I AM only 37 and I have experienced the menopause multiple times. Drugs for IVF and endometriosis paused my hormonal cycles on five separate occasions, placing me in what doctors call “artificial menopause”.
But there was nothing artificial about the symptoms – the hot flushes that burned deep inside my core at 2 am were a particular shock. So when I came across The Menopause Manifesto, written by gynaecologist Jen Gunter, I jumped at the chance to learn more about what was in store when the real thing hits.
Despite the universal nature of menopause for half the planet’s population, few of us are fully informed about the symptoms, physical changes, medical concerns or treatment options.
According to Gunter, this information vacuum is largely down to medical misogyny. Indeed, medicine’s long history of neglecting women means that menopause concerns are still too often dismissed as fabricated, unimportant or just “part of being a woman”.
Gunter’s ambition is to change this conversation, which is worthy in all the right ways. Menopause shouldn’t be a fringe part of women’s healthcare: aside from quality of life issues, social impact and physical symptoms, there is its link to cardiovascular disease. This is responsible for 1 in 3 female deaths each year – more than die from breast cancer.
So it turns out that my 2 am “hot blooms” (as I find they would have been called in the 18th century) are the least of it. Women can also expect abnormal bleeding, temporary cognitive changes, vaginal dryness, pain during sex, decreased libido and joint pain. Not to mention the increased risk of osteoporosis, dementia, metabolic syndrome (a combination of diabetes, high blood pressure and obesity), type 2 diabetes and urinary tract infections. Sound like something you should know about?
“We don’t define men as they age by an obvious physical change in their reproductive function”
Gunter’s teaching of the history and biology around menopause is second to none. Her opinions on the societal lens through which we view the menopause are just as interesting. She highlights the fact that it is misogynistic to tie a description for a third of a woman’s life to the function of her uterus and ovaries. We don’t define men as they age by an obvious physical change in their reproductive function, she points out. Yes, the menopause is a marker for increased risk of heart disease for women, but so, too, she says, is erectile dysfunction for men. Imagine a world with men in what she calls the “erectopause”.
Running throughout the book is a wealth of information on the physiological processes at play during a woman’s life. While it could do with a little pruning, it can’t fail to leave you feeling completely wised up, without veering into a biology lesson.
As a gynaecologist, Gunter also has the authority to provide vital information on treatments, from traditional hormone replacement therapies (HRT) to alternative medicines. She also shows us where we may be led astray by celebrity endorsements of natural remedies, and by “compound” therapies – treatments that resemble traditional HRT, but which remain largely unregulated and untested, she says.
There is information on drugs like fezolinetant, too, which look promising for hot flushes. My copy has many page corners turned over – things I plan to ask my doctor, now and later.
“I am here to scare you about osteoporosis,” Gunter says in one chapter. It isn’t the only scary thing she reveals about this future time in my life, but at least I am now better prepared, have the confidence to know what to ask, and feel able to have a more grown-up conversation.
Gunter promises to give women strength, value, agency and knowledge to help them through this transition in their life. She has unquestionably achieved that.