"The Menopause Manifesto" a Look at What Women Should Know about an Inevitable Change

In The Menopause Manifesto: Own Your Health with Facts and Feminism, Dr. Jen Gunter challenges these assumptions and encourages women to approach menopause with knowledge rather than fear. Her message is an important one: women deserve accurate information, thoughtful medical care, and the opportunity to make informed decisions about their own bodies.

Menopause is a natural biological transition, but that does not mean every symptom should be ignored or endured without support. Menopause occurs after 12 consecutive months without a menstrual period, when there is no other identifiable cause. The transition leading up to it, known as perimenopause, can involve fluctuating hormones and a wide range of physical and emotional changes. Hot flashes and night sweats may be the symptoms people recognize most readily, but the experience can extend well beyond temperature regulation. Some women experience disrupted sleep, mood changes, vaginal dryness, urinary symptoms, joint discomfort, or changes in sexual function. Some women have relatively few symptoms, while others find that symptoms significantly affect their work, relationships, exercise, and daily activities. Persistent symptoms deserve a conversation with a knowledgeable healthcare professional. Understanding what is related to menopause, what may have another cause, and which treatments are available can help women make decisions based on evidence rather than assumptions.

One of the central themes of The Menopause Manifesto is the importance of challenging misinformation surrounding women’s health. Menopause advice is everywhere, from social media and wellness influencers to supplement advertisements and anecdotal recommendations from friends. While personal experiences can be valuable, they cannot replace evidence about safety, effectiveness, and individual medical risk. Hormone therapy is one example. For years, many women have received confusing or incomplete messages about its risks and benefits. The reality is more nuanced than either declaring hormone therapy universally dangerous or presenting it as the right choice for everyone. Hormone therapy is the most effective treatment for hot flashes and night sweats and can help with certain genitourinary symptoms. It can also help prevent bone loss. However, potential risks vary according to factors such as age, time since menopause, formulation, route of administration, medical history, and whether a progestogen is needed.

For many healthy women younger than 60 or within 10 years of menopause onset who have bothersome symptoms and no contraindications, the benefits may outweigh the risks. Other women may need different approaches. The decision should be individualized with a qualified healthcare professional who can explain the available options and help weigh the benefits and risks. Not every woman needs hormone therapy, and women who cannot or prefer not to use it may have effective nonhormonal options. The goal is not to promote one treatment for everyone. It is to ensure that every woman has access to accurate information and an opportunity to participate in decisions about her care.

As a physical therapist specializing in women’s health, one of the areas I believe deserves greater attention during menopause is pelvic floor function. The pelvic floor is a group of muscles and connective tissues that supports the pelvic organs and contributes to bladder and bowel control, sexual function, and coordination with the rest of the body. Changes in estrogen levels can affect the tissues of the vagina, bladder, and urethra. Some women develop vaginal dryness, irritation, painful intercourse, urinary urgency, increased urinary frequency, or recurrent urinary tract infections. These symptoms can fall under the umbrella of genitourinary syndrome of menopause, a condition with several effective treatment options. Pelvic floor dysfunction can also involve urinary leakage, constipation, pelvic pressure, and pelvic pain. A physical therapy evaluation can determine what your muscles and surrounding structures are contributing to your symptoms. Women deserve to know that they do not have to quietly accommodate bladder leakage, pelvic discomfort, or painful intimacy. These concerns are legitimate reasons to seek care, and treatment can often improve comfort, confidence, and function.

Menopause education should extend beyond reproductive health. Midlife is also an important time to pay attention to musculoskeletal health. Estrogen plays a role in bone remodeling, and declining estrogen levels can accelerate bone loss. This makes bone health an important consideration during the menopausal transition, particularly for women with additional osteoporosis risk factors. Resistance training, weight-bearing activity, adequate calcium and vitamin D, and appropriate bone density screening can all contribute to a comprehensive approach to skeletal health. Muscle strength supports balance, mobility, and independence while helping women continue doing the activities they enjoy. Progressive resistance training can help preserve strength and physical function as the body changes with age.

Cardiovascular health deserves attention as well. Blood pressure, cholesterol, blood glucose when appropriate, physical activity, sleep, and family history all contribute to an individual’s overall risk profile. It is important to note the role of a physical therapist in assessment and prescription of exercise to improve cardiovascular health. Measures of cardiovascular endurance and progressive exercise can be used to reduce the impact of hormonal changes on the cardiovascular system.

The lasting message of The Menopause Manifesto is that education can change the way women experience this stage of life. When we replace shame with honest conversations, misinformation with evidence, and dismissal with individualized care, women gain more opportunities to make informed choices about their health. Menopause does not look the same for everyone, and there is no single treatment plan that meets every woman’s needs. Every woman deserves to understand what is happening in her body and to have access to appropriate care. As a physical therapist, I encourage women to think about more than getting through today’s symptoms. The goal is not to fight the natural process of aging. It is to approach it with knowledge, support, and the tools to keep living well.

References

Gunter, J. (2021). The menopause manifesto: Own your health with facts and feminism (1st ed.). Citadel Press. https://doi.org/10.1007/978-0-8065-4066-5

Meet the Blog Author

Dr. Jadyn Crooch, PT

APTA Pelvic Health's Oklahoma State Representative

Dr. Jadyn Crooch, PT is the owner of an outpatient clinic build with women in mind and serves as a physical therapy assistant program chair for Connors State College/Indian Capital Technology Center. She has practiced within the specialty of pelvic health for the last seven years. She has a passion for improving visibility to women's health topics and inspiring other physical therapists to learn more about serving our female patients across the lifespan.