Part two                                                                                                          Edited and updated

Menopause: science and feminism and a poem

A. It’s Esater here in Greece, so in today’s post I will post my quick translation of a  poem by an important Greek poet.  Mary’s monologue expresses the love and pain mothers experience when their children suffer for their “principled insubordination”, to use a term from Todd Kashdan’s book (about which I might be writing about in the next post), and for speaking truth to power.

The pains of Our Lady by Kostas Varnalis (1884-1974)

The poem belongs to the first part of the poetic composition of Kostas Varnalis, Slaves under Siege, which was published in 1927. The poet uses the archetype of the Virgin Mary to express the feelings of mothers and the injustice of this world. In Mary’s monologue there are verses that express the tender feelings of the mother and others that reflect her bitter realizations about our unjust world. The radical poet Κostas Varnalis chooses the Virgin Mary as a timeless symbol of maternal love, but also of the pain a mother experiences when she sees her child sacrificing their safety, even their life for the common good. Mary expresses all her tenderness towards her unborn child and her intentions to do what she can to protect him from the suffering of this world. She is aware that the humanitarian messages that her child will bring to the world, will be the reason why the powerful will want to kill him, in order to put an end to his effort to awaken the poor and powerless.

The poem was made into a song in 1980. A more contemporary rendition by Maria Papageorgiou at:

Excerpt … ..

Where shall I hide you, my son, so that the bad people cannot reach you?

On which island of the Ocean, on which deserted peak?

I will not teach you how to speak and shout against injustice.

I know that you will have a heart so good, so sweet,

but captured in the nets of rage, you will soon be torn to pieces.

You will have blue eyes, a tender little body,

I will keep you away from the evil eye and from bad weather

From  the very first surprises, of your awakening youth.

You are not meant to battle, you are not meant to be crucified

You’re to become a young householder,  not a slave or a traitor.

At night I will get up and quietly tiptoe,

Bend over to listen to your breathing,  my warm little bird,

to make you milk and chamomile on the fire.

And then outside the window with my heart beating I will look

while you go to school with a slate and (slate) pencil …

And if ever in your mind Justice, (like) thunderbolt light,

and Truth hit you, my child, do not speak of them.

People are wild beasts, they cannot bear the light.

Truth is not as golden as the truth of silence.

Even if you are born again a thousand times,

a thousand times again, they will crucify you……

B. Also, in today’s post I will again draw on Dr Jen Gunter’s book: The Menopause Manifesto. A big part of the book is of course dedicated to health related information and how to become more aware and knowledgeable, in order to navigate this period of life, and also, engage with prevention of disease processes more generally. I will not focus on the medical information and options women might have. One needs to read the book for that and then perhaps explore areas of interest further. In this post I will only expand on a few points made in some of the chapters I didn’t refer to in the previous post.  Overall, Gunter situates women’s experience in systemic structures and asks for a more holistic and respectful approach towards women in the field of medicine. She analyses how there are many converging factors that can cause or / and increase the risk of health problems and how some of these factors can impact the range of options that women have.  So, it is always important to view the broader contexts in which we try to navigate our lives. As Rick Hanson said in last week’s meditation-talk ( “It’s really helpful to connect the personal to the political… many of the factors that have traumatized and stressed us over our life and many of the factors that make our life harder… Many, many, many of the sources of our feeling bad inside our homes really originate on the other side of our door. They’re out there in society, in our history, economy, culture…We live in a society that’s speeding up, that’s invasive…”

Gunter provides many examples throughout the book to support this point. For instance, she claims that hysterectomy rates are higher in the United States versus other industrialized countries. Specifically, in the early 2000s, 54 percent of premenopausal American women having a hysterectomy for noncancerous reasons had their ovaries removed versus 30 percent of Australian women and 12 percent of German women. She writes: “That’s atrocious and unacceptable. Women in Australia and Germany have a longer life expectancy than American women, so keeping their ovaries isn’t exactly holding them back. In fact, it is almost certainly helping. What’s even worse is in America rates of surgical menopause are higher for African American women …” She explains that while some of this is driven by some gynecologists who recommend surgery over medical therapies and even racism, it’s important to remember that American women have to pay far more for their medical care compared with their British and European counterparts to whom they are often compared in studies on the rate of hysterectomies…..  In the United Kingdom every therapy listed in this chapter has no out of pocket expense and in most European countries there is universal health care that covers some or all of these expenses.”

In terms of women’s physical strength and fitness Gunter invites us to think back to the grandmother hypothesis.

The grandmother hypothesis:

In a nutshell, in her book, The Social Instinct, Nichola Raihani discusses menopause from an evolutionary perspective to answer questions like:  Why do women experience this sharp, non-linear decrease in our fertility in our late thirties? And why do we then persist as sterile vessels, when it would seem that we have become reproductive dead ends? By going back in time and through this lens, Raihani claims we come to realise that menopause is the outcome of a necessary evolutionary process. She refers to data that shows that when a grandmother bred alongside her daughter-in-law, all of the children suffered, and the costs were heavy because children were less than half as likely to survive to the age of fifteen when there was competition between breeding females in the extended family groups. She writes data shows that co-breeding was exceedingly uncommon. And what was more common was a case of what looks like altruism: the older females concede to the younger ones in these reproductive battles. She asks: But how might grandmothers possibly benefit from curtailing their own reproduction and allowing younger females to breed unhindered? She writes: “This puzzle can be solved by considering the ways in which the younger and older females are related to one another’s offspring. The mother-in-law has a vested genetic interest in any children produced by her son’s wife….. The benefits that grandmothers confer are well documented and can provide the selective impetus needed to favour the increased post-reproductive lifespan. From the ashes of an evolutionary conflict, grandmothers rise up. When all we have to go on are records of births, deaths and marriages, it is very difficult to infer how, exactly, grandmothers helped their grandchildren to survive. It is likely that these ancient grandmothers acted as repositories of knowledge, passing vital information on everything from breastfeeding to dealing with infants’ illnesses…… It has also been shown that increased distance between mothers and their daughters corresponded with decreased survivorship of the daughter’s offspring.”

So, it seems that the process of ageing – is not just a biological inevitability, but something that might be under the control of natural selection. Gunter writes that historically, grandmothers were helpful because they were physically active gathering food and helping to care for grandchildren. She refers to a study of postmenopausal Hadza women, which revealed they spent almost 37 hours a week foraging for food (moderate exercise according to the World Health Organization ), so being physically active not only allowed grandmothers to contribute, but also helped them remain healthy so they could continue to contribute.” She invites us to consider the imagery our societies often presents about women as we age. “Frail, delicate, standing on the side lines cheering, and yet humanity has long depended on physically fit grandmothers.”

In relation the changes that often occur in strength, size, and shape, Gunter writes that one of the sentinel physical changes of aging is loss of muscle mass, which actually starts in our thirties with some individual variation, and this progressive loss of muscle mass is associated with the slowing of the metabolism with age, or insulin resistance, which causes the body to produce more insulin to compensate, to increasing hunger and potential weight gain, which cumulatively can lead to women’s risk of type 2 diabetes. Other related concerns are limitations in movement. The diagnosis is sarcopenia and women develop it earlier than men and often suffer more because women generally start with less muscle mass, have an accelerated loss of muscle during the menopause transition, and also live longer than men. It is suggested that the best way to slow the decline of muscle mass, and even reverse some of the loss, is through physical activity. Through her own story Gunter talks about how many women have had horrible experiences regarding exercise as children at school, which can often have lasting effects in relation to how they view exercise, but exercise as one ages becomes even more important.

Chapter eight begins with the phrase: “One woman dies every five minutes from cardiovascular disease (CVD). Gunter writes: “it’s so important that women and their providers expand their concept of menopause beyond the symptoms that get the most attention in the media and on social media, such as hot flushes, mood changes,….,” She claims that there are tragic differences between the management of CVD for women versus men and that 42 percent of women die within one year of a heart attack versus 24 percent of men. Also, women under 55 who have a heart attack while in the hospital have two to three times the risk of dying compared with men of the same age. She adds that although some of this difference may be due to the biology of heart disease in women often it’s death by misogyny, either because studies have excluded women, so when women are getting what is referred to as the “best therapy” what they’re really receiving is the best therapy for men or due to the incorrect belief that women— especially young women— don’t develop CVD.  Other reasons are the fact that women receive less counseling about heart disease or the fact that women are less likely to be prescribed medications that can lower the risk of heart attack and stroke. She adds that black women are especially less likely to receive medication. She notes that women often have their symptoms brushed off as anxiety or hot flushes since there’s significant overlap in symptoms of anxiety, hot flushes, and a heart attack, and it takes a dedicated health care professional to make sure all three are being considered, not just the two that aren’t fatal. She talks about systemic gaslighting when it comes to women’s health.

In the chapter on vasomotor symptoms and on the variations found in different cultures Gunter writes that it is important to take into account how cultural factors may affect what some women are either willing to report or what they feel, and to distinguish whether women in some cultures or countries truly have fewer vasomotor symptoms, whether they have the symptoms but aren’t bothered by them, or whether they have hot flushes and night sweats and there are cultural barriers to reporting these experiences even in a medical study. She concludes that without objective monitoring of symptoms, studies reporting different rates of hot flushes by culture or ethnicity may lead to under-reporting for some groups. She also raises awareness that typical menopause related symptoms could be due to other causes. For instance, women can have two medical events that have converged at once, and therefore, a deeper exploration and knowledge allows women to make informed choices, and also, women feel more at ease if they know that their experience is typical. She also discusses the normalization of “typical” symptoms.  One example she uses is bladder health issues. She claims that even though it’s typical for women to develop bladder conditions with both menopause and age, it’s not normal, and that there is an ocean of difference between those two words. She writes: “Typical means it’s no surprise that a medical condition happens, but it doesn’t mean that condition is safe or unproblematic or needs to be tolerated. In contrast, normal sounds as if the experience is something to be tolerated.”

Gunter also discusses the need to raise awareness about the significance of osteoporosis and its devastating impact for many women, the screening process and fracture prevention. She provides information about screening options, things to do and medication options, as well as, references to studies and risks. She writes: “It feels as if there’s a cultural acceptance of osteoporosis, which is tragic and fills me with rage. Perhaps society just expects women to get frail, so why be concerned about something that’s “normal”? Maybe the needs of women as they age are irrelevant….. There’s also a false belief among some that prevention is ineffective or medications to treat osteoporosis are too risky. …… And finally, who wants to talk about a disease that we associate with crones, hags, and little old ladies? Even if women have concerns or are aware of their risks, they may not feel a space has been created for discussion. Whatever the reason, it’s women who suffer.”

Finally, throughout the book Gunter sets out to bust myths around relevant issues and remedies and point out that often there are claims about certain products without any substantial research data to back these claims. These were interesting bits to read since a lot of conflicting information is found in the media. One example is the claim that various foods or diets can provide hormone fixes, cures, and resets for women in the menopause continuum. Gunter believes that food doesn’t change hormone levels in an eat-this change-that-hormone kind of way because if plants contained hormones that could be digested and used by humans, then we’d know by now because these foods wouldn’t just improve symptoms of menopause they’d also cause premature puberty, irregular menstrual cycles, infertility, breast development for men, and vegetarians and vegans would have more of these health concerns. She writes: “But that isn’t the case. Humans don’t get hormones from plants and we’re not able to convert plant compounds into hormones. We make all our estrogens, testosterone, and progesterone from cholesterol. This is a complex, multistep process…”

All in all, in this book Gunter gives a lot of medical information, pros, cons and risk factors of medications and medical interventions, but also raises many questions to set us thinking about complex issues that will hopefully contribute to more informed and conscious choices. Towards the end of the book she writes that she hopes the book will help people take in the bigger picture of menopause, in order to reframe the experience and to consider ways to optimize health along the menopause continuum. This she says can only happen with accurate information and without the prejudice of the patriarchy. Finally, she dedicates a chapter to her own Reproductive Reckoning. I will end with a short extract from this chapter: “The source of my rage was this reproductive reckoning. The realization that menopause was just one more way that the burden of perpetuating the species is unequally borne by women and one more way that our biology is weaponized against us. It is the ultimate gaslighting because it’s this biology— from puberty to grave— that literally birthed humanity as we know it.”

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