The Perimenopause-Industrial-Complex

Welcome to part 1 of our new series on perimenopause. Over the next three weeks, we're going to be giving you the low-down on what you need to know about nutrition for perimenopause: what's good, what's fake, and what we don't really know yet. Part 1 (today), is a primer for the series, grounding the nutrition in a bit of analysis (because I can't help myself). Part 2 (23rd September) will cover supplement scams in more detail than you ever cared for (think you need that Wild Nutrition peri complex, think again!). And finally, part 3 (30th September) will cover what we think there's enough, compelling evidence for when it comes to perimenopause nutrition.

About half way through Miranda July’s All Fours we are confronted with a chart. The Y axis ticks up the years from zero to 85; the X axis tallies the approximate level of hormones in the body. For anyone socialised as female you probably already know this particular story; estradiol takes a nose-dive around the 50 year mark. This is menopause. In the book, July’s 45-year old artist protagonist is afflicted with myriad mysterious symptoms – moodiness, difficulty sleeping, irregular bleeding – and walks out of her gynaecologist visit with a diagnosis of perimenopause. In her car, she pulls up the WebMD page showing the aforementioned chart, and a whole bunch of other (often vague and nebulous) symptoms. ‘We’re about to fall off a cliff’ she tells her friend over the phone. ‘We’re going to be totally different people in a few years’. 

For anyone with a uterus, our life is centred around a central tension. Our bodies are unruly with liquid – tears, blood, milk – and in need of disciplining. Or, they are disciplined and discarded; used up. The chart, it seems, makes the transition visible and simultaneously suffuses it with medical knowledge and power. The chart shows an ominous, inauspicious event, tipping us over the edge into reproductive destitution. The chart reminds us that our usefulness under heteropatriarchy has an expiry date. 

I hadn’t heard of perimenopause until a few years ago, when it was suddenly everywhere. Maisie Hill’s Perimenopause Power, Davina McCall’s Menopausing, and Dr. Louise Newson’s The Definitive Guide to Perimenopause and Menopause. I was also hearing about it more and more in my practice; which supplements should I take for perimenopause? Which foods should I eat for perimenopause? Perimenopause is messing with my hunger and fullness cues, what should I do? And surely you’ve also had Wild Nutrition hawking their ‘Menopause Complex’ in your Instagram feed. 

A few months ago I was mooching around a bookshop with CIHAS medical correspondent (and GP), Dr. Hammad. We passed the ‘women’s health’ shelf which contained all the aforementioned titles, plus some. I gestured towards them and asked what he thought, assuming he wouldn’t really give a shit. A ten minute diatribe later and I learned that he in fact did have some feelings on the matter, which distilled down to this: the perimenopause-industrial-complex is predatory and locates a problem within individuals, turning it into a neoliberal healthism, without considering the wider social context. This is remarkably similar to most of his takes, so I don’t know why I was surprised. But he did voice something I had also wondered: is this thing real?

By ‘real’ I do not mean to dismiss or trivialise the experiences people are having in their bodies. I believe you when you tell me shit is whack. But what I mean is, are these experiences simply a result of biological changes? And are these biological changes different from aging? Or are the interactions between the social and biological? The answer is always yes, but to what extent? And what role does the peri-industrial-complex play in playing on our fears about these changes, and selling us back the solution?