Menopause Manifesto Reviewed (Guest Post)

by Alexis Shotwell

The Menopause Manifesto isn’t a manifesto. It would perhaps have been better for Dr. Jen Gunter, author of The Vagina Bible, to follow her previous branding and call this second book something like The Menopause Bible – which invokes a lot of information and story about which there is the need for interpretation, debate, and critique as a key part of faith.

I am really excited by the increasing number of books and blogs talking openly about hormone transitions of all sorts, and how they can be made less bad. I’m a feminist who studies transformations in medical practice, and I came into this book ready to cheer for anyone attacking medical sexism, especially the specific form that sexism takes in how it talks about menopause. I’m a nerd and I love there being uncountably many books about stuff I’m interested in. I’m an easy sell!

So, I’m disappointed in how strongly I cannot recommend this book to you. I was about to write, “to you feminist readers of this blog who think critically about fitness, many of whom are nonbinary, or trans women, or fat, or disabled, or asexual, or cancer survivors, or not parents, or all those things at once.” But really, having to put all those caveats in means that pretty much wherever you land on these matrices of experience the book will stab you on one of your other vectors of awesomeness.

My impulse to say: “If you’re thin, cis, straight, monogamously coupled, have had no problems having and bearing children, never had chemo related early menopause, and if you’re otherwise are this book’s normal, you can read this book” is actually really awful. I know that the particular brand of liberal feminism that means you can write a whole book, with the best will in the world, as though all the rest of us are sidenotes, actually doesn’t help even people in the supposed centre of the frame.

And I believe that Gunter really, really means well! She has taken on Goop around its antiscience grifting, the Toronto Star about bad medical reporting, and regularly engages various randos on the internet about health generally. The Menopause Manifesto has some great parts. Gunter is very sympathetic to taking hormones, especially in the perimenopausal years when they can actually help with vasomotor symptoms (hot flashes and night sweats, for example), and so she has detailed accounts of various hormone options and what they do. So those chapters will be helpful if you’re in perimenopause, having those symptoms, and interested in hormone therapy to help with them – it explains a lot.

The other very great part of the book is a list of signals for when to walk out of a doctor’s office around menopause stuff, because these things indicate that they are either quacks or so behind the science as to be potentially harmful to you. That list includes:

• salivary hormone level tests
• hormone level testing to guide therapy
• recommending only hormone therapy and not the other things that can help menopause symptoms
• prescribing topical progesterone cream to offset the dangers of transdermal or oral estrogen
•  selling supplements or products.

(Re this last one, here is your reminder that it’s always a good time to read or reread Middlemarch and to reflect on the long history of people trying to practice integrity and care, including in and around medicine.)

 But one of *my* signals for when to walk out of a doctor’s office, unless there are really really specific conditions that actually involve weight, is when they say:

• To solve these [waves hand] health problems, you should lose weight!

Gunter does this All. The. Time in this book. It’s SUPER WEIRD! Even when she’s talking critically about how sexist weight loss advice is, she reproduces it.

Doctors in general have a tragic axiom lock around weight – they struggle so much to look at fat people and treat our actual health, even when they know that fat isn’t the reason we’re in their office. They can say in one breath that standard measures, like BMI, are unscientific and useless and in the next breath reiterate just slightly updated versions of dodgy, unscientific pap about fat. Gunter goes for “visceral fat” and waist circumference.

Many doctors, Gunter included, go on from using bogus measures of fatness-as-illness to suggest weight loss as a good remedy for what ails us (in this case, menopause). In a book so critical of pseudoscience and from someone aware of the problems with generalizing health advice from a single person’s experience (Gweneth Paltrow might have good personal results from jade vaginal eggs, but she oughtn’t market them), it’s so odd to see Gunter recommend that her readers do what she does as though it will work for us.

She says, “Admittedly it’s a work in progress and I’m not recommending this approach for anyone. But experts say that journaling is a low-risk intervention that can help with weight loss and weight maintenance” (83). Which experts? Where are the studies? And it’s jarring to have her acknowledge that weight loss advice is sexist, and political, that weight interventions overwhelmingly fail, and proceed to give the usual pablum weight loss advice in the chapter “Metamorphoses of Menopause” (Watch what you eat! Cook at home! Don’t eat ultra-processed food!). I’m here to say, I’ve done or do all of these things and I’m still fat! And I’m good with that!

The standard move here is to follow “I’m fat” with “and I’m really healthy!” But appealing to health as a foil for the “it’s bad to be fat” line is just another trick. Many of us are never going to be not sick, and all of us deserve solid help for problems with menopause, fat or thin, sick or not.

Gunter writes:

“Obesity is a medical condition, but it’s one of the few in which we assign or imply blame to the patient. It’s also one of the conditions where medicine generally provides the least amount of guidance and support. What if we treated people with cancer or high blood pressure the same way? Can you imagine a world where a provider would give the diagnosis of breast cancer, imply it was the person’s fault, and then send her out into the ether to find help?” (85)

So, you can see that Gunter thinks that people should have more and better support around fat. But, as readers of this blog know well, obesity is not a medical condition – fat is not a disease. Even if it were, the precise approach to fat that Gunter here excoriates is pervasive in the book, not just in that chapter. Weight loss is suggested as a remedy for almost every problem perimenopause and menopause might throw at you, and it is named as a potential beneficial side-effect for almost every medical intervention Gunter recommends. I was going to try to give you pages to avoid if you want to get some of the helpful stuff from this book but not be sent down a fat-hating, body-surveilling wormhole and I’m afraid I got overwhelmed. So, general content warning, I guess.

But then content warning for so much more. I know I’m harping on this, but it really is shocking how Gunter is able to identify sexist medical inaccuracies and perpetuate them in the same breath and in the name of feminism.

Aside from leaving when medical professionals talk go first to fat, I have a couple of other signals to walk out of offices – when people go to evolution to explain health advice they’re giving me, when all their heroes are straight and cis, and when they have no disability analysis.

These are more signals that make me wish I’d walked out of this book, but, well, I guess I can offer you my experience. It is just hopelessly, deeply, pervasively committed to a particular understanding of evolution that grounds the worth of menopause in a narrative of “the grandmother effect” (a real and good thing, just not something that we should limit our explanatory scope to). This narrative pervades the text in a way that brings along with it a whole cluster of things around reproduction as the point of human existence, bundled with a whole bunch of stuff around evolutionary fitness. Making menopause a good thing because evolution just tangles us back up in eugenic narratives of personal fitness as a subset of the health of the population. This sucks.

The Menopause Manifesto is deeply straight. Its normative subject is someone who is going through menopause in her forties to fifties, with a uterus and overies, who is having sex with cis men. I feel it really minimizes cancer and decisions people might make around cancer risk that do not ignore other problems postmenopausal people face, such as heart disease and osteoporosis.

All of these grate the more because Gunter references misogyny over and over, and she is able to identify the sexism in her archive even as she reproduces it.  It is actually very possible to write a book about menopause that does not do these things – Heather Corinna has done so just this year!

I think that all of us should be demanding books that apply to and help women think about their experiences but that at the same time resist gender oppression generally. Acknowledging that non-binary people exist and go through menopause, acknowledging that trans men exist and go through menopause, that some people have had early menopause because of cancer or other medical treatment, acknowledging that not everyone wants to have vaginal sex, that not everyone needs to have a pregnancy test, and so on – these things actually help us fight sexism and oppressive gender norms. (Sophie Lewis’s book Full Surrogacy Now! offers a parallel example to Corrinna’s What Fresh Hell is This?, giving a political analysis of pregnancy without restricting it to women. It’s possible, and great!)

So, closing sidebar, not the point of the book but a plea for more science. Anyone who menstruates and weight lifts who I know probably has been interested in studies about lifting and menstrual cycles. There is data that training hard during your follicular cycle, the bit between when you start bleeding and when you ovulate, has strength benefits. I remember my aunt Karen Moe Humphreys, a two-time Olympic swimmer, gold-medalist in the butterfly, who has been a fierce and impressive athlete her whole life and continues to get stronger in her sixties, reflecting on her strength gains post-menopause and saying that she wished people would research this more.

Gunter, and everyone else writing about menopause, talk often about how perimenopause can involve higher levels of follicule stimulating hormone circulating in our bodies – but they do not make the connection to work on weight training during our follicular cycles as helpful. Rather they take it as given that menopause will make us weaker, less muscly, more fragile, no matter how much we exercise. So, I’m interested in someone doing more science on this, but in the absence of good studies, I’m personally going to decide that perimenopause is a good time to get incredibly strong.

And whatever you’re deciding to do with your perimenopause and menopause, I just want to say that you can do it just as you are, and you deserve help and care that doesn’t hate on any part of you.

Bio: Teacher, writer, SF nerd, functional potter, queer, currently obsessed with doing handstands in middle age. Author of Against Purity: Living Ethically in Compromised Times and working on a book called Collecting Our People, about getting together to solve big problems in which we are complicit.