To set the stage, here is a selection of titles from my local bookstore’s women’s section: Could It Be … Perimenopause?; Before Your Time: The Early Menopause Survival Guide; The Natural Menopause Plan; Second Spring; Menopause Reset!: Reverse Weight Gain, Speed Fat Loss, and Get Your Body Back in 3 Simple Steps; and the slightly ominously titled What Nurses Know … Menopause (two words: atrophic vaginitis). On the cover of a typical menopause book, instead of the perhaps more to-the-point fanged woman with the Medusa do, one is far more likely to see a lone flower—a poppy, perhaps a daisy. Curious choice? Well, no, because as one begins to read the war stories of the M.D., Ph.D., and R.N. (atrophic vaginitis!) authors who dominate this genre, one sees narratives that are indeed Stuart Smalley–esque. Here’s a pastiche:
Mary Anne, age 48, came into my office feeling overweight and bloated. She hadn’t been sleeping, work was stressful, her husband had just gone on disability, and he required daily care. Mary Anne complained to me of lower-back problems and gastritis, and also cramping during sex, which had become more and more infrequent. She was extremely depressed about moving her 84-year-old mother to a nursing home, and upon examination I noticed vaginal inflammation.
As unappetizing as that just was to read, be glad you saw only one such passage—I must have read a hundred. Because clearly, from the medical-professional point of view, menopause, or really the run-up to it called perimenopause, is a parade of baleful, bloated middle-aged women (“Lisa, 52,” “Carolyn, 47,” “Suzanne, 61”) trudging into their doctors’ offices complaining of lower-back pain and family care-giving issues and diminished libidos and personal dryness and corns. As they sit wanly on the tables in their paper gowns, they arduously count out their irregular periods—from 35 days to 44 days to 57, going heavy to light, light to heavy, sometimes with spotting, sometimes with flooding, sometimes flood-spotting, sometimes spot-flooding. Why this variation? So easy to understand, really. The simple science: ovarian production of the estrogens and progesterone becomes erratic during perimenopause, with unpredictable fluctuations in levels, which in turn can result in many different symptoms, including major mood swings. But sometimes not. You may never feel any of this! Because here’s the key: All women are different.
And yet, even though we all are different, the list of prescriptions for us seems to be very much the same, and none of it’s fun. If one must tinker with hormone-replacement therapy, one may—briefly, in moderation. But from this point on, The Change is about healthy lifestyle. We’re all to get more exercise, drink more water, do yoga stretches before bed, cut out alcohol and caffeine, and yet (and how does this follow?) reduce stress. Even the flirty exhortations to have more sex feel like yet another job on life’s chore wheel (given that it’s supposed to be with your mate of 20 years rather than with Johnny Depp). And don’t forget all the deep sensory pleasures of a reduced-calorie diet. Menopause Reset! at least initially seemed to promise a nutritional miracle cure for that mysterious spare beach floaty that arrives after 40. I for one was excited to see that, instead of Black Swan–ing it until dinner, as apparently so many of us women do (in order to heap our measly 1,500 calories together into one meal a person might actually want to eat), you’re supposed to eat many tiny meals constantly. Hurray! But alas, after reading much dietary advice for menopausal women, I concluded that, in the horrible new metrics of midlife, each of the following constitutes a meal:
Meal No. 1 (8 a.m.):
2 tsp. nonfat yogurt
Meal No. 2 (10 a.m.):
3 almonds (unsalted)
Meal No. 3 (12 p.m.)
2 oz. low-fat barley soufflé (see Appendix D)
Meal No. 4 (2 p.m.)
small Bell pepper
1 tsp. flaxseed
Just staying awake all day to eat the food—while of course getting in those 15 reps an hour of sex with your 50-something husband—seems a challenge. No wine, though: best to pair vaginal dryness with buckwheat tempeh. Oh! Oh! Oh! Where is the plate-glass window to hurl phone through? Why is life worth living? Ouch, my corns!
So that’s the basic physiological landscape of menopause. Dry as the riverbeds can seem, though, one menopause book does rise like Mount Etna above the rest. Now celebrating its 10th anniversary, it is the bible of middle-aged womanhood: The Wisdom of Menopause, by Christiane Northrup, M.D. Having recently spent (20? 50? 80?) hours with it, I’ve come to believe that The Wisdom of Menopause is a masterwork. Weighing in at two pounds and 656 pages, it is an astonishingly complete, mind-bogglingly detailed orrery of the achingly complex, wheels-and-dials-filled Ptolemaic universe that is Womanhood. Featuring, arch-conventionally, its smiling doctor/author on a soothing pastel cover, the book is very much of the genre, and yet explodes it. Northrup presents both a celebration of Western medical practice and a revolt against it. Three times as big as the others, Wisdom is no less than the Jupiter in the menopause-book solar system, our Gravity’s Rainbow.