The Menopause Manifesto: Essential Reading for Women of All Ages

“It shouldn’t 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 let’s make some noise.” Dr. Jen Gunter, The Menopause Manifesto

When I bought my copy of Dr. Jen Gunter’s latest book, The Menopause Manifesto, I noted in a social media post that I was reading it for “retrospective knowledge.” Being 2 ½ years past my final menstrual period (FMP), I assumed that very little of the book would apply to me. How wrong I was. It turns out there was a lot I didn’t know about menopause and, more importantly, the years that follow.

The biggest wow factors for me? 

  • The menopause transition can accelerate age-related loss of muscle mass, at least temporarily, which can contribute to weight gain and an overall loss of strength. 
  • After menopause, women gain visceral fat (metabolically active, i.e. bad fat) at the same rate as men, greatly increasing their risk of cardiovascular disease (CVD), the number one cause of death for women. 
  • Bone health, which is greatly affected by menopause, is not taken nearly as seriously as it should be, even though fractures from osteoporosis and low bone density “lead to as many hospitalizations as strokes and heart attacks.” (p. 136). 
  • Women can get hot flashes despite being well past their FMP, resulting in continued sleep problems if they occur at night. (And mine do, on the occasions when I get them.) 

Another shocker, for me at least, was that women can start menopausal hormone therapy (MHT) after their final menstrual period. The exact guidance: women under 60 who are within ten years of their final menstrual period and have no contraindications can use MHT to help with things like hot flushes and night sweats, preventing osteoporosis, and treatment of GUSM (changes to the vagina and vulva). Unofficially, MHT may also improve sleep and reduce the risk of type 2 diabetes and colon cancer. (p. 227-228) I had no idea. Not that I’m going to rush to my doctor to demand it now, but it would have been nice to know MHT was an option and that it offered postmenopausal benefits. 

Of course, I am far from alone in my lack of knowledge about menopause, which is why Dr. Gunter wrote this book. Her message is clear: women have not been given adequate information about the changes wrought by “the change.” By providing vital facts about how menopause affects the body, she is helping women advocate for their own health and take steps to improve it, no matter which stage of life they are in. 

Her discussion of hormones and MHT is just one example of how broad the audience is for this book. Not only does she talk about the use of hormones after the FMP–the early 50s for most women–she also mentions that women in their 20s and 30s should be “planning for menopause” when they make decisions about contraception. (p. 304) In her chapter on bone density, she notes that women should be thinking about bone loss well before menopause. Peak bone mass is reached in the 20s and the age-related decline after those years accelerates during menopause, then slows, but still continues at a higher rate than before menopause. Also pertinent to women of all ages? The importance of exercise in preventing some of the health issues that emerge during and after menopause. The earlier exercise begins the better, but, as Dr. Gunter makes clear, it is never too late to start. (But do so with a doctor’s help if you have had any health issues like CVD or osteoporosis.)

As much as this book is about menopause, Dr. Gunter is also careful to point out that menopause is not necessarily to blame for every health concern a woman has as she gets older. There is a tendency in our culture to believe that everything affecting menopausal women is a result of hormonal imbalance, but that is simply not true. Some health issues are a result of aging or genetics. Some stem from sleep deprivation, a poor diet, or sedentary lifestyle. And some may be caused by medical conditions or exacerbated by social determinants of health, like: access to medical care, education, and affordable nutritious foods; crowded living arrangements; unsafe working conditions; and adverse childhood experiences. 

To demonstrate this point, Dr. Gunter provides an “M diagram” (a Venn diagram) that connects menopause to maturity and medical conditions, while also factoring in the macro and microenvironments that surround women. Her explanation of the diagram: “Women are so much more than just their ovaries, so it’s important to sit back and look at the whole picture for perspective.” (p. 11) With that whole picture in mind, women can make informed decisions about their health, as I did.

Because of this book, I have now had a complete CVD checkup, something Dr. Gunter suggests women aged 40+ get every two to three years, or more often if they have risk factors, which I do. I have become more diligent about taking my calcium supplements and doing weight-bearing exercises to improve bone strength. (She intended her chapter on bone health to be scary and it was. I am now ready to preach the gospel of exercise and calcium supplements.) I will also be pulling out my dusty copy of The MIND Diet to break the bad nutritional habits I allowed to form during the COVID pandemic and start eating a more balanced diet for my physical and mental health. 

The Menopause Manifesto is organized by issue, so it’s easy to jump directly to your own areas of concern. There is a ton of information on each topic, including those I mentioned above and just about everything else you can think of pertaining to menopause: the history and biology of menopause, body changes, abnormal bleeding, “brain fog,” bladder health, sex and desire, sleep disturbances, and contraception. I recommend you include her chapters on bioidenticals and “menoceuticals” (supplements) in your reading too. Dr. Gunter is a longtime critic of the “wellness” industry and she backs up her skepticism with solid facts here. She also weaves her personal experiences into the book–a very valuable addition–and includes references for further reading as well as advice for finding reliable information about menopause online. 

Dr. Gunter’s approach is unapologetically feminist, as the M diagram referenced above indicates. (As does the book’s subtitle “Own your health with facts and feminism.”) She doesn’t pull punches, whether she’s discussing negative messaging about women’s bodies, medical mansplaining, or the misogynistic “branding” of menopause as an entirely negative experience that leads women rapidly downhill to old age and decrepitude. 

I remember the relief I felt in her feminist perspective; the sense that I was getting the straight goods from someone who had compassion for what women go through during menopause and could offer workable remedies for the many challenges of the change.

Among the many thoughts I scribbled down while reading this book was this one: “It’s refreshing to read someone who gets it and is on the side of women. [She’s] emphatic in her assertions that menopausal symptoms not be dismissed or minimized.” That validation and understanding is what Dr. Gunter’s feminist approach brings to the topic of menopause. She has long been an advocate for women’s health and she continues to have our backs here. The “noise” she makes is something all women need to hear, whether we are years from the menopausal transition, in the thick of it, or looking at it in the rearview mirror.   


The Menopause Manifesto is available at independent bookstores and major retailers. Highly recommended for women from 20 to 60+.

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