Dr Jen Gunter isn't taking any prisoners (Gwyneth Paltrow included) on her mission to bust myths about midlife and medicine.
The menopause is having a moment. Once the shameful "change of life" was mentioned just in whispers, today you can't move for a celebrity describing their joint pain and brain fog. Gillian Anderson, Michelle Obama, Emma Thompson and Kim Cattrall are just a few of the celebrities who've described the havoc wreaked on them by their midlife hormones.
Last week it was Davina McCall's turn with her Channel 4 documentary Sex, Myths and the Menopause. McCall, 53, pronounced, "I'm not going to be ashamed about a transition that half the population goes through."
Obstetrician and gynaecologist Dr Jen Gunter, author of the newly published The Menopause Manifesto, agrees it's great menopause is no longer taboo. "For too long it's been shrouded in secrecy," she says.
Yet, at the same time, Gunter, 54, who's achieved an unusual level of fame for a medic owing to her hugely popular blog, two health columns in The New York Times and large social media following (300,000 on Twitter), not to mention a long-running feud with Gwyneth Paltrow (of which more later), is sceptical about the way some celebrities and big business are now embracing the topic.
"They've seen there are huge gaps in medicine around the menopause and they're exploiting them, by saying 'Buy this untested supplement or this untested gadget'," says Gunter, from her home near San Francisco, where she runs clinics for vaginal and vulval disorders and female pelvic pain. "We talk about a pink tax for women – well this is like a pink, grey tax – give older women vitamins but make them more expensive by calling them menopausal vitamins. It's just a whole other layer of false claims."
The menopause business is now worth an estimated £425 billion ($833 billion), with one of its chief drivers Gunter's long-term nemesis, Paltrow. She told her 7.5 million Instagram followers that she used her wellness and lifestyle brand Goop's Madame Ovary supplements, costing £75 ($147) a month, to manage her perimenopausal symptoms – supplements, which Gunter pointed out, are packed with vitamin A, probably not necessary for women living in a developing country. "You also don't need that green tea leaf extract," she added, "unless risking liver injury is your thing."
"Paltrow was one of the first to [sell] these menopausal brand supplements, which to me is the ultimate anti-feminism," Canadian-born Gunter fulminates. "Wellness, as presented by people like Goop, to me is predatory. They are just selling snake oil, but wrapping it in a pink bow and adding #HolisticLife. But really, it's just a patriarchal message 'We're going to lie to you about your body to sell products you don't need'."
Gunter and Paltrow first clashed in 2017 when Goop started selling £60 ($120) vaginal jade eggs the company claimed could regulate menstrual cycles. On her blog, Gunter described these as "a load of garbage,"
Goop replied that Gunter was "strangely confident" in her assertions (one fan went further, calling her "the vaginal AntiChrist"). Gunter – who's been practising for 26 years – retorted, "I am not strangely confident about vaginal health; I am appropriately confident because I am the expert."
"Maybe I was affecting their sales?" she cackles gleefully.
Gunter, the divorced mother of 17-year-old twins, whose late mother considered her choice of career "dirty because it was about genitals", has achieved unlikely fame as a result of her zeal to hold to account not only Goop, but the £3.5 trillion ($6.8 trillion) wellness industry.
Soon after she and Paltrow first clashed, she published The Vagina Bible to ensure no more women followed Goop's advice to steam-clean their vaginas (one ended up with third-degree burns). "The duty of the physician is to care about the health of the public, to ensure it is not affected by misinformation," she says.
She's not convinced Paltrow believes in every theory her site promotes. "But I think one or two of her people truly believe talking to the dead is a valid way to sort out your health problems [a reference to the website's interview with a "medical medium" who gave advice on dealing with thyroid cancer]," she says.
When it comes to menopause, much of Gunter's cynicism is directed towards the trends around HRT (hormone replacement therapy), which she prefers to call MHT (menopausal hormone therapy). "HRT has a subtle patriarchal message implying low levels of oestrogen after menopause are biologically abnormal and must be replaced. I'm 54, my ovaries should not be producing oestrogen – that doesn't mean it's bad," she says.
Today, the fashion among lunching ladies is to shun traditional HRT pills, previously linked to higher risks of breast cancer, in favour of "compounded" bioidentical hormones, made from soy and yams, from expensive private clinics, although these are subject to none of the tests and regulations of conventional pharmaceutical products.
"Compound products are actually slightly riskier than pharmaceuticals, you may not be absorbing enough of them to get what you need, you might be absorbing too much, which could give you cancer," Gunter says.
In fact, Gunter explains, "Bioidentical hormones is a completely made-up marketing term. All the hormones that you buy, with the exception of Premarin [oestrogen replacement made from horse's urine] are all made at the same lab. Women have this idea that because the hormones they're using are made of yam roots they're somehow safer – but oestrogen from whatever source can still give you endometriosis or breast cancer."
Gunter herself experienced "terrible" hot flushes from around the age of 45 that left her feeling she was going to "pass out and die" at work, which she controls through oral progesterone and using an oestrogen patch. Yet at the time, she cautions, "I was so busy working, I was hardly moving at all. So I can't blame it all on hormones."
She says many women may not need HRT at all – around 15 per cent of women experience no menopausal distress, and of the other 85 per cent, symptoms vary greatly. "Definitely women are suffering, but there's a huge range and we shouldn't exclude those who have an easy time of it."
In fact, she says for most women, managing menopause simply means more of the stuff we already know is good for us: stopping smoking, exercising more, and eating plenty of fibres and vegetables. "But that's not sexy new stuff to sell," Gunter says.
But even if she doesn't want us wasting cash on faddy products, Gunter is still thrilled that myths around menopause are being busted. She was overjoyed when her research uncovered "The grandmother hypothesis", studies showing that menopausal women have always been essential to the species' survival, caring for their grandchildren, allowing others to hunt and gather.
"This really galvanised me and made me think I am no longer going to accept that patriarchal script that women lose value once they are no longer able to reproduce and should just go off into their dotage."
There's zero chance of that happening to Gunter. "I have a platform that people are listening to and I feel I have a duty to use it to educate," she declares. With that trademark Gunter sideswipe, she adds: "Maybe Goop should think about using their platform the same way."