Body Issues

Making women feel bad about themselves is big business. Makeup, fashion, and hygiene products all carry the underlying message “There’s something wrong with you.” 

Big Capitalism is on the case though, and they’ve got just the solution. That is the message that plays out everywhere, every day, all around us. That ever-present assault on self-esteem is harmful to women of all ages, not just teens.

It’s harmful to me, and I’m 48. Raised in an era of Disney princesses and Barbie, my body insecurities began by fifth grade. I always thought I’d get more comfortable with my body as I aged, but life is full of surprises. 

My bodily hang-ups are worse now than ever, because now there are errant hairs to pluck and wrinkles to frown about. Sometimes, I look around at ‘with-it’ women in snappy outfits sporting shiny smiles, and I’m sure I’m the only one feeling desperately imperfect. But I’m not.

Varying studies over the last 20 years show that women over the age of 50 often have worsening self-images. Maybe it’s because advertising and entertainment constantly remind us of how short we fall from the ‘ideal’ woman.

But what does all this have to do with menopause, you ask?

The constantly implied judgments and resultant shame affect more than our self-esteem. Our fear of being patronized and the shame our insecurities induce can prevent us from levelling with doctors and other caregivers. This, in turn, affects health outcomes.

Dealing with Body Dysphoria

I’m fat. That’s clear to me anytime I squeeze down a bus aisle. But my outward appearance is not the whole story.

In the past 18 months, I’ve cut drinking and junk food by 90 percent. I have made all my food from scratch, and moved to live by the ocean so I walk more. Yet menopause means my body is slow to reflect my massive life changes. Weight has been lost, around 40 pounds, but it’s far from enough.

My glacially-paced change constantly takes a toll on my mental health and self-esteem. I try to be proud of the headway I’ve made, but my inner voice chides me for not doing more, not being better.

Sadly, I’m not alone.

Ever since the tragedy of Karen Carpenter’s death in 1983, from heart complications of anorexia nervosa, there has been a public focus on girls, teens, and young women battling image issues and body dysphoria. 

We now know that body image is an issue to women throughout our lives, and that the voice inside our heads grows unkinder through the years. In fact, in a study of 1,800 women over age 50, a whopping 79 percent said their body shape and/or weight affected their self-perception at least moderately, or worse. [1] 

Feeling Shame in the Doctor’s Office

Recently, I had my first proper physical in years. Why it took so long is a complicated story involving living my long-term travel dreams and the self-neglect (and so much wine) that came with. 

Upon turning 48, I booked a physical as a nod to a new, accountable chapter in my life. Naturally, I dreaded it.

When the appointment rolled around, my weight was the topic from the get-go. I got defensive from the start, thanks to my body dysphoria. But a doctor’s job is to break through those walls. He didn’t.

Then, despite several years and a hysterectomy since my last internal exam, Doc decided an internal check-up wasn’t needed. Even though it’s been years? Really?

Of course, my insecurities read that to mean that a thorough internal exam was an imposition, even a burden. Even though, in reality it’s just good medicine practiced by a good doctor. I didn’t protest, though. How am I, a female patient in the #MeToo era, supposed to demand the doctor probe me internally? Awkward.

That’s when self-advocacy starts feeling like desperation, not great when someone already feels like a medical burden. 

I’m somewhat bitter, but it’s a mistake to think all medical gaslighting is malevolent. My doctor wasn’t trying to hurt me when he brought up the weight that is on my mind 24/7. I know he cares. In fact, I trust him as a person.

But I don’t trust the “clean bill of health” he gave me, because I never had an internal exam. 

Gaslighting is Systemic, Not Personal

While my doctor didn’t intend to gaslight me by declining to examine me internally, that’s what he did. My concerns were dismissed. He took the easier route. This passive gaslighting in healthcare happens to women constantly. And it’s part of the reason women turn to alternative medicine, where they often feel ‘heard’ by their care provider, for answers. 

Traditional western medicine is inherently biased towards men. Take heart attacks. Nearly every time a health site gives warning signs of heart attacks, the symptoms listed are those commonly experienced by men — not women. Our cardiac experiences differ. With heart disease alone, the leading cause of death in women, inherent medical biases can be and are frequently fatal and not mere oversights.

Medical research has predominantly been on white men, not people of diverse backgrounds, and certainly not women. 

With female health concerns like menopause, priority has long been low for funding research to what ails us. We get rote answers and treatments. After all, it’s just hormones and it’s all in our head, right?

Symptoms like anxiety, sleeplessness, weight gain, mood fluctuations, mid-life acne, muscle or joint complaints, fatigue, and all the others beyond those, are easy to write off as lifestyle-related or due to hormones. 

Write these symptoms off, doctors do. But these “symptoms” are also indicators of everything from menopause to serious illness. 

Unfortunately, biases in healthcare are achieved honestly — they’re the legacy of a system that was created by men, for men, using research on men. Even female doctors have been guilty of unwittingly dismissing patients’ concerns, because that’s what they’ve been taught. It’s in the textbooks.

If you think you’re not being taken seriously by your doctor, you might very well be right. You are your best advocate. Play to your doctor’s inherent biases by becoming a scientist yourself. Pay attention to symptoms and thoroughly log what ails you — when, how, and any other details you feel are relevant. Be diligent in record-keeping, because you may be tracking factors that influence your diagnosis and care plan — plus, it can help get your doctor onboard.

There’s good news, though. Medical sciences are recognizing how gender-biased medical research and its practitioners have been, and they’re working on it.

The bad news is that it will take time before healthcare can change. Studies need to happen, books need to be written, curriculums need to change, and students need to graduate long before young new better-prepared doctors are staffing clinics and hospitals. Awareness is growing, but self-advocacy will remain necessary for years to come. Luckily, self-advocacy is easier than ever in the age of information, and Herstasis will be here to help.

[1] Hurd LC. Older women’s body image and embodied experience: an exploration. Journal of Women & Aging. 2000;12(3–4):77–98. 

Related Pages

Check out these links to understand more about the menopausal transition as it relates to body changes.

image of a woman that is aging along a scale

Metabolic & Weight Changes

Metabolism, or the rate at which your body burns the fuel you get from food, and weight changes during the menopausal transition are partly due to hormonal changes from decreasing estrogen and increasing follicle stimulating hormone (FSH) levels.

Learn more

Cognitive Changes

You may feel that you are ‘losing your marbles’ or fear that you have early onset dementia, but most symptoms of menopausal transition are neurological, so it isn’t your fault and is likely temporary during the menopausal transition. This is despite the fact that the defining state of the menopausal transition focuses on functional changes in the reproductive system.

Learn more
Written By:

Jennifer Vander Zalm

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