Dr. Jen Gunter Sets the Record Straight on Menopause

Menopause has long been the punchline to a rambling joke about womens health. More recently, though, it has become a paycheque, with many companies and practitioners promising magical cures to cash in on our discomfort, anxiety and desperation.Enter Dr. Jen Gunter. She devotes her social media presence to tackling damaging myths about womens health and taking down purveyors of bullshit solutionsGwyneth and her vaginal steams very much included. Now the Canadian-born San Francisco-based ob-gyn hopes to make this phase of our lives more manageable, healthy and happy with her new book, The Menopause Manifesto, which delivers history, feminism and stone-cold facts. Those pills, creams and fake tests youve been hawked? Time to chuck them in the trash.(Related:9 Things You Didnt Know (And Might Forget) About Perimenopause)

Thank you for writing this book. As someone white-knuckling it through menopause, it was so helpful to read.

Oh, great! Yeah, women need a lot more information.

Do you want women to be dog-earing it and bringing it into their next doctors appointment? Whats your hope?

I hope it helps inoculate people against the misinformation online. Lies about hormones and therapies seem to be Instagram and TikTok fodder. I hope this helps people realize whats a scam, who is scamming themand who is just woefully misinformedand what might hurt them. And I hope it helps them have the conversations they need to be having with their health-care providers and be able to push back if theyre not getting the information and help they need.

But where can we get help? Articles about womens health always blithely say, Talk to your health-care provider, but you really only get 15 minutes with your family doctor.

I think its impossible to have a conversation about menopause in 15 minutes. Its not even possible to have it in an hour, because youre talking about health implications for 40 or 50 years of someones life. Thats like saying to a 16-year-old, We have 15 minutes to talk about your adulthood. Lets go. I really think providers need to say, Listen, I want to help you with your fmenopause, and I cannot help you all in one visit, so let me give you some basic information, and well have you come back or we can follow up with a phone call, and we can do it over several discussions. Its a big concept. And people come in with so much misinformation about hormones. Ill say, What do you hope hormones can do for you? and theyll come in with this long laundry list of things that sound like, well, lifenot menopause.(Related:What Happens When Doctors Don’t Listen to Patients)

Right, so when someone comes into your office and says, Hey, Im sleeping like crap, its important to remember it might not always be menopause-related.

Exactly. Menopause doesnt happen in a vacuum. When youre in your late 40s or early 50s, and you might have children in middle school or high school, its a stressful time. Theres a lot of other things going on. So many women take care of everybody else except themselves. The three healthiest things a woman can do to help her menopause are not smoke, exercise regularly and eat right. So I always start off with the basics. You cant look at hormones as a magic wand. They arent. They are a piece of the puzzle for some people, though not for everyone. But theyre not the whole picture.

What you said in the book about how exercise is like free moneythat was a light bulb for me. I always think, Oh, if I cant commit to a seven-days-a-week regimen, whats the point? But every little bit counts! A 10-minute dog walk is great! Thats like 10 free bucks.

Many women are very guilty of this right-or-wrong binary because thats how this patriarchal society has made us feelwere either good girls or bad girls. Its taken me a long time to move away from that. There are days where theres too much going onbut if I can only get in 15 minutes on the Peloton, thats okay. Its better to do it than not, and the more I just do a little bit, I find, ooh, maybe I can do 20 minutes or maybe 30. And I know a lot of people have difficulty exercising or have physical limitations, but even doing gentle stretching, even balance exercises is always beneficial.Michelle Yee Dr Jennifer Gunter 3

What symptoms are women most likely to seek treatment for?

I think the most bothersome ones are hot flushes and sleep disturbances. Vaginal dryness is one I treat all the time. Women come in and are always so surprised that theres a wealth of over-the-counter moisturizers. Those can work for many people. Theres oil-based, theres hyaluronic acid-based and theres silicone-based. By and large, Id say the silicone and hyaluronic acid moisturizers tend to be really well-tolerated.

Lets talk about menopausal hormone therapywhy do you use this term over hormone replacement therapy?

Menopausal hormone therapy is the term all providers should be using now. HRT is really out of date, because were not replacing something. Your ovaries are supposed to stop producing estrogen. I think its really important to get away from this idea of a replacement, cause its not. Its a treatment. Its a therapy. Otherwise, it makes it sound like its essential. And its not, necessarily.(Related:Can Hormone Therapy Ease Your Menopause Symptoms?)

Its the estrogen that provides the therapy, right? And then you have the oral routes and the transdermal routes, like patches, gels and rings.

So transdermalwhether you put it on your skin or in the vaginais by far the safest, because it doesnt increase your risk of blood clots. Oral estrogen could increase the risk of the major complications, like heart disease, blood clots, stroke and possibly dementia long term. The risks are still not super huge, but why not take the lower risk? Progesteroneor progestincan be given orally, in an IUD or in a combination patch, combination ring or vaginal gel.

It can be incredibly hard to get time with a doctoreven without a global pandemicwhereas I can have a 90-minute conversation with a naturopath who will ask me everything about my life. Thats pretty tempting, when Im desperate to be heard.

Absolutely. Unfortunately, from what Ive seen, the majority of naturopathsthere might be good ones out thereare spreading gross misinformation within those 90 minutes. I think naturopaths are taking advantage of the gaps in medicine as opposed to solving them. What if, in 90 minutes, that naturopath had an incredible conversation about diet and exercise and sleep hygiene? But they make their money on salivary testing. They make money by telling women they have to come back regularly to retest their hormones.

I admit Ive tried quite a few things you lay out as red flags, including salivary hormone testing.

Its much harder to say if a therapy is good, but its easy to say if its awful. First of all, salivary hormone testing doesnt tell us anything. Its a nonsensical test, and the results are meaningless. Hormone testing is generally not needed because we dont base treatment on hormone levels. We treat based on symptoms, and we see if the hormones make you better or not. Seeing where you are is not predictive. The menopause transition is so chaotic. You can have super high levels one cycle and two months later, look like youre in menopauseand two months later, have normal estrogen levels again.(Related:5 Easy Lifestyle Changes That Can Help Ease Perimenopause Symptoms)Michelle Yee Dr Jennifer Gunter 4

Another one of your big red flags: compounded hormones.

Theres very little data around them. Why would you want to use something where you dont know how much hormone is getting absorbed into your body? Here are these providers who believe in hormone levels saying how important it is to know your hormone levels and yet giving someone a therapy where absorption is unknown! It makes no sense. As I explain in the book, many of these [compounded formulas] contain less or more hormones than they indicate theyre supposed to. So a woman concerned with osteoporosis cannot at all be assured that a transdermal compounded estrogen could protect her.

Okay, let er rip: What are the supplements and treatments you find most enraging?

Number one: anything homeopathic. I mean, that is 100 percent a scam. [Homeopathy] is based on abusing the laws of physics. It was invented in the late 1700s. It has been disproven in multiple studies. If someone recommends homeopathy, walk out the door. Do you really want to see a provider who thinks the laws of physics dont apply? Do you want the pilot flying your plane to not believe in the laws of physics? I dont think so.

Okay. Whats next?

Something that really irritates me is [the notion that] a therapy is ancient so it must be good. The ancient Greeks believed that women were overly moist. We dont accept that understanding of physiology, so why would we accept treatment based on it? In ancient Egypt, if you had ear pain or jaw painsomething we might think now is an ear or sinus infectionthey fumigated your vagina, thinking it was all related. As I say in the book, I never mean to insult people from 3,000 years agothey were doing the best they could at the time. I often think people in ancient cultures would be horrified to think, Wait, you had 3,000 years to advance, and youre still doing what we were doing?(Related:9 Questions About Menopause Youve Been too Embarrassed to Ask)

What about MTHFR testing?

This latest trend irritates me to no end. MTHFR is a genetic mutation thats related to many functions. Its a nothing variant. However, in the naturopathic and functional-medicine communities, this has become a cottage business. People come in, and they have MTHFR testing and special supplements and hormone levels and all kinds of things. These practitioners make up lies about how it impacts estrogen and how it impacts your ability to get vaccinated and how it impacts pregnancythe testing is completely unnecessary. It is NOT needed. But its a huge thing on Instagram right now, and its absolutely obscene.And lets add topical progesterone to that. One, its not going to help with any of their symptoms, so theyre paying a lot of money for a placebo. But if theyre also taking estrogen, theyre now not getting their uterus protected and they are increasing their risk of endometrial cancer.

I really wanted it! A couple of years ago, I saw a woman on Twitter say, Oh my god, you guys, I got this cream, its a magic cream, Im sleeping, Im happy and I went in search of the magic cream. How desperate we all are for the magic cream!

It really shows you the power of placebo, right?

Yeah, she really believed it. She was saying, Oh god, this is saving me.

Its very dangerous. Yeah, that really irritates me. My next one is the conflation of phytoestrogens and estrogens. They are different things. People think theyre getting estrogen from their food. Providers lead people to believe this, so I have patients come in convinced theyre using phytoestrogens when theyre using estrogen, so I think thats an issue.And my last one is the absolute misinformation about plant-based hormones. Because all hormoneswith the exception of Premarinare made from the same thing. So whether you take estradiol from Big Pharma or get estrone from a compounding pharmacy, it is made in the same place from the same thing. Its literally like having a box of generic Cheerios and then taking some out and wrapping them up in a pretty glass bottle with a ribbon and saying, Here are your bespoke plant-based Cheerios. Its a scam. Women deserve medicine. They dont deserve marketing.

Because they know were desperate.

Everybody wants an easy answer. Everybody. I want easy answers to all my medical problems as well, and for my children and for my partner, and for people I love. But life is complex. Medicine is complex. And there are no easy answers. But there are many solutions, and those solutions can be found in a lot of places. If people are only selling you homeopathy or only telling you to have compounded hormones, youre not getting the wealth and breadth of evidence-based medicine you should be hearing about. If youre making a decision about treatment, its not even an informed decision, because you havent been informed!

I love this quote of yours: Facts can bring certainty to the chaos and uncertainty of menopause.

People are so happy to have things explained in a way they can understand so they can sit back and make the decision that works for them in an informed manner.Im all about options. I trust women to make decisions about their bodies. What I have found over my whole medical career is that people want a plan. When they come in and theyre desperateand I hear they are desperate, and I appreciate that they are desperatemany people mistake that for desperate for a prescription. But what they are desperate for is a plan.Next, this is what Timothy Caulfield has to say about anxiety and debunking popular health myths.

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