a reason some people have sex, but people may also decide to engage in physical intimacy for reasons other than desire—for example, comfort, or satisfying their partner—and then once things get started desire kicks in. Desire often comes after arousal and it’s important to normalize this arousal-then-desire experience.

When a medication exists for hot flushes—even if you don’t want to take that medication—it vindicates the ones that you’re experiencing. Many of my own patients told me they suffered at home because they believed hormones weren’t safe, so I never even had the chance to have a conversation with them about their bodies, to try to put the risks of estrogen in perspective, or to consider other nonhormonal options which were becoming more available.

Women who started MHT within ten years of their final menstrual period actually had a lower than expected risk of coronary heart disease, and those who started ten or more years after their final menstrual period displayed a slightly increased risk. Women using MHT between the ages of fifty and fifty-nine also had a 30 percent lower risk of dying versus those women given placebo.

Explain this issue to women. It took me less than 200 words in the preceding paragraph. Women are very capable of understanding risk. After all, most are familiar with weighing whether they should walk down a specific street at night or whether it’s better to take the bus.

Medications for erectile dysfunction cause blindness for 3 out of every 100,000 men who take them, and yet society trusts men to decide if those risks are worth it.

When we say it’s acceptable for a woman to assume the risk of a VTE with pregnancy and not assume a lower risk than that with MHT, what are we saying about the worth of women? That as long as she’s in servitude to her uterus the risk is acceptable and once her natural resources have been consumed by society her health concerns are barely worth a mention? Because that is exactly what it sounds like to me.

women need medicine, not marketing.

In 2015 the New York State attorney general investigated herbal products sold at GNC, Target, Walmart, and Walgreens, and 80 percent of the products didn’t contain any of the herbs on the labels.

To me studying all therapies regardless of source is an act of feminism, because women can only be empowered about their health with accurate information.

We don’t accept the Hippocratic understanding of a woman’s body being too moist, so why wouldn’t we turn that same critical eye to all of historical medicine?

Lydia Pinkham’s Vegetable Compound for ailments peculiar to women,

Pinkham’s Vegetable Compound was tested in 1911 and the results published in the British Medical Journal—it was 19.3 percent alcohol, which is the same alcohol content of most port wine for reference. (I know, right?!) No evidence of any active substances was identified.

A large clinical trial that followed over 13,000 women ages fifty-five years and older found taking a 1 g omega-3 supplement (the brand Omacor, a prescription fish oil supplement) reduced heart attacks by 40 percent for White women who had less than one and a half servings of fish per week in their diet and by 77 percent for African American women regardless of fish intake.

For many women, an omega-3 supplement of 1 g a day makes good sense.

WHAT DOES THE OFFICE OF DIETARY SUPPLEMENTS AT THE NATIONAL INSTITUTE OF HEALTH RECOMMEND? You can find out at ods.od. nih.gov.

• IF YOU DO TAKE A SUPPLEMENT, LOOK FOR ONE THAT HAS BEEN VERIFIED BY AN INDEPENDENT AGENCY FOR PURITY: Look for products with a seal of approval from one of three independent agencies—NSF International, US Pharmacopeia (USP), or ConsumerLab—that