The Guardian has referred to Dr. Jen Gunter, author of the bestselling The Vagina Bible, as “the world’s most famous—and outspoken—gynecologist.” In her follow-up book, Gunter lives up to that appellation. The Menopause Manifesto: Own Your Health with Facts and Feminism is just that—a manifesto that declares “what the patriarchy thinks of menopause is irrelevant. Men do not get to define the value of women at any age” (xii).
In her introduction, Gunter describes her subject: “Menopause is like being sent on a canoe trip with no guide book and only a vague idea where you are headed—although the expectation is it’s awful” (ix). With The Menopause Manifesto, Gunter sets out to provide women everywhere with that missing guide. She gives them the tools to knowledgably handle the menopause transition and along the way pulls no punches in pummeling the patriarchy that denied women that guide in the first place.
As Gunter puts it, “For women to navigate menopause, they need facts because empowerment requires accurate information—but they also need feminism because our bodies, our medical care, and even our thoughts have been colonized by the patriarchy” (xi). As a case in point, Gunter reminds us, “It’s … misogynistic to tie a description for one-third or possibly even one-half 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. … Imagine a world where we said men were in erectopause” (22) (emphasis in original).
Words matter to Gunter, as they should to all good skeptics. She relates how the terms we use to describe menopause and its accompanying symptoms make a difference in how women in this time of life are perceived and treated. For example, she dislikes the term hot flash. It is inaccurate in that it implies a quick event, and it “can downgrade the severity of the experience” (16), thus contributing to the dismissal of menopausal women’s symptoms. She prefers hot flush or, even better, hot bloom. Another term on Gunter’s blacklist is vaginal atrophy: “Women are already diminished by society as we age, so a term that makes the vagina sound like a decrepit shrinking violet is unacceptable” (160). Gunter notes that thankfully this term has already fallen by the wayside.
Gunter provides a history of the term menopause—it was coined in the early nineteenth century by Dr. Charles De Gardanne—as well as early attitudes of the medical establishment toward menopause and aging women in general even before that term was invented. She describes how the sixth edition of The Ladies Physical Directory, published anonymously in the eighteenth century by “A Physician,” contained information on how to treat many conditions women experience during their menopause transition. Some of the “recipes” for treatments given in the book were harmful—“courtesy of the dangerous ingredients, such as oil of savin, arum root, and iron filings” (16)—and some were benign but ineffective. The directory also listed “a range of vaginal potpourri that would make Gwyneth Paltrow jade with jealousy” (16).
In addition to the jabs at Paltrow, there is much else for skeptics to love in Gunter’s manifesto. In a section in Chapter 14, “Bladder Health: Breaking the Culture of Silence,” on recurrent urinary tract infections (UTIs)—the risk of which greatly increases after menopause—Gunter breaks down the facts and myths behind treating and preventing UTIs. Gunter lists several treatments that have been proven to help with recurrent UTIs, including vaginal estrogen and antibiotics. Then she lists several that many think help but have not been proven to do so—such as cranberry juice (“Most of the work here has been funded by—surprise—the cranberry industry” [181]), vitamin C, and emptying the bladder immediately following sex.
Another skeptical gem is Gunter’s advice on “How to Do Your Own Research,” which can be found in her chapter on menoceuticals, the author’s term for menopause-related supplements. The bottom line of her advice is “avoid over-the-counter hormones” (303), but she offers readers questions they can ask themselves to evaluate menoceuticals, such as “How can this product help me in a meaningful way?” (301), “What do medical professional organizations [such as the North American Menopause Society (NAMS), the International Menopause Society (IMS), and the American College of Obstetrics and Gynecology (ACOG)] say about this supplement?” (301), and “Can I change my diet so I don’t need the supplement?” (302). She ends the chapter with “P.S. I expect a lot of hate mail for this chapter” (303).
She also gives similar advice on how to know if you are seeing a trustworthy medical provider. For example, she tells women to look elsewhere if “the provider is antivaccine or engages in other medical conspiracy theories. … Medical conspiracy thinking is the opposite of rational, measured thought and has no place in medicine” (332).
Gunter’s medical knowledge is impressive, but even more so is her ability to distill that knowledge into easily digestible morsels for a lay audience. She can simplify without dumbing down, something that is essential when relaying medicine and science to a general audience. Except for the final two, each chapter of Gunter’s book ends with a sidebar of the “Bottom Line” of that chapter’s main takeaway points. This is helpful for those who might want to read the main points of each chapter and then from there decide if they want to delve more deeply into the full chapter.
Gunter’s book is well organized into twenty-five chapters in four parts, and there is a nice sprinkling of figures, tables, and charts throughout the chapters as well as in the Supplementary Material section at the back of the book. There is also a section of Selected References for those looking for more information. Unfortunately, there is no index, which I think would have been helpful for those reading the print version. For those reading an e-book, the search function makes the lack of an index less important.
Gunter’s book is an impressive, invaluable volume. She handles what for many is a sensitive subject with compassion and humor, and she does so capably. She dedicated her manifesto “For every woman. Your awesomeness is unrelated to your estrogen.” And that’s exactly who should read this book and exactly the message they should take away from it.