What is the Non-Binary Experience of Menopause?
WORLD MENOPAUSE MONTH OCTOBER 2021
I’ve written this post in honour of World Menopause Month and, more’s the point, in honour of non-binary folks. Further down the page you will find seven ways that non-binary people may be impacted by menopause when trying to navigate it in a world still entrenched in binary gender.
ONGOING INVISIBILITY
It is challenging to be non-binary and peri/menopausal when there are so few relevant resources available, and so little acknowledgment of how this experience may differ from the mainstream.
But as more and more people talk about their non-binary lives, I sense a wave building. For example, I look at the trans/non-binary menstruation movement and am certain that, in the years and decades to come, when the people involved reach perimenopause and menopause, this wave is going to be magnificently huge and impossible to ignore.
But while we wait for that to happen, what’s going on for non-binary people who are reaching this point in their lives? Unsurprisingly, there’s a lot here - and a lot that needs to be done.
MENOPAUSE AMPLIFIES EVERYTHING
It’s important to remember that peri/menopause intersects with everything already present in a person’s life, whether in terms of identity (minority or minoritised), available resources, class, race, past trauma, present trauma, support networks, stress, poverty, health, and/or disability. So no individual person is going to have exactly the same life experience as another.
However, one thing’s for sure: if things are already challenging - if someone already is experiencing difficulty or discrimination - menopause is likely to make things harder.
WHO EXPERIENCES MENOPAUSE?
In this piece my main focus is on non-binary people with ovarian systems (see #1 below). It’s important to know, though, that anyone may experience menopause-like effects due to a change in hormones - for example a person with a testicular system who has been taking supplemental oestrogen but then has to stop taking it for some reason, or the effects have worn off. There is a lot more to be explored here, not least in terms of legal and workplace implications.
It is well documented that older LGBTQ+ people have particular needs and experiences. It’s also important to know, though, that menopause can happen to someone at any age, if their ovaries malfunction or are removed, including as a teenager. The ‘winter is coming’ ageing narrative does not apply to everyone. We need more research on the non-binary experience of ageing across the board.
STARTING A CONVERSATION
This article can’t cover everything, but I hope it starts a conversation. Everyone’s life experience is different. If I have missed out something significant I welcome your input and I will add it here. If you are creating resources or seeing clients, please take some time to understand how to make your offering inclusive of non-binary people.
Actually, if you don’t have time to read what I’ve written below, much of this can be summed up as:
The Absolutely Endless Gendering Of Absolutely Bloody Everything
(1) GENDERED LANGUAGE OVERALL
In menopause-land you will find binary gendered language everywhere - Ladies! Ladies! Ladies! I have written more about this here, with a more detailed explanation of why calling people ‘ladies’ all the time isn’t helpful. For many, (including some cis women in fact), it feels like nails down a blackboard. As I repeat very often - Menopause happens to PEOPLE.
So when someone who isn’t a woman comes looking for help with menopause and all they see are references to women, what are they supposed to do? This language excludes people. It can also cause dysphoria, a feeling that may range in magnitude from discomfort to devastation. If someone is having to navigate these feelings just to get basic information, it is going to be harder to focus on the information that is actually being sought. Pronouns are also a major factor here - calling everyone ‘she/her’ by default just adds to the negative impact.
The point is: people are missing out on support and treatment because of this.
So, what language to use?
Well, there’s people, for a start. If you want to be more specific, you could say people with ovarian systems (as opposed to people with testicular systems). As people start to question and dismantle the gender binary, you will hear constructions like ‘people with vaginas’ or ‘vulva-havers’, which may well feel clunky (and don’t forget some trans and non-binary people don’t wish to use those words for their genitals in the first place), but it’s a sign of humans trying to bust their way out of an outdated and restrictive framework.
Language shifts frequently, particularly around gender, so some better terminology is likely just around the corner. Maybe if we started with non-binary approaches rather than binary ones as the baseline for everything, the world would look and feel very different.
(2) GENDERED AESTHETICS AND COMMUNICATIONS
The pinking-and-purpling-and flowering of things, whether decor, leaflets or products can be alienating. Even if the decor is more neutral, the chances are that the place will be full of posters and leaflets addressed to ‘women’, ‘ladies’, etc.
Staff being matey in a ‘woman to woman’ way, (while this may of course be well intentioned), can be similarly stressful. If you are wondering why this is the case, (and I refer to the concentration issue in the first point above), hearing yourself misaddressed and misdescribed may distract you from the vital information you may be needing in, say, a cancer clinic. You find yourself sitting there turning over in your mind whether to say something and correct them. Then you start thinking, if I do say something, will it be heard and listened to, or will I have to start ‘debating’ with staff about a fundamental aspect of myself? All this likely on top of limited appointment time.
Sitting there cringeing at being misgendered (or any other form of wrong assumption for that matter) is draining. If you are also experiencing other microaggressions, for example racism or ableism, this is a recipe for a very poor experience in healthcare. You may decide it’s just not worth it.
Educating people is stressful. It is draining. We have better things to do than use up energy and resources explaining things that should have been covered in basic training. And don’t forget anticipatory stress - as many people report, it’s hard enough gearing up to discussing menopause on its own, let alone being open about your gender and sexuality as well.
(3) GENDERED HORMONES
Oestrogen, testosterone and progesterone are not gendered, despite what you have been mis-told at school and everywhere. I have written a bit more about this here. All bodies need these hormones to function. In fact, the ovaries produce testosterone, and the testes produce oestrogen. I only learned this in the past year!
Society’s obsession with locking everything into a closed circuit of ‘masculine or feminine’ means that sex hormones are treated like quasi-mythical substances (somewhere between melange and kryptonite) and there is still tremendous gatekeeping about who gets to have them and how. Testosterone (T) has a particular load attached to it when discussed in terms of people with ovarian systems. You may see the world ‘virilisation’, for example, used as something to be feared.
We all need more information on sex hormones and how they work, in our bodies and with each other. Especially relevant here is the effect of MHT ( Menopausal Hormone Therapy, AKA HRT, usually oestrogen and progesterone), and also the interaction of MHT with T.
Not every non-binary person wants to, or is able to, take hormones. But for those that do, it should be way more straightforward to get a microdose prescription of T than it is already. Someone wanting to take T both for menopause and for gender affirmation may have to negotiate with multiple gatekeepers.
But such is the inadequate and binary explanation of hormones, if someone non-binary or trans is experiencing menopausal discomfort that is not eased by taking T, they may decline supplemental oestrogen, in however small a dose, due to feelings of dysphoria and fear of being feminised, and lose out on potentially helpful treatment.
(4) DISMISSING THE NON-BINARY BODY
Our mainstream media, and much artistic output, is often very gender binaried in its imagery. More and more individuals are standing up and showing the world that there is a life beyond this. But there is very little mainstream guidance about living in a non-binary body.
As one person said in conversation, ‘I don’t owe anyone androgyny’. If you are non-binary then your body is non-binary, full stop, whatever shape or size. However, this again may need explanation in a clinical context. The person may also need treating with care.
Some non-binary people dread menopause because of the potential increase in intimate examinations in clinics, such as breast/chest exams and genital ones. Being touched and having certain words used may also create distress.
Body changes in menopause such as weight gain may cause distress and dysphoria. Menopause itself may create dysphoria as a reminder of the person’s connection with what is known as feminine. (Some may feel the reverse, and wish to retain bleeding to feel a connection to that part of themselves.)
As one person put it, a non-binary person in menopause may not recognise the signs because we aren’t told about them, or public information is so offputtingly excluding that people may simply feel it doesn’t apply to them.
(5) SEX - NON-NORMATIVE INFO NEEDED
Your sexual life is likely to shift in peri/menopause. Your libido may drop, and it may also increase, especially in peri. You may experience GSM, or Genitourinary Symptoms of Menopause, including vaginal dryness. Your orgasms may change in intensity.
As I have said elsewhere the mainstream, cisgender heterosexual, response to menopause represents a huge failure of sex education: giving primacy to PIV (penis-in-vagina) sex, declaring everything else to be ‘foreplay’, ignoring the whole body’s capacity for sensation, and promoting ‘providing PIV to a cis man no matter what the cost’ over seeking pleasure.
There are more and more sex educators out there talking about this, but it needs to be mainstreamed for the benefit of absolutely everyone.
(6) SOMEONE ELSE’S NEED FOR INCLUSION DOESN’T ERASE YOURS
If you are a cis person reading this (a person living in the gender you were assigned at birth) and feeling as if non-binary people in menopause are erasing you or stealing something from you, it’s worth stopping and reflecting. What might have changed for you on hearing that non-binary people have a specific set of needs and requirements in menopause?
We are all encouraged to have a scarcity mindset - about accessibility, respect and even love - and to feel that if other people have something, they must have obtained it dishonestly. For some to win, others must lose.
But please remember that inclusion isn’t a zero sum game. There is room for everyone and we are stronger together.
[I’m aware that the concept of inclusion has a power binary within it: who is doing the including? When a better word comes along I will use it.]
(7) MENOPAUSE AS LIBERATION
There are liberating factors here. The end of menstruation! The end of fertility and the fear of unwanted pregnancy! No more pressure to procreate! Menstruation is so connected with femininity and womanhood, many non-binary people are delighted when it’s over.
Some are happy to get their desired Hormone Replacement Therapy from their own bodies - as the oestrogen in the body drops, the testosterone may have more impact and make them look and feel more congruent with who they are.
Menopause is a hormonal transition in itself, and many may find truer versions of themselves in the process.
CONCLUSION
I hope this has been helpful, useful, or enlightening. There is so much more to say on this subject!
There needs to be much more training of medical practitioners, those delivering healthcare, and therapists. You can download my research on LGBTQ+ menopausal peoples’ experiences in therapy and in the healthcare system here. (Journal page here.)
You can find further links and organisations on my resources page.
If I have missed anything out in this post, if you would like to tell me about something you think would be good for the resources page, or if you would like to work with me as a client in therapy, please get in touch.