The doctor behind 'The Vagina Bible' wrote a new book on menopause, and she says she's skeptical of the startups targeting middle-aged women

• Gynecologist Jen Gunter's new book debunks myths about menopause.
• Gunter said most startups that are trying to tackle menopause aren't selling anything new.
• Her expert advice for those approaching or in menopause: quit smoking, exercise, and eat healthy.

Menopause - medically defined as the stage after a biological female's final menstrual period - is as universal an experience as first starting your period in puberty.

Accompanied by declining levels in sex hormones and eventual loss of fertility, the experience of going through menopause isn't exactly well-depicted in media or commonly spoken about - so Dr. Jen Gunter wrote her second book about it.

"Menopause is puberty in reverse," she writes in "The Menopause Manifesto," set to be published May 25. Unlike pregnancy, menopause will happen in all biological females who live past a certain age, yet few honest, accessible, and women-centered discussions on the reproductive transition exist, Gunter said.

Beyond the loss of period and measured hormonal declines, menopause symptoms can vary widely. Common ones include changes in body temperature, mood, sleep, weight, and sex drive.

Intended to be an inclusive, educational and historical guide to the fertility transition, "The Menopause Manifesto" is Gunter's follow-up to The New York Times-bestselling "The Vagina Bible" published in 2019.

Gunter, a practicing gynecologist in the Bay Area, also dispenses science-backed health advice for women across the board.

Having first spoken out against Goop's controversial jade eggs in 2017, Gunter is a vocal online critic of health misinformation and the many forms misogyny can take within it.

Speaking to Insider, Gunter said she was inspired to write "The Menopause Manifesto" largely due to the negative stereotypes women approaching menopause face around their sexual value and social worth, as well as the lack of easily understandable, de-stigmatized information on the biological transition.

Similar to her first book, it cuts through the misogyny embedded in conventional Western medicine to talk about women's health to debunk myths and provide historical and social context. Her 25 years of clinical experience and her personal experiences with premenopause, the long and varied phase leading up to it, guided its writing as well.

Gunter's focus on aging women is happening at a time when there's been a"menopause product boom," and calls for increased venture funding. Though she said that women over the age of 45 have been "treated like a silent demographic," Gunter expressed skepticism about the increased attention to the estimated $600 billion market.

"If you need calcium, you can take a calcium supplement," she said. "Why do you need one branded for menopause? Is that like a pink tax, plus a menopause tax on top of it?"

Instead, Gunter offered three general health recommendations for those either already in or approaching menopause: quit smoking, exercise, and eat a healthy diet - with plenty of fiber.

Venture-backed menopause startups aren't doing anything new

"The Menopause Manifesto" draws upon dozens of scientific studies evaluating the evidence for different approaches to managing menopause symptoms, most of which are caused by declining levels of the sex hormone estrogen.

One of the first mainstream medical treatments for menopause that might come to mind is hormone replacement therapy. In her book, Gunter rejects the term for its value-laden connotations, preferring to use the term menopausal hormone therapy, or MHT.

"While MHT can be helpful for many people, it really needs to be looked at as one part of the puzzle," Gunter said. "Often the focus seems to be on estrogen, as opposed to the whole experience."

Other approaches beyond MHT and lifestyle recommendations, Gunter found, have little evidence for wellness and alternative health products in treating the symptoms of menopause. In "The Menopause Manifesto," she devotes seven chapters to both medical treatments and unregulated products, including dietary supplements, bioidentical hormones, birth control, and MHT.

Although Gunter said she would need to consider each product on an individual basis, she's wary of slickly marketed products, particularly supplements and other combination products that market themselves as blanket solutions.

"Things claim to be 'ovary support' or 'menopause support,' but that's a medically meaningless term," she said. "Most people don't need to take a supplement."

With the exception of omega-3 fatty acids and vitamin B12, the data on efficacy for most menopause-targeted supplements, including popular multivitamins, remains spotty and scarce, according to "The Menopause Manifesto." Despite the billions of dollars consumers pour into the supplement industry, food remains the best way to get micronutrients.

In the last year, she said a handful of startups have pitched her menopause-related ventures, none of which seemed to be different for existing free resources for menopause patients.

"Someone pitched me some app that women would sign up for and pay for with all the guidelines [for menopause]," Gunter said.

"And I'm like, 'The North American Menopause Society has one and it's free! How is your app different from that?' Then there's just a big silence."

Her doctor's advice for managing menopause symptoms is science-backed and likely unsurprising

Menopause symptoms can include hot flashes and brain fog. Gunter pointed to some ways to improve health and well-being during that time.

Gunter's recommendations for people in menopause are simple: quit smoking, strive for the American Heart Association's recommended 150 minutes of weekly aerobic exercise, and learn how to eat healthier - including hitting the broadly recommended daily 25 grams of fiber.

"The science of nutritional studies is really challenging for a lot of reasons, but the takeaway really is that people need to eat more vegetables," she said.

In addition to getting enough fiber, Gunter added we'd likely all be a little bit better off with trying to eat more plant-based protein and minimizing processed food. More accessible, high fiber, healthy food would improve public health overall, and reduce people's risk of other conditions like hemorrhoids and colorectal cancer.

"I guess what people can benefit from isn't sexy," she added. "Nobody wants to buy a book about the hundred joys of fiber."

Gunter also highlighted adding weight-bearing exercise, since strength training can help mitigate the effects of bone loss and accelerated loss of muscle mass that occurs during menopause.

What works for one person may not work for another, but Gunter is firm in her belief we all probably need to move our bodies more - a message that's often lost in Instagram-friendly advertising for women's health products.

"If health and wellness is something that appeals to you - exercising and learning how to eat better and prepare meals is good, but there isn't a specific pillow or bed sheet or supplement that's going to help with menopause," she said.