From the world's most renowned obstetrician and gynecologist
All about menstruation (the female body)!

Here comes a book that promises to revolutionize the way women experience menopause.
This is the "Wan-gyeong Declaration," a book packed with tips on how to protect your body and mind with facts and feminism as weapons.
Jennifer Gunter, the world's most famous obstetrician and gynecologist, has come to Korea to confront the absence of discussion, the flood of misinformation, the use of derogatory language, the indifference of the medical community, and above all, the dominance of patriarchy.


The book unravels the tangled web of myths, misconceptions, and silences surrounding menopause and perimenopause, drawing on scientific, historical, and medical evidence.
It covers women's physical and mental health from both an emotional and practical perspective, including pre- and post-menopausal period, fever, cardiovascular health, sleep disorders, depression and mood swings, skin and hair problems, pseudoscience and folk remedies, bladder health, hormone therapy, contraception, and diet.
Gunther is vocal in her emphasis that menopause should not be a mystery to women, and that its symptoms are not a minor problem experienced by a small minority.
The "Wan-gyeong Declaration" is a guide, a manual, a partner, and an ally that accompanies you on this journey.

When it comes to menopause, only terrible stories are told.
But to be honest, the experience of being a diasporic person is one of enormous scale.
Many women experience only mild or moderate symptoms, while others experience extreme pain.
Symptoms often appear and disappear briefly, but sometimes they can last a long time.
It is true that the biological changes that occur in the body with menopause increase the risk of developing certain medical problems, such as cardiovascular disease and osteoporosis.
However, the paint that paints a picture that captures the entire female figure is not the only one that has the phenomenon of wankyung.
Age, other health conditions, diet, exercise, and even childhood adversity all add color to the portrait.
So, if you're a woman determined to develop a strategy, it's important to take a step back and look at the whole picture.
Caring for the body during menopause is the ultimate form of holistic medicine that takes the entire body into account.
---From the "Declaration"

Social shame extends beyond the doctor's office.
There is a general disdain for aging women.
Perhaps the word 'disrespect' is not appropriate.
The problems associated with aging women are often so trivial that they are not worth even the slightest effort.
They are so simply ignored that their very existence is ignored.
---From Chapter 1, “Second Adulthood”

The term 'menopause' existed before science discovered the existence of hormones.
The term never meant 'stop'.
The term was coined by a man who believed women should cover their arms and avoid wearing makeup.
This man's book on menopause contributed nothing to the body of knowledge on the subject other than to perpetually shackle women to menstruation.
Except that it left behind one term that would forever link women to menstruation.
Since then, the word "menopause" has been weaponized by the pharmaceutical industry, turning an annoying stage of life into a lifelong disease that affects all women.
Moreover, it was not just any disease, but the worst disease that turned women into beings that men did not want.
This chapter was not a beautiful etymology story.
The word 'man-gyeong-gi' needs an update.
---From Chapter 2, “History and Language of Wan-gyeong”

The menopausal transition period has several important biological characteristics.
These include accelerated loss of follicles, changes in hormone production patterns in the remaining follicles, and changes in signals from the brain.
There are several potential reasons why these changes occur.
At the ovarian level, the primordial follicles may themselves be aging, or the remaining follicles may not have been very healthy to begin with.
This may be why these follicles have not ovulated in the first place.
Additionally, blood flow to the ovaries may decrease with age.
This may affect your ability to produce hormones.
Some of the changes in the signals the brain sends correspond to changes in hormone production patterns in the follicles, but others are associated with aging.
Fundamentally, the menopausal transition is a complex process involving several mechanisms working together.
---From Chapter 3, “The Biology of Perfection”

Human intelligence has enabled us to grow beyond our evolutionary programming in many ways.
Therefore, even if the grandmother hypothesis explains how we came to have menopause, it is important to note that this does not mean that women have value only as grandmothers.
The function of the grandmother hypothesis is to deliver a major blow to society's prejudice against women who have had menopause.
The grandmother hypothesis makes the patriarchal idea that a woman's worth is diminished when ovulation stops seem even more repulsive.
Because women who have had menopause are truly helping the evolutionary process.
We must also acknowledge that not all women become grandmothers, either by choice or, unfortunately, due to infertility or the death of a child or grandchild.
We must also acknowledge that not all grandmothers add value to the lives of their children.
---From Chapter 4, “The Evolutionary Advantages of Perfection”

Primary ovarian insufficiency (POI) refers to the cessation of menstruation before the age of 40.
Until relatively recently, this medical condition was referred to as 'premature ovarian failure (POF)' or 'premature menopause', but the name has changed for several reasons.
Menopause is the permanent cessation of menstruation, but in about half of women with primary ovarian insufficiency, ovarian function may return (ovulation may occur suddenly again, and menstruation may occur intermittently).
Women who have had menopause cannot become pregnant, but women with primary ovarian insufficiency can become pregnant, with some studies reporting pregnancy rates of 5 to 10 percent.
Besides, the word 'failure' is insulting.
---From Chapter 6, “If Menstruation and Ovulation Stop Before Age 40”

I'm cautious about how I talk about my weight.
There are many cases where people quickly conclude that obesity is the cause of women's health problems without properly examining their health, which puts many women at risk for their health and even their lives.
It's a shame that overweight women are not welcomed in the medical community.
I, too, have been on a diet for 31 years, and I hope no one else has to suffer that cursed fate.
I strictly controlled what I ate every day, and I felt guilty when I failed to do so.
This phenomenon is a combination of the influence of my mother, who told me I was fat when I was a teenager, and the fact that I grew up in the 1980s, when fitness culture was just emerging and people emphasized that being thin was beautiful and good.
I first joined Weight Watchers when I was sixteen and weighed 70 kg (154 pounds).
At just sixteen years old, with a BMI of 21.8, I was accepted.
---From Chapter 7, “Changes Due to the End of the World”

The differences between women and men in managing CVD are striking.
Forty-two percent of women die within a year after suffering a heart attack, compared to 24 percent of men during the same period.
Women under 55 who suffer a myocardial infarction while hospitalized have a mortality rate two to three times higher than men of the same age.
Some of this disparity may be due to the biological characteristics of heart disease in women.
For example, there may be biological differences between women and men in the way atherosclerotic plaque breaks off and causes a heart attack.
But, apart from this, deaths due to misogyny are not uncommon.
Women are often excluded from studies on heart disease, claiming they receive the "best care," but in reality, the best care is often for men.
Another problem is the misconception that women, especially young women, are less at risk for CVD than men.
And women are less likely than men to receive medical advice about heart disease and are less likely to be prescribed statins.
Statins are drugs that can significantly reduce the risk of heart attack and stroke by lowering cholesterol levels.
It is particularly rare for Black women to be prescribed statins.
---From Chapter 8, “The Heart of the Problem”

Cognitive behavioral therapy (CBT) is a treatment method that considers the connection between the mind and body.
This does not mean that menopausal fever is a made-up or imaginary symptom.
Since the neurotransmitters that direct thoughts and actions can also influence feelings of heat, this means that menopausal feelings of heat may actually influence emotions and vice versa.
CBT for menopausal hot flashes involves not only gaining a medical understanding of what is happening, but also teaching people how to replace negative beliefs with more positive, or at least objectively accurate, facts.
For example, in response to menopausal fever, you might think, “My head feels like a waiting room of hell” or “This will never end.”
These negative thoughts are called cognitive distortions, and in these cases, we feel that they are accurate (we firmly believe they are accurate) or even rational, but in fact, we are exaggerating and emphasizing the negative aspects.
If this happens repeatedly, you may end up feeling worse and the fever may feel more painful.
These negative thoughts can also reinforce parts of the brain that transmit messages about feeling hot, making the onset of a fever more likely or more severe.
---From Chapter 9, “Isn’t It Too Hot Here? Is It Just Me?”

When you ask a female patient if she has heavy menstrual bleeding, the answer is usually no.
However, if you ask the same patient whether it is severe enough to wet his clothes or if it is 'pouring', he will say yes.
It's not that he doesn't know his body well.
This is because they have always had heavy bleeding and have either ignored it or been ignored by medical staff or parents when they previously expressed concerns about the amount of bleeding.
Personally, I prefer to use the word "pouring" to describe heavy bleeding during menstruation.
When most women use this word, it seems to mean that their clothes are soaked with blood or that they narrowly escape disaster.
Some women may be surprised by the increased amount of menstrual flow during the menopause.
Culturally, women are trained to feel shame about their menstrual experiences, which often prevents them from discussing them with other women, and medical professionals often not only fail to provide women with adequate information, but also readily dismiss them.
As women go through the menopause, they begin to feel that their bodies are being ruined and that they are the only ones who “feel” their periods (a common experience, in fact), which is a form of oppression against women.
---From Chapter 10, “Menstrual Chaos”

If you're reading this book and are in your late twenties, you're already losing your bones as you turn the pages.
Bones are constantly being remodeled, meaning they are constantly being absorbed and new bone is being created.
This process is ongoing and can be considered as the entire skeleton being replaced approximately once every ten years.
Women reach peak bone mass in their late 20s, after which bone loss begins, gradually but steadily, at a rate of less than 0.4 percent per year.
Estrogen plays an important role in bone formation.
Therefore, bone loss is most active about one year before the last menstrual period and continues for about three years.
On average, women lose 6 percent of their bone mass over these three years, but some lose as much as 3 to 5 percent per year.
Even after this period, when bone loss is most rapid, bone loss continues at a rate higher than before menopause, at about 0.5 to 1 percent per year.
Aging also weakens bones in several ways.
---From Chapter 11, Bone Health

Science is important in all matters related to menopause, but especially when discussing brain health, it's important to base our discussions on the most clear and scientifically sound facts.
Because there are so many harmful cultural discourses that link women's abilities to hormonal function.
We are constantly criticized for our hormonal mood swings before, during, during, and after our periods.
And what happens after you're finally free from those "toxic" hormones? You're now told there's something wrong with your brain.
Judging women by their hormones is a clear personal attack.
No, I think 'Goddess Attack' would be the correct expression.
This is character assassination and a core tenet of patriarchy.
---From Chapter 12, “What Happens to the Brain When Menopause Comes?”

Progestin was added to MHT in the 1960s to manage bleeding caused by MHT, making it less resistant to MHT in women (estrogen thickens the endometrium, and without progestogen, the endometrium becomes unstable and breaks down randomly, causing irregular bleeding).
Moreover, the regularity of menstruation due to progestin fits with the 'natural' marketing of MHT, which is based on the notion that it replenishes the hormones that every woman must have.
This perfectly illustrates how absurd the word 'natural' can become.
Because there is nothing more unnatural than a postmenopausal woman experiencing menstruation.
In "The Eternal Feminine," Dr. Wilson describes menstruation as "a certificate of femininity."
Yes, that's right.
Before menopause, menstruation was a terrible curse, but as soon as it disappeared, it became a blessing and a symbol of sexual attraction to men.
What beat should I follow?
Is it possible for a woman's body to never remain in a 'good' state?
---From Chapter 17, “Menopausal Hormone Therapy”

I think many women will simply not feel comfortable reading the information in this book about so-called "natural remedies and hormone replacements."
It's a normal reaction to want to pretend you don't know this information.
Because I have to admit that I have been on the wrong path so far.
It's important to remember that without accurate information, it was impossible to make informed decisions about these products in the first place.
If custom-formulated drugs or so-called plant-based products were truly great and better, there would be good documentation about them, professionals like myself would be prescribing them, and professional organizations would be promoting their use.
If it's truly safe and effective, why isn't there a single study in a billion-dollar market proving it?
---From Chapter 20, “Bioidentical Hormones, Natural Hormones, and Prepared Hormones”

About 60 percent of adult women living in the United States take at least one health supplement.
Although they are usually taken for general health issues or preventative treatment purposes, during the menopausal transition and postmenopausal period, many women seek out various products to relieve symptoms or address menopausal-related issues.
I call these health functional foods related to menopause 'Menoceuticals.'

In the previous two chapters, we examined the evolution of menopausal hormone therapy from biological, chemical, and economic perspectives.
Now, let's take a look at the health functional food industry in a natural order.
The health functional food manufacturing industry is not just a neighborhood healing evangelist selling medicines made in small batches in their own kitchens. It is an industry in itself.
It is so huge that it boasts a scale of over 30 billion dollars per year in the United States.
Health functional foods are cultivating their brand image as promoting a healthy lifestyle—a lifestyle that's healthy from the inside out! However, associating health functional foods with wellness is no different from associating Premarin with a glamorous and sophisticated lifestyle in the 1950s.
The ugly truth is that lifestyle marketing strategies always work.
---From Chapter 22, Menoceuticals

The failure rate for combined hormonal contraception is typically 9 percent in women under 45, but only 0.3 percent when used exactly as directed.
Looking at the difference between these typical failure rates and ideal failure rates, we can see that remembering to take your pills every day or changing your patch or ring is not easy for many people (even for their gynecologists).
As pregnancy rates decline during the menopausal transition, the failure rates of these contraceptive methods also decline.
Basically, even if a 47-year-old woman misses two birth control pills, she is much less likely to ovulate during the same time period than a 27-year-old woman.
---From Chapter 23, “Contraception and the Menopausal Transition Period”

Of course, some people believe that menopause is a normal phase of life and that estrogen should never be taken.
However, this is an attitude that does not take into account the risk of developing diseases such as osteoporosis and depression due to menopause, as well as the quality of life.
If estrogen could safely improve the quality of life of a woman who suffers from hot flashes twenty times a day and sleeps poorly for weeks, why wouldn't it be used? Pregnancy is a normal phase of life, but we don't refuse measures to alleviate morning sickness or labor pain, or refuse blood transfusions during labor due to excessive bleeding.
Excessive bleeding can occur even after labor has proceeded completely normally.
The reality is that many women find estrogen helpful for a variety of reasons, while many others do not need this help.
This is precisely why it is important to know as much as possible about menopause so that you can make the right choice for yourself.
---From Chapter 24, “Welcome to my farewell party”

Throughout my transition, I was consumed by a seething anger that grew more and more intense.
Witnessing so many women experiencing similar conditions as I did made me wonder why.
It took me quite a while to gather my thoughts.
Because for a really long time, I couldn't think of anything else but screaming at the top of my lungs.
But screaming into the void might feel good in the short term, but it's ultimately exhausting and doesn't do much to help you take care of yourself or change.
What is the root of my anger?
Only by figuring out what was going on could I stop that anger from taking over my mind and use its power constructively.
And in the process of writing this book, I was able to see the core of the problem more clearly.

---From Chapter 25, “Concluding Remarks”