Free to read
Inside Women’s Health After Menopause
All 10 chapters: what each one opens on, the questions it answers, and the one small thing to do when you have finished it. About 25,300 words in the book itself.
Chapter 1 · about 1,800 words
The Postmenopausal Health Baseline
It opens on Doreen Whitcomb drove a school bus in western Nebraska for twenty-six years and retired at sixty-two with a good pension, a bad knee, and a manila folder she'd been adding to since her fifties.
What it answers
- Isn't the doctor supposed to be tracking all this?
- In theory. In practice, records fragment every time you change insurance, move, or see a specialist whose system doesn't connect to your primary care office. Your body is the only thing that stays in one place. Being the keeper of your own record isn't a sign of a broken relationship with your doctor; it's the thing that makes the relationship work.
- I feel completely fine. Do I need any of this?
- Feeling fine is good news and worth having. It's also not information about your bones or your blood pressure, both of which are perfectly capable of drifting for years without producing a single symptom. The point of a baseline isn't to find something wrong. It's to have a record from when things were good, so that later, when a number moves, you and your doctor can tell.
When you have finished it
Get one sheet of paper. At the top write your name and today's date. Underneath, list every single thing you swallow in a normal week, prescription, vitamin, supplement, tea you take for a reason, copied exactly off the container. That's it. That one list, in your handbag, is more useful in an emergency room than almost anything else you own, and you can build the rest of the page around it later.
Chapter 2 · about 2,100 words
Heart and Metabolic Health
It opens on Ana Beatriz Ferreira, who everyone calls Bea, was sixty-seven and still working four days a week supervising housekeeping at a hotel in Miami when she started feeling wrong in the afternoons.
What it answers
- My blood pressure is only high at the doctor's office. Doesn't that mean it's fine?
- Maybe, and maybe not. Some people genuinely spike in clinics. The way to find out is to measure at home with a cuff that goes around your upper arm, at consistent times, over a week or two, and bring the log in. Home readings taken properly carry real weight, and they turn an argument into data.
- I've always been the healthy one. Isn't this mostly about weight?
- Weight is one factor among several, and plenty of women with heart disease are slim. Blood pressure, cholesterol, blood sugar, smoking, family history, and what happened during your pregnancies all contribute independently. Being thin has never been a substitute for having your numbers checked.
When you have finished it
Say your blood pressure out loud. If you can't, you've found your first task. Write down the date of the last time it was checked, and if that's more than a year ago, or if you don't know, make one phone call this week. Many pharmacies and senior centers will check it free, no appointment required, and that reading is a perfectly good place to start a record.
Chapter 3 · about 1,700 words
Bone, Muscle, and Falls
It opens on Here is a small fact that reorganizes how most people think about bone.
What it answers
- I take a calcium supplement, so my bones are covered, right?
- Supplements are one small piece and not a substitute for loading your skeleton. There's also such a thing as too much calcium from pills, so the amount should be discussed rather than assumed. If you take one, mention it every time you list your medicines, since it's exactly the sort of thing that never makes it into a chart.
- I'm afraid of falling, so I move less. Is that sensible?
- It's the most understandable response in the world and it makes things worse, because the strength and balance that would protect you both fade with disuse. The fear itself is worth mentioning to your doctor, since fear of falling is a recognized problem with real approaches. The way through is supervised, gradual strengthening, not avoidance.
When you have finished it
Stand behind a sturdy chair, hold the back of it lightly, and stand on one leg. Count how long before you need the other foot down. Write the number and the date on a scrap of paper and tape it inside a cupboard door. Do it again in three weeks. That single, free number tells you more about your fall risk than almost anything else you can measure at home, and watching it improve is the most reliable motivation anyone's found.
Chapter 4 · about 1,700 words
Pelvic and Urinary Health
It opens on Let's start with the sentence that ought to be printed on a card and handed out: leaking urine is common, and common is not the same as normal, and neither of those means untreatable.
When you have finished it
For the next three days, keep a bladder diary. On a piece of paper note the time every time you pass urine, roughly how much, whether it was urgent, and anything you leaked and what you were doing. Note what you drank and when. Three days is enough. That single page turns a vague complaint into a pattern a clinician can work with, and it is the most persuasive thing you can carry into that appointment.
Chapter 5 · about 2,000 words
Sexual Comfort and Intimacy
It opens on Margit Halvorsen was widowed at sixty-eight after forty-one years of marriage, and at seventy-three, to her own considerable surprise, she found herself seeing a man from her cross-country ski club in northern Minnesota.
What it answers
- I'm seventy-eight. Isn't it a bit late to be starting this?
- No. Women in their eighties have this conversation with their doctors, and tissue responds to treatment at any age. The main thing that gets in the way is the assumption, held by patients and occasionally by clinicians, that nobody is asking. Ask anyway.
- I have no interest at all and my partner does. What do we do?
- Start by ruling out the physical: pain, medication effects, depression, exhaustion. Then talk about what intimacy means beyond intercourse, because a lot of couples find that touch, closeness, and time in bed together without a required destination take the pressure off and sometimes restore the rest. If it stays stuck, sex therapists exist, they're professionals, and seeing one is no more remarkable than seeing a physical therapist for a shoulder.
When you have finished it
Write one sentence on a small card describing the thing you'd most like to say to a clinician about this subject. Just the sentence, in your own words, as plainly as you can manage. Put the card in your wallet. You don't have to use it this month. But the sentence exists now, outside your head, and that's most of the distance.
Chapter 6 · about 1,600 words
Sleep, Mood, and Cognition
It opens on Priya Raghunathan was sixty-two, still working as a software tester from a spare bedroom in Seattle, and had not slept a full night in three years.
What it answers
- Is it worth mentioning that I only sleep five hours, if I feel all right?
- Sleep need varies, and some people genuinely do well on less. What's worth mentioning is a change from your own pattern, waking unrefreshed regardless of hours, daytime sleepiness, or anything that suggests apnea. It's the change that carries information, not the number.
- My family says I'm short-tempered now and I don't see it. Who's right?
- Possibly both. Irritability is a very common way that poor sleep, pain, and low mood show up, and it's more visible from outside than inside. Rather than settling the argument, treat it as a data point worth bringing to a doctor along with everything else, and see whether it improves when the sleep does.
When you have finished it
Tonight, before bed, write tomorrow's worries on a piece of paper and leave it on the kitchen table. Everything nagging at you, in a list, out of your head and onto the page. It's a small, slightly silly-sounding practice with a decent track record for the two-in-the-morning problem, and it costs nothing but the paper.
Chapter 7 · about 1,900 words
Hormone Therapy and Other Treatments
It opens on If you want to understand why women your age are confused about hormone therapy, look at what they've been told over the course of one adult lifetime.
What it answers
- My friend takes it and swears by it. Shouldn't I just try what she's on?
- Her history isn't yours, and the fact that a treatment suits her tells you nothing about your own clotting risk, cancer history, or blood pressure. Take her enthusiasm as a reason to have the conversation, not as a prescription. And never take anyone else's medication, which sounds obvious and happens more often than you'd imagine.
When you have finished it
Write down, in one sentence, the specific symptom you'd most want treated. Not "menopause symptoms." Something like I wake four times a night drenched or sex hurts or I leak when I cough. Precision here is what turns a vague appointment into a decision, because the treatment for each of those is different, and the risk conversation for each of those is different too.
Chapter 8 · about 1,700 words
Preventive Care and Self-Advocacy
It opens on Fern Deloria drives ninety minutes each way from her home on the reservation in South Dakota to the clinic where she can be seen, and she does it in a truck with a heater that works when it feels like it.
What it answers
- Won't I get labeled a difficult patient?
- Some women worry about this a great deal. In practice, a prepared patient with a written list and specific questions is usually experienced as easier, not harder, because they've done the work of organizing the visit. Difficult is a vague, escalating complaint with no specifics. What you're doing is the opposite of that.
When you have finished it
Take an index card. Write the date of your next appointment at the top, and underneath, the words "Most important today:" and leave the line blank. Put it where you'll find it. When something comes up over the next weeks that you'd normally shrug off, write it on that line. Then hand the card over at the start of the visit, before you're asked how you've been.
Chapter 9 · about 1,800 words
Cancer Screening and Shared Decisions
It opens on Winnie Cheung spent thirty-four years as an accountant in San Francisco and came to her seventies with a professional discomfort about being told what to do without seeing the working.
What it answers
- Isn't more testing always safer?
- No, and that's the hardest idea in this chapter. More testing finds more things, and a proportion of those things are false alarms or harmless findings that lead to procedures with real risks. There's a genuine sweet spot, and it's different for each person, which is exactly why the decision is shared rather than automatic.
- If I skip a screening this year, have I ruined it?
- Not in any dramatic sense. Screening works over years, not on a knife edge, and a delay is a reason to reschedule rather than to give up. What matters far more than perfect timing is responding promptly to symptoms, because symptoms are a different category entirely. Screening is for when you feel fine. Anything on the warning lists in this book gets attention regardless of when your last test was.
When you have finished it
Write down, from memory, every cancer you know of in your blood relatives, who had it, and roughly how old they were. Leave gaps where you don't know. Then pick one relative who might fill a gap and call them this month. Family history is the single most powerful free piece of information in cancer screening, and almost nobody has it written down.
Chapter 10 · about 1,600 words
Build a Personal Postmenopausal Health Dashboard
It opens on By now you may be feeling something this book didn't intend, which is that your health has turned into a second job.
What it answers
- What if my page and my doctor's records disagree?
- That's useful information rather than a problem, and it happens often. Point it out. Errors in medication lists are common and occasionally dangerous, and you're the only person positioned to catch them.
- I started one and stopped after two months. Is there a point in restarting?
- Yes, and stopping is the normal experience rather than a failure. Restart with less: just the medication list and the dates. A minimal page you keep is worth more than a beautiful system you abandon. Almost everyone who maintains one of these long-term is on their second or third attempt.
When you have finished it
Find an envelope. Write your name and this year on the front. Put in it the single most recent piece of paper you have from any doctor, and one sheet with your medications listed. That's your dashboard, started. Everything else in this chapter is an improvement on a thing that now exists.
Women’s Health After Menopause
Menopause gets the pamphlet. The forty years after it get almost nothing. This is the missing briefing.