How to Menopause

Fadal begins each chapter with a personal anecdote, opening with trust and relatability. In Chapter 5, she admits she once took sleep for granted but now understands true exhaustion means being tired but not able to sleep. Her use of metaphor, such as comparing disrupted sleep to The Princess and the Pea, concludes with the line: “Let’s remove the peas one by one” (107). This is a dose of encouragement, where Fadal lets readers know that her book can help them in myriad ways. She also discusses difficult topics like Alzheimer’s without instilling fear, as “one in three cases can be either prevented or delayed” (128). Lists and other items enclosed in boxes, like Fadal’s daily routine or a statement from a doctor, offer advice in a quick, concise format. A “love letter” to partners explores body image, intimacy, and the emotional changes that come with menopause. This layered format—blending medical data, lived experience, and tangible takeaways—makes the book readable and emotionally impactful. Fadal empowers women not just with information but with permission to take themselves seriously.

Fadal effectively uses rhetorical strategies to address hormone therapy (HT), first sharing her own fear and skepticism. She then discusses the “widespread panic” following the Women’s Health Initiative study’s end in 2002, explaining how the study involved older, unhealthy participants and misreported statistics at the press conference. She clarifies that HT has changed, and safer options now exist, including a patch. She supports this with statistics to restore reader confidence in HT. By explaining the source of fear and providing balanced facts, Fadal uses a narrative-then-data structure that makes scientific information accessible, addressing both emotion and logic while Removing the Mystery and Stigma from Menopause. This technique highlights that women must often unlearn harmful narratives in order to advocate for themselves. Fadal’s approach bridges mistrust and understanding, fear and empowerment, and helps women reclaim a sense of agency over their own treatment paths.

Fadal critiques cultural norms that dismiss women’s health: “Despite all these data, too often in our current reality, women feel they are not given the right to decide, in partnership with their doctors, what level of risk they find acceptable in return for improved quality of life” (81). Her own experiences of being dismissed, and the hundreds she has since heard of, fuel a deep dissatisfaction with the healthcare system. This critique functions as a form of feminist medical resistance, placing menopausal care in direct conversation with other forms of gendered medical neglect, such as chronic pain dismissal, misdiagnosed heart conditions, and the underfunding of endometriosis research. 



There are only two FDA-approved medications for low female sex drive, compared to 26 for men. Fadal also discusses the general view of middle-aged and older women: “And then there is how society views a menopausal woman. Like she is invisible” (168). This invisibility is what she aims to change. Fadal is committed to openness, including candid conversations about sex toys and how menopause affects intimacy. By integrating discussions of sex and libido, Fadal challenges the desexualization of aging women and reclaims sexual pleasure as a valid, vibrant part of midlife. Her candor counters the dominant cultural script that treats female aging as synonymous with decline or asexuality. Importantly, Fadal presents sexual agency as a central component of well-being, reminding readers that joy, curiosity, and connection don’t end with menstruation.

By being transparent about her own experiences and creating a space for others to do the same, she helps normalize sexual health and pleasure during and after menopause. She explains that being open about menopause includes being open about how it affects sex. This section contributes to the broader discussion of women’s sexual health and pleasure. It also reinforces the book’s core mission: to create space where women can live fully, ask questions without shame, and make choices rooted in knowledge, not fear. Fadal’s frankness about sex serves as both advocacy and affirmation.

Fadal explains the biology behind menopause symptoms: Estrogen keeps airways flexible, and progesterone helps calm the body. Since both decline with age, these symptoms become commonplace. This knowledge brings clarity to common but misunderstood issues. Brain fog left her anxious at work, ruining her confidence. These lesser-known effects of menopause are rarely discussed, yet they carry deep emotional consequences. Here, Fadal’s strength lies in linking physiology to emotion. She validates how even “minor” symptoms can produce a domino effect of self-doubt, workplace anxiety, and relationship strain, making it clear that menopause is not simply a biological event, but a lived reality with psychological and social dimensions. Fadal’s willingness to reveal these uncomfortable truths, along with the science behind them, helps readers feel validated and encourages them to seek solutions and support. By combining vulnerability with clarity, she models what it looks like to move through menopause with both tenderness and tenacity—a tone that invites readers not only to endure change, but to embrace it.