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The Power of Postmenopause

July 30, 2016 • By

On July 29, 2016, at age 68, Hillary Clinton accepted the democratic nomination for President of the United States. Yes, she is a woman of a certain age. The benefits of her being a woman in politics post-menopause became the subject of a Time article by Dr. Julie Holland last year that spiraled out of control:

The point of the article was to provide some medical facts about postmenopausal women in the face of harmful perceptions that women are somehow hormonally incapacitated past menopause. One of the points made was to emphasize that women are now living one-third of their lives post-menopause to an average age of 81, which means that even if elected President in November, Hillary easily has four more years with good preventative healthcare (notwithstanding my concerns about her thyroid medication earlier this year:

Whether endocrinologists agree with the facts in the Time article is another story, but in 2015, the first set of evidence-based guidelines authored by women were published by the Endocrine Society on the treatment of menopause. See: and

The theme of the practice guidelines is to offer individualized therapies to peri- and postmenopausal women, as it is clear that one size does not fit all, and there are a myriad of biological variations of menopausal symptoms and age-related risks.

Several of Hillary’s critics argued that Holland unfairly championed the nominee’s age when, previously, male nominee’s ages had been questioned. Ronald Regan famously said at age 73 at a 1984 debate: “I will not make age an issue of this campaign. I am not going to exploit, for political purposes, my opponent’s youth and inexperience.”

But there has never been a female nominee for the U.S. Presidency before, which makes the issue of Hillary’s postmenopausal achievement personal for many women. The feminist adage, “the personal is political” has perhaps never been so pronounced as it is in this election. Given that her opponent, Donald Trump (70) has made menstrual periods a reason to discount a critical female journalist (“She had blood coming out of her…wherever”), when his “gloves come off,” as he announced yesterday (see:, will Hillary’s hormonal status become a major political issue? Certainly her voice has (See:, which is also a biological feature associated with menopause:

Hillary wore a white pantsuit, which was an historical nod to the Suffragette movements in Britain and the U.S. (See: It’s critical to note that women’s reproductive status and rights were always at the center of being denied the vote, or in participating in the political process. (See:

But there is also evolutionary power that comes after menopause. Evolutionary biologists propose that menopause favors natural selection because women are biologically more secure once they are no longer vulnerable to the risks of pregnancy and childbirth:

This has been self-evident in the story of American politics. As living conditions and reproductive justice improved for American women – both occurred precisely because they participated in politics. And then so did their lifespans. In 1992, there was a population explosion of menopausal women who were Boomers (see: This is Hillary’s cohort (Hillary was 45 in 1992, and just becoming First Lady). Nancy Pelosi, the first female House Speaker, was born in 1940, and began her career when she was elected in 1993 (age 53).

Women’s careers in politics are usually not possible until their childrearing years are over, given the demands parenting places on women’s time.

Whatever the opinions are about Hillary and trust, it’s impossible to deconstruct the public attitudes about Hillary without being entangled in gender bias, which becomes particularly brutal past menopause. As difficult as it is for our appearances to become objectified as young women, aging on a very public stage is not pleasant for women when their wrinkles, “cankles”, cellulite, and adiposity become part of someone’s debate prep. Carly Fiorina (61) is another case in point, when Trump remarked that she had an ugly face during the primary season (see: That remark dominated the news just when Fiorina was being praised for her oratory skills, which stood out against her 17 male opponents. Once her face was up for debate, her popularity plummeted, even as the remark was criticized.

Today, we have about a greater than 50% chance of electing the first female President, an achievement that would be virtually impossible for any pre-menopausal woman, given our social arrangements. In fact, all glass-ceiling breakers who came before Hillary were also women of a “certain age”. Golda Meir was 71 when she became the first woman Israeli Prime Minister in 1969. Margaret Thatcher was 54 when she became Britain’s first female Prime Minister; she was the longest serving Prime Minister of the 20th century (1979-1990).

The question for Hillary and the country is really this: are there enough American women voters past menopause who will support her, given that young women leaned toward an even older Bernie. (His shouting was not an issue for his supporters.)

Elections are no longer determined by white men; they are dying out:

So the power of postmenopause in 2016 isn’t just about the nominee. It’s about one of the largest voting blocs: female baby boomers who are not going to “Boo” but vote. Amid hot flashes and all, they will “feel the burn” for a political revolution that could put the women in charge, now that Theresa May (59) has become the second female British Prime Minister.




Ethics of Authorship: What’s So New About the Upcoming Clinical Practice Guidelines for Menopause : They’re Written by Women

June 14, 2015 • By

When I attended the 2015 Endocrine Society meeting in San Diego, I was struck by the sessions about the upcoming clinical practice guideline on menopause (Treatment of Symptoms of the Menopause): they were authored by women. Here’s an interview with Cynthia Stuenkel, MD, Chair of the Menopause Clinical Practice Guidelines Taskforce for the Endocrine Society:

Ethically, does gender really matter when it comes to producing evidence-based practice guidelines on menopause? Yes. It does when it’s about menopause.

When considering beneficent therapies for peri and post-menopausal women, it’s still difficult for male practitioners to understand and appreciate subtle and nuanced qualitative differences in menopause symptoms. The most caring and sensitive male practitioner has still never experienced an ordinary period and cramps, flooding, hot flashes, and bloating. And for many women reaching their career peaks in peri- and post-menopause, it’s difficult for males to imagine these symptoms while chairing a meeting or making a major presentation. Several professional women in this phase of life pack plenty of red clothing (pant suits, dresses, or skirts) when traveling because of the unpredictable nature of their menses.

From a medical sociological perspective, women bond over their uterine experiences. Transgendered females (who transitioned from males) have noted the differences in intimacy between female and male friendships, for example: women talk about their bodies. Women who don’t know each other may immediately share information about the state of their uterine health in a public bathroom or private boardroom.

Clinical practice guidelines authored by female experts in menopause hormone therapy may help to ensure that patients’ reported symptoms help to guide goals of treatment. At the same time, patients may begin to place trust in evidence-based guidelines for hormone therapy when they can no longer just brush them off as a “male-dominated industry”.