The Internet's Gynecologist Will See You Now

Image via @dramiehanlon.

By Elizabeth Keifer

During peak pandemic times, Jen Gunter MD — otherwise known as the Internet’s gynecologist — started to notice a convergence of alarming trends. 

“There were all these crazy viral fears about the vaccine and menstrual cycles,” she recalls, “in tandem with this rising discourse on TikTok and Instagram that hormonal contraception is evil.” She witnessed more and more “menstrual coaches” hawking their services, and naturopaths marketing “period repair supplements” that claimed to help rebalance hormones and “reset” your cycle — broadly, a boom time of period-related exploitation. 

“To be clear: There's no such thing as balancing your hormones. Anyone selling you a supplement to do that is either medically illiterate or grifter,” explains Gunter, who devoted a deep-dive installment of her Substack, The Vagenda, to this subject in January. Knowledge gaps about women’s bodies and reproductive health make people more vulnerable to misinformation. Accessible facts provide an antidote. Gunter’s new book, Blood: The Science, Medicine, and Mythology of Menstruation, aims to provide exactly that. 

Read on for more about, well, blood … and why puberty is a helpful framework for thinking about perimenopause. 

What will readers find when they pick up Blood? 

A factual menstrual instruction manual: what the menstrual cycle is, what the bleeding is, why you have cramps, the science behind PMS, the most common medical conditions that affect the reproductive tract (like endometriosis, polycystic ovarian syndrome, fibroids, heavy bleeding, and — the most common condition — pain with periods), along with the treatments for these conditions and how to sort out information online. 

Menopause has really entered the chat in the last few years: Why — and how?  

My husband would say that it's because I wrote a book on it, which is partly true. Also, Gen X women have really raised the level of conversation and the whole online discourse about menopause — like, “Wait a minute, why don't we have more information about this?!” 

But there’s another reason: Menopause has gone from something that was never discussed (because if you're old, you may as well be dead, right?) to being something to monetize. Whenever there's an opportunity to sell something, it creates space for conversation. But it also creates opportunities for charlatans to take advantage of those gaps.  

What’s an example we should watch out for? 

There are tons of gaps in medicine. But most of them, instead of being filled, get exploited. Supplements are a $50 billion year business. If you have a line of menopause supplements, you're exploiting that gap. The North American Menopause Society (NAMS) just reviewed all of the non-hormonal therapies for hot flashes, and not one supplement had good enough evidence to recommend. I always tell people: If somebody is selling supplements or advertising them, they're a pharmaceutical company. Would you get health information from a pharmaceutical company? And the answer is almost certainly no. 

Let’s talk about hormonal therapies for menopause, because there’s a lot of confusing messaging out there about what’s available and what actually works. 

We think that menopausal hormone therapy is safe for the majority of women, and that it carries some risks, but they're very low — like on par with a-glass-of-wine-a-day low. In the United States, the only FDA-approved indications for menopausal hormone therapy are hot flashes, night sweats, vaginal dryness (although we recommend vaginal therapies for that), and prevention of osteoporosis for people at high risk. 

There are also some other, softer reasons. Those require more of an in-office discussion. For instance, joint pain is a common symptom of menopause. But hormones only help about 20 percent of people experiencing that. So hormone therapy isn't necessarily wrong to try, but it's also not for everyone or everything. 

I’m also hearing my peers talk more about perimenopause. Can you give me a quick crash course? 

Think about perimenopause like puberty in reverse. The menopause transition — which is what we call perimenopause now — can last anywhere from four to 10 years. The average age of onset is 45. Right now, we believe that the earliest reliable symptom of perimenopause is menstrual irregularity, such as a seven-day change. What will happen is the time between periods lengthens. It might go back to normal for a while, then space out again. Once people are reliably skipping a period — at times going around 60 days between bleeding — it usually means menopause is about one to three years away. 

Aside from checking out your books and newsletter, what can women do to help prepare for this transition? 

Strength training: It helps with the preservation of muscle mass, it's good for depression, it's good for your heart health, it's good for your brain, and it helps prevent falls. Follow a healthy diet, make sure you're getting enough protein. Hormones can definitely improve some symptoms, but they will never do as much as exercise, diet, and not smoking will when it comes to longevity and healthy aging.  

Menstruating people are the target demographic for your writing, but one thing I appreciate about your Substack and your books is how they make the subject accessible for everyone, including men. It’s helpful (and important!) for them to be more fluent in these topics. 

I agree. I've had a lot of men reach out to me and say that they bought the Menopause Manifesto and read it because their partner wouldn't talk about what they were going through, which is sad. But it's also sweet to know that there are men and coupleships who were doing that as an act of caring. I've had single dads and gay dads reach out to me about buying The Vagina Bible or Blood so they can better understand what’s happening with their daughters. There are so many gaps in women’s health, including knowledge gaps, that harm us all, and fighting to close them benefits everyone. 

Blood: The Science, Medicine, and Mythology of Menstruation by Dr. Jen Gunter is available now. For more information about the book and her tour, check out the information page on The Vagenda.  

**This interview has been lightly edited for length and clarity.**