Q&A with Caroline Harris, editor of M-Boldened: Menopause Conversations We All Need to Have

January’s Hysterical Women Book Club read is M-Boldened: Menopause Conversations We All Need to Have, a book about menopause unlike any other. Moving away from a single narrative, it opens up the conversation in new and profound ways for people across the globe. Recognising menopause as a human rights issue that affects everyone everywhere, it includes contributions from women’s rights activists across the world, including women living in rural Afghanistan and Pakistan (where in some cases women’s health provision is so poor that there aren’t even words to enable the conversation) alongside contributors from urban New York and London.

I sat down with the book’s editor Caroline Harris, to find out why the menopause is such a huge feminist issue and how the conversation is shifting.

SG: I really love the book’s unashamedly feminist approach to the menopause – why do you feel the menopause is such an important feminist issue?

CH: The menopause intersects with so many other feminist issues, and speaks to lots of issues around attitudes towards women. We’re pretty clear that there is a gender health gap, in terms of how the male body is so often taken as the model for diagnosis, and there are problems with women just not being listened to at the GP surgery or when seeing a consultant. We also have a gender gap in research and in testing of pharmaceuticals. That’s something that Dr Wen Shen and Dr Christine Ekechi talk about in their contributions to the book, and also Mandu Reid, leader of the Women’s Equality Party – that real lack of research on health outcomes for women.

It also intersects with attitudes to women’s bodies – cultural and religious views that see female bodies as something to be hidden. When women’s bodies are hidden, and women’s health is not talked about, that’s led to an ignorance of natural processes – whether it’s menopause or menstruation – and a lack of knowledge and understanding about female anatomy and health. That also means women can end up ignoring when things are not right, because they don’t necessarily have the knowledge to know when things aren’t as they should be. Women undervaluing their own health is something that really came across in Shad Begum’s piece, talking to women in rural Pakistan, where women just didn’t see their health as important. You can see that globally to an extent.

The third big issue is around women and ageing. In Western cultures we have a kind of cult of youth, where youth is seen as desirable and older women end up being denigrated. Women in menopause are joked about as sweaty and hot flush ridden, or made invisible. You have the idea of the dried up hag, and lots of other stereotypes. In other cultures it’s fertility, rather than youth per se, that’s highly valued – so older women come up against ageism, prejudice and exclusion because of that.

These are all huge feminist issues, so it feels difficult to talk about menopause without having a feminist viewpoint on it.

Absolutely. Why then has it been missing from feminist conversations for so long?

I think there are plenty of reasons not to talk about it. The difficulty of talking about being a woman and ageing, and the issues around women’s bodies and health, have made it hard to put your hand up and say, “we need to talk about the menopause.” There’s also been a culture of women gritting their teeth and getting through it, so even among feminists menopause has been a long way down the agenda. There’ve been other things we had to fight for first, if you like.

There’s also this idea that you shouldn’t make a fuss, and especially if you feel you have to live up to the idea of being a ‘strong woman’. When it comes to getting a foot in the workplace, and proving that women can take up important roles at work, it’s been really difficult to admit to anything that might cause people to see women as inferior, or vulnerable, or hysterical.

How are we starting to see the conversation shift?

The menstrual movement amongst younger women has made a difference, as well as the #MeToo movement, and the changed attitudes towards mental health. We’re beginning to see things happening on a number of different levels, and then of course Diane Danzebrink’s Make Menopause Matter campaign, which has led to menopause education being added to school curriculums. We have workplaces beginning to take seriously the need for a menopause policy. I think the government and businesses are also starting to recognise the economic case for supporting women and their loved ones through menopause as well.

There is a lot more that still needs to happen – better education for GPs, for example, and much more joined up provision in health. There’s such a huge range of symptoms that people can have – from difficult and heavy periods in perimenopause, to brain fog, memory issues and emotional symptoms. I think education is really key.

How did you go about selecting such a diverse range of voices and experiences for the book?

From the beginning I wanted it to be a more diverse range of voices and viewpoints than what was out there already. It was partly about finding some people who are already known – for example, Olympic gold medalist Tessa Sanderson has written a very powerful chapter. We also have others who have spoken or written about menopause before, like Caryn Franklin and Lynne Franks.

At the same time, I wanted there to be people who were not known, and who come from different backgrounds. We have the experiences of a group of nurses in Australia, for example, who were members of the Australian Nursing and Midwifery Federation. I did lots and lots of looking around, approaching people, because I knew I wanted to have a real range. I think everyone in the book has so much to offer, and often they are talking to several different stories – like Tessa’s wonderful piece, where she’s not just talking about menopause but also the experience of adopting young twins.

There are also people whose voices are often not heard, like Clare Barstow, whose chapter is on her very difficult experience in the UK criminal justice system and the lack of care for women in prisons. We also have women’s rights campaigners in Afghanistan, which is such an interesting chapter. They talked about how just how difficult it is to speak openly about menopause in Afghanistan.

What do you feel you learned from editing the book? Did anything particularly surprise you, or make you think about the menopause in a new way?

I’ve learned such a lot through doing the book. There’s only so much you can learn from doing your own research and reading things online, but hearing people’s experiences – either of going through menopause themselves, or their viewpoints as professionals – is so much more powerful. The main thing I learned was about the uniqueness of people’s experiences, and how everyone’s experience is different.

There are general themes and ways in which those experiences connect globally – but, at the same time, each experience is unique. One interesting thing was that people sometimes feel they should have a certain type of menopause, or be able to deal with something, because their mother or sister did. On the one hand, the menopause is this universalising thing that 50% of the population will go through, but at the same time you can have a hugely different experience even from people in your own family.

One of the ideas I was most struck by was the need to balance getting medical professionals to take women’s symptoms seriously, and treat them where appropriate, without pathologising the menopause as a problem to be ‘fixed’. How do you think GPs in particular can strike that balance?

Yeah, it’s interesting, and I was really struck by this when I first read Dr Padmini Murthy’s chapter, which gives a global overview. She talks about how menopause is medicalised in countries like the UK and US. Although I knew that already, hearing the culture in this country spoken about made me stop and think about it again. It is a very medical model and it’s easy to fall into menopause being seen, therefore, as a lack – a lack of oestrogen that can, as you say, be ‘fixed’. But that chapter also highlights how a lot of the things that affect experiences of menopause are not medical. They’re things like people’s relationships, their work situation, beliefs, financial security.

One of the things that also comes through in Jennifer Nadel and Carol Russell’s chapters is about menopause as a time of taking stock or letting things go, rethinking values, or discovering the values you already had and acting according to them. People may be questioning their sexuality or relationships around midlife and menopause. Menopause generally can be a time of thinking about what’s important and what to prioritise, which is not a medical issue at all.

For GPs, if someone is coming to surgery who is struggling or finding things difficult and having distressing symptoms, I do think first thing is for GPs to listen, to really take seriously what the person in front of them is saying. So many people have their symptoms shrugged off, ignored, or belittled. The first step is to actually listen to someone when they come to their GP, and also for GPs to be informed and have an open mind. There are many different HRT options, and there are other complementary things you can do in terms of diet or lifestyle. There’s a lot around GP education, so that GPs can be more confident about listening to and working with the person who’s sitting in front of them.

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