Anti-naturalism,technoscientific empowerment and rage: Insurgent feminist knowledge in an online menopause forum

Abstract

This article explores feminist theorising about menopause in the world’s largest online menopause forum, r/menopause. Building on earlier feminist Internet research on menopause, it conceptualises this online theorising as a form of epistemic insurgency in relation to biomedicine. It analyses forum users’ comments about medical misogyny, menopausal hormone therapy and rage to demonstrate how their subjective experiences of menopause inform a vernacular feminist politics with its own unique configuration of the relationship between bodies, gender, biomedicine and biotechnology. Distinct from the postfeminist healthism which dominates media representations of menopause, this vernacular feminism parallels other feminist projects but is not reducible to them. The implications for feminism include the urgent need to address both these women’s alienation from biomedicine and recent problematic albeit well-intentioned feminist public health messaging.

Introduction

In March 2024, to coincide with International Women’s Day, The Lancet published a series of articles calling for a ‘balanced conversation’ about menopause. Recalling feminist arguments of the 1990s (Berger, 1999; Greer, 1991), the series editorial claimed that menopause has been ‘over-medicalised’ and that commercial organisations have co-opted feminist narratives to ‘position use of menopausal hormone therapy [MHT, formerly HRT] as a way to empower women to regain control of their bodies, while downplaying risks’, a move said to endorse a menopause-as-disease narrative (The Lancet, 2024).

Far from rejoicing that this stalwart of biomedical publishing had adopted an overtly feminist position on menopause, large numbers of women took to the Internet to voice their outrage over the series. The Lancet’s largely unengaged-with Instagram account received over 1000 overwhelmingly negative comments about the series, an online Change.org petition to have the editorial retracted was circulated and the articles were dissected across social media. This article seeks to contextualise this popular outpouring of rage by exploring feminist knowledge production within the r/menopause subreddit, the Internet’s largest menopause community. While the online backlash against The Lancet’s menopause series might initially appear to be an anti-feminist product of the menopause-as-disease narrative, I argue that it reflects an insurgent form of feminism grounded in menopausal women’s bodily experiences. I contend that understanding the epistemic insurgency of what I term the ‘menosphere’ can allow feminists to reconfigure along more inclusive lines the conceptions of gender, empowerment and agency mobilised within public and scholarly discourses surrounding menopause.

The backlash against The Lancet series occurred in the context of unprecedented popular interest in menopause which Jermyn (2023) has dubbed ‘the menopausal turn’. In 2021, British news reporting on menopause surged (Orgad and Rottenberg, 2024) and a television series hosted by Davina McCall was said to have instigated a run on MHT, sparking a widespread shortage of hormone products and leading to talk of a ‘menopause revolution’ (Jermyn, 2024). A parallel phenomenon was observed in the United States, with celebrities such as Gwyneth Paltrow, Oprah Winfrey and Michelle Obama speaking publicly about their menopause experiences (Hunter et al., 2023). Feminist analysis of the menopausal turn across media, advertising and public policy indicates that despite its feminist objectives of overcoming shame and challenging ageism, it consistently constructs menopause as obstructive to a feminine subjectivity centred on perpetual youthfulness, sexual attractiveness and economic utility (Bettany, 2023; Jermyn, 2024; McCartan, 2025; Orgad and Rottenberg, 2023, 2024; Rottenberg and Gilchrist, 2025). While this supports earlier feminist accounts of the menopause-as-disease narrative, recent representations of menopause differ in that they tend to replace a predominant medical framing with notions of empowerment through personal transformation and individual entrepreneurship (McCartan, 2025; Orgad and Rottenberg, 2023). The menopausal body thus becomes the object of surveillance and management at the individual level through biotechnologies such as MHT and wellness apps (Orgad et al., 2024), dietary supplements and cosmetics (McCartan, 2025); and at the collective level through policies aimed at maximising the productivity of menopausal workers (Rottenberg and Gilchrist, 2025). These simultaneous appeals to both feminist and individualist neoliberal logics have led some feminists to describe the menopausal turn as distinctly postfeminist in its outlook (Bettany, 2023; Jermyn, 2023; McCartan, 2025). It can thus be situated within a broader discourse of ‘postfeminist healthism’ (Riley et al., 2018) which implores women to constantly self-monitor and consume their way to individual empowerment.

Women whose debilitating menopause symptoms are not adequately addressed by health care professionals (HCPs) have become increasingly visible within the menopausal turn (Orgad and Rottenberg, 2024). The reluctance of some HCPs to treat menopause symptoms was a recurrent theme in women’s submissions to a recent Australian Senate Inquiry into issues related to menopause and perimenopause, prompting the government to recommend compulsory training modules on menopause to remedy the existing ‘limited and varied’ undergraduate training for Australian GPs (Senate Standing Committees on Community Affairs, 2024). The Lancet’s assertion that menopause is ‘over-medicalised’ and its use of feminist terminology therefore obviously riled women who had experienced inadequate menopause care. While The Lancet’s claim was more likely aimed at the menopause turn’s uncritical focus on MHT (see Jermyn, 2023) than clinical practice, other biomedical literature has made similar statements that unequivocally refer to clinical practice. A British Medical Journal editorial, for instance, recently asserted that menopause is over-diagnosed and over-treated, and that ‘the risk-benefit calculus [of MHT] does not favour treatment for many women’ (Abbasi, 2022: 1).

While increasing access to MHT and addressing HCPs’ indifference to menopausal women have long been prominent feminist issues in places such as France (Löwy and Weisz, 2005), these imperatives are mostly new to feminist politics in the Anglophone world. This may be the legacy of radical feminists’ adherence to a natural/medicalised binary in their framing of menopause in the 1990s, which constructed menopause as a natural bodily transition that is negatively shaped by a biomedical narrative of disease (Berger, 1999; Ferguson and Parry, 1998; Greer, 1991). In this view, the suffering menopausal body is less the biological effect of dwindling hormones than the bodily materialisation of the patriarchal ideology of biomedicine. Despite some notable exceptions (see Guillemin, 2000; Hyde et al., 2010), earlier feminist studies of menopausal subjectivity tended to marshal women’s experiences around this natural/medicalised explanatory frame (Lupton, 1996). Menopause was said to be a natural part of ageing that most women experience as inconsequential or positive (see de Salis et al., 2018; Dickson, 1990; Dillaway, 2005; Winterich and Umberson, 1999), with severe menopause symptoms claimed to be overstated, caused by things other than menopause and/or the effect of the medicalisation of menopause (see Berger, 1999; Gannon and Ekstrom, 1993; Perz and Ussher, 2008; Winterich and Umberson, 1999). MHT was consequently viewed as a technology of patriarchal control, leading to polemical statements about its dangers, such as Klein and Dumble’s (1994) claim that it is a drug of addiction. The Lancet and British Medical Journal editorials thus appeared more aligned with this earlier anti-medicalisation feminism than more recent feminist scholarship critiquing postfeminist menopause talk.

Although Internet research on menopause is limited, studies of online menopause forums have long complicated anti-medicalisation accounts of menopause. The suffering menopausal body cannot be easily overlooked via rhetoric about somatisation or ‘nature’ in a context dominated by women’s narratives of pain, misdiagnosis and dismissal of symptoms (Goldstein, 2000; Halliday and Boughton, 2009; Im et al., 2008; Lazar et al., 2019). For women who are marginalised from biomedicine in this very literal sense, online menopause forums become important sites of alternative knowledge construction. Drawing on Foucault’s notion of subjugated knowledge, Goldstein (2000) theorises menopause forum activities as a ‘gradual construction of “vernacular health theory”’ – subjugated in relation to medical authority, such constructions of illness circumvent biomedicine to directly address the concerns of women experiencing bodily suffering due to menopause (p. 314). I argue that women’s online menopause discussions are also important sites for constructing vernacular feminist theory. Created and sustained by feelings of collective identity and belonging, online discussion forums are ‘affective publics’ which can liberate and empower individual and collective political imaginations (Papacharissi, 2015). While considerable attention has been paid to the toxic masculinity of the so-called ‘manosphere’ (see Kay, 2025), comparatively fewer studies examine online feminist communities, and those that do focus on spaces mostly made up of younger women (see Keller et al., 2018; Massanari, 2017; Rentschler, 2014; Roth-Cohen, 2021).

Following Murphy (2012), my interest in the vernacular feminism of the menosphere is not motivated by an evaluative logic, but rather a desire to understand the epistemic reassemblies underpinning older women’s online performance of menopause-related feminism. Is the vernacular feminism of the menosphere simply a direct reflection of the menopausal turn’s postfeminist healthism? Or is it constituted differently? What exactly afforded it the coherence (or semblance thereof) necessary to situate itself in an adversarial position in relation to the anti-medicalisation feminism expressed in The Lancet? And what, if any, is its relationship with other political grievances?

Methods

Recognising Lazar’s (2017) call for greater feminist engagement with postfeminist discourses, this study uses a feminist critical discourse analysis (FCDA) methodology (Lazar, 2007). Informed by claims that critical discourse analysists too often ‘cherry-pick’ their textual data to fit their arguments (Sriwimon and Zilli, 2017), thematic analysis (Clarke and Braun, 2017) was used to locate a representative sample of feminist comments to analyse. This approach was also necessary to address the issue of the volume of comments on the sub: r/menopause has over 250,000 registered users, putting its size in the top 2 percent of reddit subs and making it among the largest menopause discussion groups on the Internet. Initially, posts containing comments about The Lancet series were read to get an overall sense of common themes in the backlash. This netted a sample of eight posts containing 622 comments. Based on this preliminary reading, the keywords ‘medicali*’, ‘misogyn*’ and ‘gaslight*’ were selected to source further comments expressing feminist theories about menopause. To ensure a manageable dataset, the first 25 posts containing each word (or equivalent variations) were selected, with posts sorted by relevance and duplicate posts removed. This generated 3583, 3366 and 1331 comments for each word, respectively. Thus, a total of 83 posts containing 8902 comments were initially examined.

Next, relevant comments were coded into themes, with key words/terms used to identify more comments related to each theme. For instance, words relating to rage were used to locate other comments specifically about anger and rage. These key word searches were conducted in January 2025 and a three-year limitation was placed on comments to ensure they were part of the menopausal turn. This limitation was largely unnecessary, as the greatest volume of feminist-themed comments were made in the immediate aftermath of Trump’s second US electoral win in 2024. Identification of sub-themes stopped when thematic saturation was reached. FCDA was then used to examine how feminist meaning was constructed in relation to each theme, focusing on articulations of gendered social relations. The focus of the analysis was thus less on the texts themselves, but rather on intertextuality as understood within Fairclough’s (1992) tripartite conception of critical discourse analysis: that is, how the texts which constitute a discourse relate to other (feminist) discourses.

While this approach allowed a significant body of comments to be mapped, the use of anonymous content presents limitations because it is not possible to know the characteristics of users beyond what they choose to share. Frequent references to insurance and co-payments, the NHS, and Medicare indicate that many users are based in the United States, United Kingdom and Australia, but the exact breakdown of sub membership is unknown. Most significantly, this precluded any serious consideration of race, despite several posts discussing Black women’s experiences. The anonymous nature of sub also presented the ethical issue of participants potentially being identifiable through the information they share about themselves, either within r/menopause or other Reddit subs. This was an especially important consideration given that sensitive health information is routinely shared within the sub, and political allegiances including voting preferences were often shared in this specific dataset. Ethics approval was granted by the institution, and the approved protocol entailed ensuring that participants’ identities could not be reasonably be determined through their commenting histories. Australian ethics guidelines concerning Internet research emphasise participants’ relationship with their data over its public accessibility. Informed consent was not obtained from participants both because of the volume of data collected and to preserve anonymity; the institution’s ethics review body was satisfied that the risk of participants feeling aggrieved by their comments being used for this research was minimal.

It should be noted that while the methodology facilitated a representative picture of how feminism is enacted within the sub, other discourses are also evident within users’ comments, including anti-feminist ones. The subs rules, however, significantly limit the extent to which alternate discourses can gain traction within this knowledge community. Before commenting, users must read an 11,000 word Wiki which marks the sub’s epistemic boundaries, explicitly positioning it as a space centred around peer-reviewed scientific knowledge. The outlook of the Wiki is also overtly feminist, evidenced by its concluding statements about menopausal women becoming ‘a force to be reckoned with’ and the need to overhaul employers, businesses and HCPs (https://menopausewiki.ca). As such, posts or comments referencing alternative therapies such as naturopathy or homoeopathy are removed by moderators. Likewise, the sub explicitly forbids fat-shaming or discussion of fad diets and pseudo-scientific nutritional advice, hence posts about weight loss are only allowed in a single monthly thread which is closely moderated. As a result, the public idiom of the sub skews overwhelmingly towards an evidence-based approach to health knowledge and the political identities most aligned with that outlook. Thus, expressions of feminism within this context cannot be generalised to other online menopause communities.

Biomedicine and nature

While r/menopause contains posts on a vast array of menopause-related topics, it is dominated by the narratives of negative experiences of medical care that most often lead users to join the forum for support. Women in the sub describe: having their reported symptoms ignored, minimised or even explicitly ridiculed; being told that they are ‘too young’ for perimenopause in their 40s; and/or being told that menopause is ‘natural’ and therefore does not require treatment. Users in perimenopause often say they are denied treatment on the basis of blood tests – which are not a recognised diagnostic tool for perimenopause – and are routinely offered antidepressants and/or advised to lose weight, see a therapist or exercise more. Within these narratives, treatment with MHT is seldom offered and is often denied when requested, even for the severe vasomotor symptoms for which it is frontline treatment. Some users reported HCPs being honest about their lack of expertise in menopause care; more often, however, HCPs were said to refuse to prescribe MHT because they did not understand it or personally objected to it (‘she told me that she “doesn’t support HRT”’). As one user summarised it in relation to The Lancet’s claim that menopause is understood as a disease:

The disease thing is a red herring, the implication that [menopause] is being so over medicalized when so many struggle to (1) have their symptoms taken seriously and (2) get medication if they want it is what is so horrible about this article.

These women’s experiences of biomedicine are thus what might be described as what Fricker (2007) terms testimonial epistemic injustice: ‘when prejudice causes a hearer to give a deflated level of credibility to a speaker’s word’ (p. 1).

In Fricker’s (2017) view, epistemic injustice is limited to unintended misjudgements; intentional acts are better thought of as deliberate gaslighting. In the sub, feminist interpretations of HCPs intentions fell across a spectrum. At one end, the withholding of care was understood to be the result of ignorance and neglect borne of biomedicine’s misogynistic view of women. At the other end, it was understood to be part of a deliberate and far-reaching patriarchal effort to oppress women:

[. . .] this ‘ignorance’ is all about control, the whole world likes to control every step of a female’s life from birth until we die. They can’t just let us have it easy.

There is thus a parallel here with radical feminists’ argument that biomedicine seeks to have women submit to medical authority for the entirety of their lives (Greer, 1991). A similar alignment is seen in the below comment, which mirrors radical feminism’s argument that women are regarded as no longer socially useful at menopause:

Women are treated like cattle. Society tries to put us out to pasture when we hit 50, and lets nature take its course. If we make a fuss, we’re considered hysterical and often prescribed ‘self care’ remedies like sleep, yoga, and meditation. Some of us actually have debilitating menopause symptoms. Some of us have manageable symptoms that make life very unpleasant. But, we have to face The Gatekeeper to get treatment. [. . .] Yet Viagra has very real heart risks, and men are offered it at appointments when they hit 50. Also testosterone. FUCK THE PATRIARCHY. I am not a cow. I am human.

While this comment shares the radical feminist view of the gendered construction of menopausal subjectivity, the constituent signifiers of nature and biotechnology are reinterpreted according to the experiences of women on the sub. ‘Nature’ becomes not a positive realm to which to retreat, as per the anti-medicalisation feminist figure of the crone (Greer, 1991), but the oppressive realm of the non-human. Biotechnology becomes not a tool of patriarchal control, but a technology of liberation withheld by the patriarchy. The following comment, made in response to The Lancet series, further exemplifies how the concept of ‘nature’ is understood as oppressive to women:

It is utter bullshit. Some drs are just pissed at our generation advocating for ourselves and asking for basic medical care. Meno and peri wreck lives. Sometimes we don’t survive. Mentally, heart attacks, bones. This is just another attack on women/people born with uteruses. If letting it happen naturally without medical support is the best way, why don’t we do that with literally every medical condition? Starting with erectile dysfunction. Fucking misogynistic numpties.

The logic of these comments relied on the apparent gendered asymmetry of how ageing bodies are understood by biomedicine; as one user succinctly put it, ‘Why are women required to endure nature but men are treated for natural aging?’

The radical feminist appeal to nature was also explicitly critiqued on the sub as a logical fallacy, in terms similar to those used by Lupton (1996):

The appeal to nature logical fallacy is so stupid! You know what else is natural? Being born without clothes on. And yet, here we are, wearing clothes. Extend it out to literally everything that enhances life and health and you can see that the appeal to nature fallacy ‘it’s natural therefore better’ quickly falls apart.

This was not merely abstract feminist theorising. Users identified the appeal to nature as a rhetorical barrier to treatment that could potentially be negotiated. Identifying it as logical fallacy in a doctor-patient encounter therefore becomes a strategy for challenging denial of treatment:

I now have two responses for my doctor when we next discuss [treatment] if she says anything about what is and isn’t natural: ‘Cancer is natural’. And ‘Tell me what about medicine, which is an intervention into a naturally occurring disease state, is natural?’

Some users were less bothered by the logical incoherence of the appeal to nature than its failure to account for the structural conditions that shape menopausal subjectivity and thus one’s ability to forego medical treatment:

It is a natural part of life. Preaching to the choir, but for some of us, like me, it’s disruptive to the point we can’t keep our lives together and are risking far greater problems/fallout if we don’t get treatment. I am desperately trying to hold onto my job, and I saw my Dr. to discuss HRT. I pray that I can access it and that it works. I have no partner, no family, no safety net to catch and support me while I struggle through this. I HAVE to be functional.

Other users made similar comments to the effect that the ability to ‘raw dog’ or ‘white knuckle’ menopause is the domain of the relatively privileged who do not have the burden of full-time work with or without the additional pressure of caring for children.

The sub’s anti-naturalist discourse aligns with the foundations of Kwok’s (2013) Haraway-influenced cyborg menopausal politics, which broke with anti-medicalisation feminism to advance a politically contingent position on MHT, advocating for it or opposing it depending on whether the situation progressed a cyborg understanding of the menopausal subject. Haraway’s anti-naturalism has also been taken up in theorisations of xenofeminism, and here again there are parallels with the sub’s anti-naturalism. Describing themselves as ‘disobedient daughters’ of Haraway and reviving the anti-natalism of 1970s Marxist feminist Shulamith Firestone, xenofeminists understand nature and the natural ‘as a space for contestation – that is, within the purview of politics’ (Hester, 2018: 19). Technoscientific intervention into biology for the purposes of feminist emancipation is thus a core tenet of xenofeminism; as the final line of the xenofeminist manifesto (Laboria Cuboniks, 2015) reads, ‘If nature is unjust, change nature!’ Xenofeminism’s anti-naturalism directs the focus of its proposed technoscientific interventions towards reproductive justice and gender abolition. Xenofeminists align themselves with trans activists’ ‘bio-hacking’ projects – efforts to circumnavigate biomedical authority to obtain and self-administer sex hormones, and the 1970s grassroots feminist self-help collectives that sought to place abortion directly in the hands of women via the Del-Em, a feminist-designed menstrual extraction device (Hester, 2018). While menopause does not explicitly figure in xenofeminist theorising, there is a nod to it in this consideration of emancipatory possibilities of certain biotechnologies:

Without the foolhardy endangerment of lives, can we stitch together the embryonic promises held before us by pharmaceutical 3D printing (‘Reactionware’), grassroots telemedical abortion clinics, gender hacktivist and DIY-HRT forums, and so on, to assemble a platform for free and open source medicine? (Laboria Cuboniks, 2015)

I am not suggesting here that sub members are crypto-xenofeminists. Nor am I drawing these parallels to lend the vernacular theorising of the sub intellectual legitimacy via its proximity to feminist academic scholarship (Helen Hester, one of xenofeminism’s founders, is a professor at the University of West London). Rather, the point is that the configuration of anti-naturalism, biotechnology and feminism apparent on the sub is not unique to it.

Biotechnology and empowerment

What role then does biotechnology play in the vernacular knowledge ecology of the sub? Thus far we have seen how the absence of MHT operates as a structuring force in the sub’s discourses about nature and biomedicine: the withholding of MHT demands the rebuttal of the appeal to nature that is foundational to the logic of MHT being withheld. For users who have obtained it, MHT often plays an important role in justifying the sub’s representation of biomedicine. Here, for instance, MHT ‘proves’ that women are indeed being gaslit by biomedicine:

My symptoms are so obvious and I’m very in tune with my body and since HRT nearly immediately eradicated all my symptoms, I won’t be deceived into thinking it’s something else.

Women espousing feminist views on the sub tend to be aware not only of the risks associated with MHT, but how those risks have been constructed differently across time, with the Women’s Health Initiative (Writing Group for the Women’s Health Initiative Investigators, 2002) study frequently mentioned as the catalyst for HCPs currently refusing to prescribe it. Part of the criticism of The Lancet articles concerned what was seen to be not just an overly conservative view of risk, but also one that did not adequately consider benefits:

[The Lancet article authors] fail to factor in the benefits of HRT when discussing risks. Okay, if my risk of breast cancer goes up slightly, what about my risk of breaking a hip? Does that go down? If so, how is that weighed against cancer risk? I’m not stupid, I can handle more than one statistic at a time. God, I’m so sick of being talked down to.

Biotechnology also lent itself to theorisations about how biomedicine could be reconfigured to serve the interests of women. Users optimistically mused about how diagnostic biotechnologies currently used for reproduction or illness monitoring could be applied to relieve the suffering of menopausal bodies:

When I was doing fertility treatments, I had to go every 2nd day to do bloodwork and ultrasounds, to determine the state of the eggs. [. . .] So if they can monitor a woman so closely for fertility treatments, they can apply the same precision to make sense of ‘fluctuating’ hormones.

You know those continuous glucose monitors that they have nowadays? My dream is that one day, there will be one for hormone monitoring. [. . .]

The implication in these comments is that through monitoring and thus ‘making sense’ of hormones, symptoms could be more accurately diagnosed and the correct dose of MHT could be administered to alleviate them. In other instances, it was theorised that biotechnology would revolutionise how women’s reproductive capacity is understood by society:

I think periods themselves as ‘natural’ are going to be questioned [. . .], and medicated out for those who are tired of having their lives turned upside down by them. I tell this to my daughters: that it will be more talked about in conjunction with menopause-awareness. And that they’re lucky to be on the brink of a great shift in consciousness about the ‘natural woman’.

Once again, there are direct parallels here with the anti-naturalist and technoscience-positive stance of Firestone, Haraway and xenofeminism.

For women with uteruses, finding the right combination of MHT is often a matter of trial and error. Participants in conversations about self-medicating often demonstrated considerable knowledge about different hormone products and their dosage equivalents – information which can be difficult to source – as well as how to manage risks and side effects. While users understood this biohacking in feminist terms, it did not align with xenofeminists’ vision of creating an open source medicine or the objectives of the women’s feminist self-help groups of the 1970s (see Murphy, 2012). Rather than seeking to place medicine directly in the hands of women, users understood their biohacking measures as a necessary intermediary step in the transition towards gender inclusive public health systems:

This Sub and continued sharing of information will enable us to build a bridge between Menopause and the NHS. [. . .] We will force them to evolve whether they like it or not. By the time girls grow into women, Menopause Health in the UK will have taken a huge leap. We just have to keep chipping away at the archaic and regressive model of Menopause Health we currently have.

This logic extended to perceptions of private menopause clinics, which were seen as a necessary although ultimately undesirable stopgap measure for addressing mainstream medical systems’ failures to provide adequate menopause care.

Similar logic was at play within discussions about menopause advocacy. Alongside providing a space for women to have their experiences acknowledged, a key purpose of the sub is to empower women to advocate for themselves in medical settings. To this end, the sub itself provides clear and succinct information about the risks and benefits of MHT, and tips for engaging with HCPs who may lack education in menopause care. Within user discussions, newcomers to the sub were frequently advised to arm themselves with information about menopause and advocate for themselves to obtain treatment. Users often reported successful treatment as a result, so in a pragmatic sense self-advocacy could be understood as empowering:

This sub has helped me make sense of a ton of symptoms I’ve experienced in the last few years, and gave me the information and the courage to advocate for myself with my gynecologist and get started on HRT at age 40.

More often, however, women expressed resentment at being placed in the position of having to advocate for themselves in the first place:

It’s because doctors and/or the medical system have failed us, and keep failing us. It’s not an easy problem to fix, so we’re told we need to pick up the slack by ‘advocating for ourselves’, but this is not a position we’re supposed to be in, generally. It’s just all we’ve got.

The gendered dimension of advocacy was also not lost on users:

I personally wouldn’t waste my time, money or patience bringing medical literature to a doctor and supplementing their training. Fuck that, it’s their JOB to be up on the latest training and their JOB to ensure you are treated fairly . . . They wouldn’t do this to a man . . . vote with your money, find a doctor who wants to treat women fairly . . . fuck the rest of them.

Once again, the underlying point was that the medical system is unjust, and women should take whatever pragmatic means necessary to receive the treatment they need. This is quite different to the consumerist, uncritical understanding of advocacy advanced through postfeminist healthism.

Nevertheless, the meaning of advocacy on the sub had some significant limits which were evident within discussions focused on advocacy for non-menopausal women, including trans women. Advocating for trans rights was seen as a feminist imperative in the sub due to the Right’s attacks on gender affirming care. However, this was not expressed as solidarity with trans people solely because of these attacks, but because users saw the rights of older cis women as tied up with trans rights in the current (United States) political context. The prevailing understanding in the sub was that the withholding of gender affirming hormone treatment would have a knock-on effect on the availability of MHT because, as one user put it, ‘HRT is “gender affirming care” regardless of whether one is transgender or not’. While for some users MHT was the collateral damage of anti-trans politics (‘It’s a very leopards ate my face moment for right wing women’, as one user put it), others saw MHT as being directly targeted:

They’ve already started coming for both HRT and BC by attacking transgender therapy as a talking point. By attacking transgender rights and conversion, they can sneak through laws that ban all HRT and BC without the backlash of coming after women’s healthcare. We don’t matter to them, after reproductive ages, we’re considered useless anyway. The trans argument is just smoke and mirrors.

In both cases, feminist advocacy for trans rights was thus ultimately centred on the rights of cis women, rather than a deeper politics of allyship seeking empowerment for trans women in their own right.

Rage and no fucks feminism

Rage is a commonly discussed symptom on the sub, with users often feeling bewildered by its sudden onset. This led some users to express sympathy for ‘Karens’ – publicly aggressive middle-aged white women who have in recent years become a social media folk devil. While this seemed somewhat tongue-in-cheek, users often recounted instances where they felt they had lost control of themselves in public. These scenarios were often applauded by other users, such as the story of a user launching into a tirade of verbal abuse at a stranger in the street after he made a negative comment about her Kamala Harris t-shirt. Others, however, were clearly a source of shame; one user described how she had physically assaulted a young café worker with a tip jar, while others described feelings of shame for verbally abusing their partners and/or children.

Media portrayals of menopausal rage overwhelmingly frame it in biologically determinist terms as an inevitable result of ageing women’s hormone deficiency; portrayed as irrational, hysterical and ridiculous, women are charged with managing and controlling their rage through biotechnologies such as mental health apps or MHT (Orgad et al., 2024). Orgad and colleagues argue that this dominant media framing renders older women’s legitimate rage in response to gendered social injustice illegible, thus depoliticising it. While many of the discussions on the sub centred on containing rage, treatment was a less prominent theme in posts about rage. Instead, participants were often keen to point out the structural sources of their rage:

My anger comes from having to still take care of my parents. We are immigrants. I was very little when we moved to the US. It’s been 43 years now. My dad never learned English. My mom was not very emotionally stable. Lots of drama. My sister and I had to always go to their doctor appointments, bank, lawyers, every other damn thing. Now they are old and are demanding and I’m just done. I shouldn’t be done. I should be helping my old parents out but after 40 years, I’m just tired. Not to mention I’m 45 and still have a kid at home, husband, cats, house, and new career. I’m so over it.

Others explicitly critiqued biologically determinist understandings of their rage in similar feminist terms to Orgad et al. (2024):

People dismissing it as menopausal rage, as if it’s a medical condition, only makes it worse for me. Because it isn’t. It’s the result of a lifetime of injustices and oppression, and men and their pick-mes gaslighting us into thinking every one of our valid feelings is merely HoRmOnaL. This is a righteous and empowering rage that has been building in me since I was fucking born. It is a natural and correct response to lived experience and observation. I will not allow it to be pathologized.

Some users posited their own theories about the effects of diminishing levels of oestrogen on the brain. Yet again, these did not align with recent media biological explanations of menopausal rage. Rather, oestrogen was understood to be a masking agent – ‘the hormone of appeasement’, as one user termed it – that obscures social reality for evolutionary purposes. The experience of menopause was thus akin to having the scales fall from one’s eyes:

When we are young, all that estrogen makes us sweet and nice to make sure we are more likely to procreate [. . .] Then we lose the estrogen and all that appeasement goes right out the window. We don’t need to birth any more babies for the species so fuck em all.

The rage that is subsequently unleashed is therefore seen as a legitimate response to the gendered social injustices that oestrogen was obscuring:

It’s a perfect storm of generalized misogyny coupled with hormones in flux, meaning that even the estrogen that often kept our emotions in check are just ‘fuck this, peace out’. The combination of toxic workplaces in the US in particular, the continuation of fascism and also dealing with [the healthcare system] has me feeling full of rage. I really hope to find more women’s communities [. . .]. I can’t spend a lot of time around male energy. I feel horrible typing that out, but it feels like it’s been draining me for decades.

In these discussions, participants seemed ultimately more attached to their political claims about women’s social reality than this theorised relationship between oestrogen and rage. In one exchange, a user asked whether the hypothesised hormonal aspect of rage meant that MHT diminishes rage. Another user replied that while MHT may have possibly blunted her rage, she was still angry. Overall, it was as if once the social conditions that oestrogen is said to mask are revealed, it is impossible to put the genie back in its bottle, so to speak.

Similar to rage, a number of posts discussed the phenomenon of ‘having no fucks left to give’. Like rage, this was theorised in biological terms as the result of diminishing hormones:

I think we run out of fucks just like we run out of eggs. I was born with only so many eggs and fucks to give and they’re both almost run out!

‘Giving fucks’ was a polysemic concept, but most often referred to a willingness to perform emotional labour for others or adhere to gendered appearance norms. For the most part, dispensing with the giving of fucks was embraced as a positive (sometimes the only positive) aspect of menopause, and often equated with cronehood:

OMG the loss of nurturing instincts caught me by surprise! All the fucks lost within months. It’s GLORIOUS. Why didn’t our mothers and grandmothers tell us this??? I sleep like a lamb. Or, like a man, if you wish :)

Pre-menopause I had uncontrolled empathy [. . .] Now, I evaluate where I want to spend my emotional energy. . . and I usually decide to keep it for myself. This part of cronehood is absolutely fabulous. Rock on sisters.

In a discussion of role models for menopausal women, this mind-set led users to praise celebrities Michelle Yeoh for being ‘a stone cold bad-ass’, Shirley Manson for being a ‘spitfire’ and Katherine Hepburn ‘who lived in her house on the ocean with a big “Go Away” sign at the entrance to the driveway’. The film characters Thelma and Louise were also mentioned in a number of posts, with one user saying,

[. . .] loved the ending – (talk about out of fucks to give) but also my take away from it was – our male driven society literally gave them no better option than to drive off a fucking cliff. in some ways, I guess menopause and all the shit leading to it kind of feel the same. but instead of driving off a cliff I’ve shedded all the superficial bs I do for society, men or other people – makeup, uncomfortable clothes, saying yes when I don’t want to etc

Another user invoked Thelma and Louise in a serious discussion about suicidal ideation, saying that she wanted to ‘go out Thelma and Louise style’ with other women. ‘There’s nothing wrong with us, we’re just seeing the world as it is, without the filters we used to have. I hate it, but it is what it is’, she said.

Where self-discipline was discussed, it was directed less towards policing the menopausal body and more towards preventing oneself from tacitly slipping back into the gendered prioritisation of others’ interests:

I’ve stopped reminding him of things, like to put his ear plugs in at bedtime because the water softener will be running its regen cycle tonight. I caught myself just as my lips opened and thought, fuck it, why do I feel the need to say shit like that? He’s a grown man, he can figure it out for himself!

In the same way that ‘giving no fucks’ meant recognising the patriarchal injustice upon which giving fucks is premised, this labour of disciplining oneself not to give them was seen as a political act that is part of a broader online feminist consciousness involving not just other menopausal women, but also younger women:

I think there is also a societal shift whereby women are realizing they do have a voice and can stand up for and fight for themselves. I think that the metoo movement is a great example of that. I’m thrilled to see the younger generation really calling things out. I spend a lot of time in r/twoxchromosomes, and though I’ve always considered myself a feminist, that subreddit has taught me a lot and helped me see how much internalized misogyny I have and was raised with by my mother. I think this may be the only good thing about social media; it’s helping women really SEE what’s going on. My opinion is this is a combination of age and wisdom and also a greater change in society that’s causing many of us, me included, to be unwilling to put up with this shit anymore.

This broader move towards a rage-based ‘give no fucks’ style of feminism has also been recognised beyond social media platforms. Cooper (2018) identifies it in Black women’s rejections of respectability politics, such as Michelle Obama dressing casually for Trump’s first inauguration. Referring to examples of young female British and US politicians’ ‘no fucks’ feminist behaviour, Wood (2019) believes it offers hope for building feminist solidarity by ‘channelling esteem into more public, collective and political moments of “fuck you”’ (p. 612).

Conclusion

This study supports the findings of earlier research on online menopause communities that menopause forum users overwhelmingly experience menopause as marginalisation from biomedicine (Goldstein, 2000; Halliday and Boughton, 2009; Im et al., 2008; Lazar et al., 2019). Grounded in women’s bodily experience as objects of converging biomedical and feminist health narratives, the feminism espoused on r/menopause shares the traditional radical feminist understanding of biomedicine as patriarchal, yet differs in its embrace of biotechnology as a tool of feminist empowerment. The Lancet articles sparked intense outrage in this community because, in describing menopause as over-medicalised and appealing to the natural logical fallacy, they were understood to rhetorically support the biomedical marginalisation of menopausal women. Far from being duped into internalising a menopause-as-disease narrative by commercial interests, forum users offered carefully reasoned critiques of the epistemic basis of anti-medicalisation feminism which, taken as a whole, represents a remarkably consistent vernacular feminist understanding of menopause. This understanding demonstrates clear parallels with recent and not-so-recent anti-naturalist techno-feminisms, but it is not the direct product of them. It is vernacular in origin and consciously insurgent, not just in relation to anti-medicalisation feminism, but in its wider ambition to reshape patriarchal health systems towards gender inclusivity, even if that inclusivity is centred on cis gendered women.

While there is certainly some overlap with postfeminist healthism around ideas about biological self-surveillance, the idealised feminist subject of the menosphere is closer to Haraway’s cyborg than postfeminist healthism’s liberal consumer. Likewise, enthusiasm for MHT in this context does not directly mirror the postfeminism apparent in dominant media representations of menopause. While there was evidence of users engaging in a disciplinary project of the self, its idealised feminist subject refuses to pander to patriarchal norms, in either domestic, public or healthcare settings. Anti-medicalisation feminists often conceive of menopause through an optical metaphor, urging women to embrace the ‘invisibility’ that comes from no longer being subjected to the sexualising male gaze (see Greer, 1991). The idealised feminist subject of the sub is an agent of a more comprehensive optics. Menopause is understood to engender her with an omnipotent gaze, allowing her to discern the ‘true’ nature of gendered social relations that empowers her to tell the world, quite literally, to fuck off.

The implications for feminists located both within biomedicine and outside of it are several. First, women’s experiences of estrangement from biomedicine need to be urgently acknowledged and addressed by the medical community. An obvious limitation of this research is that r/menopause is primarily made up of women whose experiences of menopause tend to be at the moderate to severe end of the spectrum and who report experiencing inadequate care from HCPs. Nevertheless, similar concerns about healthcare for menopausal women have been raised elsewhere (Senate Standing Committees on Community Affairs, 2024). Given menopause is an experience shared by all women who live long enough, if even a small percentage of women are denied appropriate medical treatment, then this translates into significant numbers of women. For feminists working within biomedical settings, extending adequate care to all menopausal women who may benefit from it must be prioritised as a political objective over reassuring the public that most menopausal women do not experience severe symptoms, even if this may be true. While the desire to rhetorically counteract the darker aspects of postfeminist healthism is admirable, the experiences recounted in the sub indicate that it is not unreasonable for women to be fearful of potentially having to face moderate to severe menopause symptoms without appropriate treatment.

Second, there are lessons here for how feminists structure menopause narratives, particularly regarding the use of the nature/biomedicine dichotomy within health information. Feminists need to rethink the rhetorical use of ‘nature’: biomedical feminists’ truisms such as ‘menopause is a natural part of ageing’ are enraging for women who are keenly aware of the natural logical fallacy because it has been wielded against them in biomedical settings. Sub users are correct in identifying a gendered double standard in the use of this language to describe ageing women’s health but not men’s. This points to a strong need for the careful consideration of how gendered language shapes older women’s experiences of public health messaging.

Third, feminists of all persuasions must acknowledge that women’s desire for MHT does not necessarily signify their subjugation to biomedical discourses or lack of feminist knowledge. In this context, it tended to be associated with increased health literacy in relation to both the biotechnology itself, and the biomedical and feminist discourses surrounding it. As discussed earlier, the sub cultivates an epistemic culture firmly grounded in peer-review evidence-based health knowledge, so this observation cannot be generalised beyond the sub. Nevertheless, it does draw attention to the epistemic flimsiness of the recent biomedical feminist trope of the fearful, uninformed menopausal women being led astray by the combined forces of biomedicine and commerce. Despite biomedicine’s recent embrace of a rhetoric of empowerment, its understanding of the menopausal subject remains founded on assumed vulnerability and deficiency.