Science doesn’t exist in a bubble. It’s shaped by the world around us. Medicine, too, is influenced by social, cultural, and historical forces — even though we often think of it as neutral. Take, for example, how medicine views the female body vis-à-vis the male body. Historically, the cisgender male body has been considered the norm, and any deviation is the other. What happens when this lens is used to look at women’s reproductive systems, and the medical care that exists around it? What, moreover, happens when those bodies that are not cis female, but also trans bodies?  

Knowledge gaps in reproductive health have shaped our society deeply, and influenced the perception of women, especially middle-aged women, both medically and socially. The consequences are grave. Societies persistently reduce women’s health to their capacity to reproduce which, in turn, affects how medicine, society, and culture look at menstruation and, crucially, menopause.  

That’s where Dr Jen Gunter’s “The Menopause Manifesto” enters the conversation. The book tackles this bias head-on, and analyses menopause through multidisciplinary insights; rich with evidence-based medical and socio-anthropological analysis — all delivered with biting humour. 

 Why talk about menopause? 

Culturally and socially, menopause is still surrounded by confusion, stigma, and outdated ideas. Those who are going through it don’t know what to expect, or how to get the right care that works for them. A gynaecologist by training, Gunter began writing about women’s health in 2004 after realising that there was little publicly available information about it. Gunter felt compelled to write this book after a press tour for her previous, non-menopause related book. During the tour, reporters would ask her about menopause and hormone therapy among other things. She writes of that experience — “During many interviews with reporters I often heard (and still hear today) “What do I do?” and “Where do I turn?” 

It was this question that compelled Gunter to look for information about menopause – which she found missing not only from online spaces, but also from general medical know-how. It occurred to her that the gap largely exists because menopause is often associated with decline and the loss of fertility. This framing is problematic in societies where youth — particularly for women — is equated with beauty and value. Arguing how menopause is seen as a failure, rather than recognising it as a natural transition in a woman’s life, Dr. Jen Gunter writes:, “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.” 

Patriarchy, feminism, and menopause 

The norms which shape our understanding of menopause as a biological phenomenon are shaped by history, social norms, values and cultures — many of which are inherently patriarchal. For instance, during the Renaissance, people believed menstrual blood was toxic and that the perimenopause symptoms occurred because women’s aging bodies were supposedly too weak to flush out the menstrual bloodi. While the final menstrual period was acknowledged as a significant event in ancient medical writings, the concept of a menopausal transition is often absent. Gunter offers a possible explanation:  “It’s important to remember that medicine, like everything else, primarily existed to satisfy the needs (and hence secure the patronage) of the male elite who were likely not interested in the ageing female body.”

Which is why, she argues, that women need facts to empower themselves when it comes to tackling menopause.  

Facts, and feminism.  

Women’s bodies, diet, culture and menopause 

The chapter on menopause and diet particularly resonated with me as a fat person dealing with reproductive health issues. For many girls and women, the doctor is often the second person—after their mother—who makes them believe they are fat, and that eating “right” (usually meaning skipping meals to lose weight) is the only solution to any health concern. Gunter challenges this harmful belief and acknowledges that food science is complex for many reasons: clinical trials are expensive, participants may not stick to the same diet over time, it’s impossible to control for all confounding factors, and funding bias is common. She also points out that many doctors lack training in communicating nutritional information, and that access to qualified nutrition experts is limited. Rampant fatphobia in medicine further complicates the issue. 

Gunter offers readers a clear and accessible breakdown of nutrients, processed foods, and fats in the context of dealing with menopause. She writes a kind of love letter to fibre and coffee—both of which she considers extremely beneficial—and stresses that a nutritious diet is also shaped by social determinants such as education, income, and access to affordable healthcare.  

There is no magical diet or superfood; there are too many variables for a one-size-fits-all answer. However, some advice has been proving to be universally valuable in recent years: ultra-processed foods and trans fats are harmful; saturated fats are fine in moderation; and dietary changes can mean simple things like switching from white rice to brown rice. Her approach to diet is empathetic, evidence-based, and grounded. It’s a refreshing contrast to mainstream diet discourse, which can fixate on weight instead of overall health, and has taken a particularly worrying swing away from body positivity in recent years, especially on social media. Gunter’s focus on how diet affects things like cardiovascular and gut health, and how that, in turn, supports the body during the menopausal transition, offers a more holistic perspective on the problem. 

Menopause and the global south: the need for plurality 

Although Gunter’s book is a comprehensive explainer on menopause, socially it made me wish for more additional context and  experiences from the global South.  We learn about how menopause is perceived in the Western tradition and the reasons behind it, but it does not inform the reader about other non-Western histories that might have a different perspective on the role of menopause in society.  

But one person’s scholarship or perspective cannot be exhaustive of all cultures, especially a person of European descent, trained primarily in medicine. Which is why I’m so happy to know that Indian women have begun the dialogue on menopause.   

Gunter also acknowledges the need for plurality in her book. She redirects the reader to important resources like the book, “Fearing the Black Body: The Racial Origins of Fat Phobia” by Dr. Sabrina Strings. She admits that stories about menopause are scarce, and it is a lonely experience for women. In the penultimate chapter, she reflects on her own menopausal transition: “At times my flushes make me feel as if I have had too much to drink and I need to pray to the porcelain God. I thought I was the only one, but many women have messaged me to say they also thought they were the only ones. As this book gestated, I began to wonder how many other questions haven’t been asked because for so long people who experience menopause and who are best able to say what is happening haven’t had a seat at the medical table?”  

In a healthcare system that routinely overlooks women’s needs and relies on male-centric data, Gunter’s manifesto becomes both a guide and a call to action. It empowers women to advocate for themselves, confront systemic misogyny, and reclaim control over their health and bodies. It is an honest, and comprehensive account of menopause, and the misogyny underlying it — how it came to be and what today’s women can do about it.  

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[i] Travis, C. (1992). The Mismeasure of Woman.  

[ii] Parker et al. (2017). A visual analysis of gender bias in contemporary anatomy textbooks. 

[iii] Gunter, J. (2021). The Menopause Manifesto: Own Your Health With Facts and Feminism