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Women in menopause helped drive evolution weve had enough of shame and silence – iNews

Posted: May 25, 2021 at 1:56 am

If menopause were on Yelp it would have one star:

This establishment has temperature control issues. Drenching heat followed by terrible chills. Defies the laws of thermodynamics. Would not recommend.

Awful, awful, awful! Bleeding was scheduled, but was rebooked without notification so arrived three weeks later than expected while I was in an Uber and I flooded the car. The driver gave me a terrible review!

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The sex was dry.

And its no surprise. Most women have no idea what to expect when they are no longer expecting a period, and its uniquely awful and disempowering to not understand what is happening to your body and why.

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 its awful. There will be no advice on how to get there or how to manage any of the obstacles, such as rapids. That is if any exist. Who knows? Have fun figuring it out! Good times. Oh, and dont write. No one wants to hear about your journey or what it is like when you arrive.

Fear? Check. Uncertainty? Check. Medical ramifications? Check. Unpleasant symptoms? Check. Societal irrelevance? Check. No wonder menopause receives such awful reviews.

The culture of silence about menopause in our patriarchal society is something to behold. Menopause doesnt even rate the shame that society gives to the vulva and vagina. Apparently there is nothing of lower value than an aging womans body, and many in our society treat menopause not as a phase of life, but rather as a phase of death. Sort of a predeath. What little that is spoken about menopause is often viewed through the lens of ovarian failurethe assertion that menopause is a disease that exists because women and their ovaries are weak.

The only grounds for this claim are that men dont experience menopause. But comparing women and men in this way is the same as comparing the liver with the heart. The liver isnt weak or diseased because it doesnt beat like the heart, and women arent diseased because the ovaries stop making estrogen.

Menopause occurs when there are no more follicles in the ovaries capable of ovulating, meaning there are no more eggs. The average age when this happens is 50 to 52 years. One of the defining features is the dramatic drop in estrogen levels as the follicles are the main source of estrogen. Its the drop in estrogen that causes many of the symptoms and medical concerns unique to menopause; however, theres new research that suggests other hormone changes are also important.

Many women will live one-third to one-half of their lives in the menopause continuum. The absence of menopause from our discourse leaves women uninformed, which can be disempowering, frightening, and makes it difficult to self-advocate. Consequently, many suffer with symptoms or dont receive important health screenings or therapies because they have been dismissed with platitudes like, this is just part of being a woman or its not that bad. But the issues with menopause even go beyond these knowledge gaps and the medical neglect.

In the more than 25 years that Ive been a gynecologist, women have often told me that menopause is lonely; that there are no stories or culture. And so there is no whisper network to take up the slack from medicine. Nothing to offer comfort.

But many women are desperate to know more about menopause so they can understand how and why their body is changing, and they want information so they can make decisions that work for them. They also want to talk about what is happening to their body. I contrast these experiences with my own. Having started medical school when I was 20 years old and my OB/GYN training when I was 24, I cant remember back to a time when I didnt have a detailed understanding of the hormonal changes of both the menstrual cycle and menopause. And not just the biology, but how to apply it practically to my own body. I never once thought, Wow, that is unexpected, or Why am I sweating so much at the age of forty-five? or WHAT IS GOING ON WHY AM I BLEEDING EVERYWHERE!?

My medical knowledge didnt prevent me from having menopause acne, hot flushes, or those special heavy periods that are all typical of the menopause transition. But because I knew exactly what was happening and when to seek care, it made the whole process feel routine. Because I understood the medicine, it was much easier for me to navigate the treatment options and choose the safest most effective therapy and avoid the snake oil.

For women to navigate menopause, they need facts because empowerment requires accurate informationbut they also need feminism because our bodies, our medical care, and even our thoughts have been colonised by the patriarchy. The cultural absence of menopause from our discussions isnt because thats what women want. The often pejorative language about menopause and the medical neglect also arent up there on the meno wish list.

Women often only hear the awful stories about menopause, but the truth is the menopause experience is a vast diaspora. Many women have mild symptoms, some moderate, and others severe. Often these symptoms are temporary, but occasionally theyre long lasting. Menopause does start a series of biological events that increase a womans risk of several medical conditions, such as cardiovascular disease and osteoporosis.

But menopause isnt the only paint on a womans canvas. Age, other medical conditions, diet, exercise, and even adverse childhood events are also adding color to her portrait. So when a woman wants to consider what she should do, its important to step back and look at the whole picture. Managing menopause is the ultimate exercise in whole body or holistic medicine.

Theres a common fallacy that women were never meant to experience menopause. This assertion claims that menopause is an accidental state that resulted from longer life expectancies from modern sanitation and medicine, allowing women to live beyond their ovarian function. A benevolent patriarchal society allowed the failings of women menopauseto be uncovered.

The tenacity of this myth is testament to the impact of patriarchal dogma. When something feels off balance I replace the word women with men to see how it sounds. If it sounds reasonable Im more likely to consider the hypothesis worthy of further evaluation, but if we would never speak about men that way, then theres going to be a lot of side eye on my part. Has anyone in the history of medicine ever uttered these words? Through good sanitation and health care, men are now living long enough to develop erectile dysfunction? Doubtful.

Menopause is not a disease. It is an evolutionary adaptation that is part of the survival of the species, like menstrual periods or the ability to suppress the immune system during pregnancy so the body doesnt attack the fetus. The evolutionary advantage of menopause is grandmothers. Grandmothers confer a survival advantage for their grandchildren, likely by gathering food and assisting with child care and shelter. This is known as the grandmother hypothesis, and there is plenty of science to back it up.

Researchers looked at birth and death records from women in the 1700s1800s in Canada and Finland. What they found was the longer a woman lived, the more grandchildren she had. The researchers controlled for the number of children the grandmothers themselves had as thats obviously an important variable in the number of grandchildren. Grandmothers werent passing on genetics for an easier childbirth, because the grandmother effect extended to both daughters and sons.

While genetics may have played some rolegrandmothers who live longer may have genetics that also favor survival in infancygenetics wasnt a major driver, as the grandmother effect disappeared with distance. If a grandmothers daughter or son lived close by, they had almost two more grandchildren compared with those who moved away. It wasnt just having a grandmother who was healthy enough to survive, it was being close to one that really mattered. It really does take a village.

Human intelligence has allowed us to grow in many ways beyond our evolutionary programming, so while the grandmother hypothesis explains how we developed menopause, it doesnt mean that women only have value as grandmothers. What the grandmother hypothesis should do is give society a kick in the ass about the worth of women in menopause. It makes the patriarchal idea that womans worth diminishes when ovulation stops even more offensive, because women in menopause literally helped drive evolution.

Like other biological phenomena, menopause is associated with downsidesin this case its bothersome symptoms for some women and an increased risk of several medical conditions. But menopause also occurs while a woman is aging, so its equally important not to brush off every symptom as hormone related. Its vital that women know about menopause, but also everything that is menopause adjacent, so they can understand what is happening to their own bodies, put that in perspective, and advocate for care when indicated.

A manifesto is a public declaration or proclamation and we are well past due for a manifesto on menopause as 2021 is the 200th anniversary of the introduction of the word. My manifesto is for every woman to have the knowledge that I had to help them with their own menopause. I demand that the era of silence and shame about menopause yield to facts and feminism. I proclaim that we must stop viewing menopause as a disease, because that means being a woman is a disease and I reject that shoddily constructed hypothesis. I also declare that what the patriarchy thinks of menopause is irrelevant. Men do not get to define the value of women at any age.

It shouldnt require an act of feminism to know how your body works, but it does. And it seems there is no greater act of feminism than speaking up about a menopausal body in a patriarchal society. So lets make some noise.

The Menopause Manifesto by Dr Jennifer Gunter is published by Piatkus, an imprint of Little, Brown Book Group Ltd, 14.99. Out now

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Women in menopause helped drive evolution weve had enough of shame and silence - iNews

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