Skip to main content Skip to search Skip to search

Medical Gynecology & Obstetrics

The Menopause Manifesto

Own Your Health with Facts and Feminism

by (author) Jen Gunter

Random House of Canada
Initial publish date
May 2021
Gynecology & Obstetrics, Women's Studies, Menopause
  • Paperback / softback

    Publish Date
    May 2021
    List Price

Add it to your shelf

Where to buy it


In her follow-up to the #1 bestseller The Vagina Bible, Dr. Jen Gunter, Canadian OB/GYN and the internet's most fearless advocate for women's health, brings us empowerment through knowledge by countering stubborn myths and misunderstandings about menopause with hard facts, real science, fascinating historical perspective, and expert advice.

The only thing predictable about menopause is its unpredictability. Factor in widespread misinformation, a lack of research, and the culture of shame around women's bodies, and it's no wonder women are unsure what to expect during the menopause transition and beyond.
     Menopause is not a disease--it's a planned change, like puberty. And just like puberty, we should be educated on what's to come years in advance, rather than the current practice of leaving people on their own with bothersome symptoms and too much conflicting information. Knowing what is happening, why, and what to do about it is both empowering and reassuring.
     Frank and funny, Dr. Jen debunks misogynistic attitudes and challenges the over-mystification of menopause to reveal everything you really need to know about:
* Perimenopause * Hot flashes * Sleep disruption * Sex and libido * Depression and mood changes * Skin and hair issues * Outdated therapies * Breast health * Weight and muscle mass * Health maintenance screening * And much more!
     Filled with practical tips, useful information and startling insights, this essential guide will revolutionize how women experience menopause--and show them how their lives can be even better for it.

About the author

Contributor Notes

DR. JEN GUNTER is an obstetrician and gynecologist with nearly three decades of experience as a vulvar and vaginal diseases expert. She is the author of the #1 national bestseller The Vagina Bible, and has been called Twitter's resident gynecologist, the Internet's OB/GYN, and a fierce advocate for women's health. She writes two regular columns for The New York Times, called "The Cycle" (monthly) and "You Asked" (weekly), and has written for a broad range of outlets, from academic publications to The New Republic, Chatelaine, Self, The Cut, and many more.

Excerpt: The Menopause Manifesto: Own Your Health with Facts and Feminism (by (author) Jen Gunter)

Introduction: The Manifesto

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 3 weeks later than expected while I was in an Uber and I flooded the car. The driver gave me a terrible review!
The sex was dry.

And it’s no surprise. Most women have no idea what to expect when they are no longer expecting a period, and it’s 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 it’s 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 don’t 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 doesn’t even rate the shame that society gives to the vulva and vagina. Apparently there is nothing of lower value than an aging woman’s 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 failure—the assertion that menopause is a disease that exists because women and their ovaries are weak. The only grounds for this claim are that men don’t experience menopause. But comparing women and men in this way is the same as comparing the liver with the heart. The liver isn’t weak or diseased because it doesn’t beat like the heart, and women aren’t diseased because the ovaries stop making estrogen.

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 don’t receive important health screenings or therapies because they have been dismissed with platitudes like “This is just part of being a woman” or “It’s not that bad.” But the issues with menopause even go beyond these knowledge gaps and the medical neglect. Women tell 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 twenty years old and my OB/GYN training when I was twenty-four, I can’t remember back to a time when I didn’t 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 didn’t 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 knew the tests that were indicated and those that were not, and 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. By the time I entered my own menopause transition, I had spent over twenty years speaking with women about their menopause and helping them manage their symptoms and any health concerns, so I had heard many stories and had knowledge of the range of experiences as well as the treatment options. It was fortunate that my view of the subject wasn’t confined to what I saw at home. My mother’s menopause was volcanic, and if that was all I had to go on, I would have been quite frightened.

Online, on book tour for The Vagina Bible, and during many interviews with reporters I often heard (and still hear today) “What do I do?” and “Where do I turn?” from women about menopause. I remember one interview in particular that had nothing to do with menopause or even menstruation and when for some reason I tangentially mentioned I was using an estrogen patch the conversation derailed and all the reporter wanted to discuss was menopause. Hearing over and over again from women from many countries about this need for knowledge made me obsessed with the idea that every woman should know about menopause like a well-informed gynecologist and so that is what I have set out to do in these pages.

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. The cultural absence of menopause from our discussions isn’t because that’s what women want. The often pejorative language about menopause and the medical neglect also aren’t 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 they’re long lasting. Menopause does start a series of biological events that increase a woman’s risk of several medical conditions, such as cardiovascular disease and osteoporosis. But menopause isn’t the only paint on a woman’s 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, it’s important to step back and look at the whole picture. Managing menopause is the ultimate exercise in whole body or holistic medicine.

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 doesn’t attack the fetus. Like these other biological phenomena, menopause is associated with downsides—in 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 it’s equally important not to brush off every symptom as hormone related. It’s 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.

If you are years from menopause, this book will hopefully help you understand the road ahead. My hope is that it allows you to view menopause as a phase of life, as well as inform you of the preventative care that can be taken to lessen any impact of menopause on your health. In addition, may this book provide the knowledge to best manage your menopause with a view to your unique concerns.

If you are already on Team Menopause, I hope this book helps you understand how you got here—biologically speaking—and informs you of important health considerations that may still lie ahead. It’s never too late for preventative health care and many symptoms and medical conditions may still need managing.

And if you are in your menopause transition and experiencing that hormonal chaos, know for many women this is the rockiest phase. Often just that acknowledgment can help. I hope the information here helps you reframe what is happening to your body, and if you are suffering I hope you take comfort knowing there are many explanations for how and what you are feeling, as well as therapies—and these rapids won’t last forever. My hope is that this book helps to hold your canoe steady so you can catch your breath.

Facts can bring order to the chaos and uncertainty of menopause, because knowledge can dispel fears and open up treatment options. Even if the option is to take no action, it is still a position of power because it is an act of self-determination. Feminism can help women see the biases that may have informed previous beliefs and reframe their menopause not as a terminal event, but as another phase of life.

Women want more information about menopause and that knowledge can reduce suffering. Knowing what’s happening to your body and that you’re not alone in your experiences is powerful medicine. Facts empower women to make the health decisions that work for them—you can’t be an informed patient with inaccurate information.

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.

Editorial Reviews


"Dr. Gunter has done it again, but this time with a focus on mature women. The Menopause Manifesto is the definitive guide to navigating the menopause based on science, not fiction. Between The Vagina Bible and this book, Dr. Gunter takes the mystery out of women’s health and replaces it with evidence-informed concrete recommendations. Brava!" —Dr. Lori Brotto, Canada Research Chair in Women’s Sexual Health, Executive Director of the Women’s Health Research Institute, and author of Better Sex Through Mindfulness
The Menopause Manifesto gives women the playbook to follow when discussing these matters with their doctors. This, along with The Vagina Bible, deserve a prominent place on every woman’s bookshelf. Doctors should also do themselves a favor and get their own copies.” —New York Journal of Books
“The wise and feisty Dr. Jen Gunter has ridden in (once again) on her white horse to save the day! Read this book immediately.” —New York Times bestseller Ayelet Waldman, author of A Really Good Day and Love & Treasure
"As a fellow Gynecologist, I am so appreciative of Dr. Gunter's work and how she has laid the groundwork for communicating no-nonsense, science-based, health education to our patients. She is changing the way we practice medicine and communicate with our patients and her books are leading the way to more informed and empowered generations." —Dr. Danielle Jones (Mama Doctor Jones)
“Dr. Gunter has managed to write a book that's just as important for healthcare providers as it is for women themselves. Where was this kind of resource when I did my medical training?! This is the new 'it' book for women who want to prepare for or understand what menopause is (and isn't).” —Dr. Jennifer Lincoln

Praise for The Vagina Bible
"With The Vagina Bible, Gunter hopes to give women their combat armour. The clear-eyed encyclopedia touches on just about every matter. . . . While the Twitter-loving OB/GYN is certainly not the first to dispel these myths about women’s sexuality, today, she holds the loudest megaphone.” —The Globe and Mail

“Women must wade through a constant barrage of misinformation and fake health claims about their bodies. Dr. Jen Gunter is the warrior-in-chief in the battle against fake vagina news, and her book arms us with the facts we need to join that fight.” —Dr. Danielle Martin, author of Better Now: Six Big Ideas to Improve Health Care for All Canadians
“Dr. Jen Gunter’s The Vagina Bible brilliantly dispels myths and imparts knowledge with large doses of wit, wisdom and invaluable advice. This empowering and engaging resource belongs on every woman’s bookshelf.” —Ami McKay, author of The Birth House

“Whether she is debunking the damage done by Freud or providing the low down on the science of sex, Dr. Gunter provides a frank, funny and thoroughly science-informed perspective. This is the exact kind of book the world needs right now. Gunter pulls no punches and provides a clear and concise summation of the facts on every vagina-related topic you can think of. Seriously. Everything. The world needs more Jen!” —Timothy Caulfield, author of Relax, Dammit!

Other titles by Jen Gunter

Related lists