Menopause: A Comic Treatment

Book Review by Kevin Wolf

I fear I might come across as mansplaining in some of this book review. I don’t mean to. Here’s how I go about doing a review in summary form. I’m not a healthcare provider. I’m a health actuary by profession and a lover of graphic works. An actuary works with probability and statistics to mathematize financial human risks (for example, insurance premiums, and how much insurance companies need to cover the cost of claims for those human risks); we develop estimates which are always subject to correction. Whenever I read a graphic work on a subject that I’m unfamiliar with or have a general knowledge of, which is common for many of the graphic medicine works I review, I do two things. First, I expect the graphic work under review to teach me about the topic(s) and second, I do additional research for information provided in the graphic work by looking to a reliable source on the web or digging up another source I’m already familiar with. Lately, I often review two or more books at the same time because they’re covering similar topics or help me understand all books under review. When I learn something new, I like to share it in the review. My primary goal is to provide my (and they are mine) insights into the work I’m reviewing, and I fully expect that others will have a different and probabilistically better treatment of the work reviewed. Menopause is far from my personal experience, but I decided to review MENOPAUSE: a comic treatment edited by MK Czerwiec for many reasons. 1) Any medical topic I’m not that familiar with interests me; 2) This book is an anthology with twenty-eight contributors and twenty-five works (three have separate writer and illustrator) that vary from 1 to sixteen pages with 13 in color, so there will be many perspectives on a similar topic; and 3) the editor introduced me to the subject of graphic medicine for which I’m forever grateful (See the end of this review for a more complete disclosure). The contributions in Menopause are often wonderful. The ones I enjoy the most are the personal stories, while a few lose some of their impact—because of an anthology’s limitation—by trying to cover a very big topic in a relatively short story. I will write here about a few of the stories in the anthology; and I highly recommend the reader acquire their own copy to read all the stories in this anthology.

The editor, when going through perimenopause herself, turned to comics, but found them lacking about the topic of menopause. She writes, “The first (and only, as far as I can tell) book-length [40 panel] collection of comics about menopause … appeared in 1950 … titled Minnie Pauses to Reflect by Nora Preddy. … The women … are frequently portrayed as judging one another for inappropriate management of symptoms (not seeking surgery or taking hormone medications, eating or drinking excessively) … [and being inconvenient] for … everyone around them, particularly the men in their lives.” (pages 1-2) Her sources for Menopause were her idols, role models, and contacts through graphicmedicine.org and queersandcomics.com reflecting “… a range of life experiences, professions, ages, gender, and sexual identities, ethnicities, and health states.” (2) “The comics in this collection testify to the importance of sharing our stories,” she writes. (3) The editor was influenced by disability rights’ perspective, especially, “How do we adapt to the bodies we find ourselves in?” (3) MK writes “Comics have a long history of taking on stigmatized topics. They make literal the metaphors we use to describe our bodies, and they can be playful and enjoyable, even if the topic they tackle is not.” (3)

There’s a lot of variety in the stories, including cartooning styles, ending patriarchal control, myth, national and religious context, page lengths, symptoms, medical details, personalities, attitudes, genders, and of course, uncountable stories yet to be told. Several speak of menopause freeing them and others of their invisibility. In the introduction the editor explains that “perimenopause” is the symptomatic time span (typically body heating, mood swings, periods become sporadic), and once a person has gone a year of not menstruating they are post-menopausal or “free” as several of the people declare in Menopause. Lynda Barry’s piece (“Menopositive”) provides a generational perspective: her own, her mother’s (“in the 1970’s when a record number of women underwent hysterectomy, including my mother and many relatives” (11)) while her grandmother said “God loves uterus,” which Barry indicates sounds better in her native Filipino Tagalog—with the word Bahay-Bata for uterus and literally means “child house.”

Ajuan Mance (“Any Day Now”) who calls themself “Woman-Identified-Gentleman Scholar” and “genderqueer” writes a very funny piece with each page having a deep color with lighter shade emphasized. Ajuan’s story is pre-menopausal with a concern, among many, that hot flashes will make their beloved ties and sweaters unusable. Mance’s issues aren’t related to fertility but aging, like memory problems, reduced physical activity, gender-identity (e.g. “If the ability to have a child hasn’t had much of a bearing on the trajectory of your life, then is menopause a significant change …?) (72) Mance mentions Allison Bechdel’s menopausal story in Are You My Mother? (Houghton Mifflin Harcourt, 2012) as eneventful “whatever” … just when her periods stopped. (73) Maybe it will be like all other times …”only a little bit warmer.” (73)

There are four pieces that have been published elsewhere. For example one page from Teva Harrison’s memoir, In-Between Days: A Memoir about Living with Cancer (House of Aansi Press, March 2017). Her tale, “The Big Change,” is presented as a stand-up comedienne with microphone in-hand (“People are all … ‘Hot flashes am I right?’” (page 83) She goes on to provide additional symptoms panel-by-panel: ”hot flashes … & cold sweats … thinning hair … vaginsmus [tightness] dry skin … foggy memory … lousy sleep … and then ends with a punchline. Mimi Pond’s “When the Menopause Carnival Comes to Town” is a hilarious presentation of menopause as metaphor of a carnival from a drying up tunnel of love to a politically incorrect––her words––Freak Show.

There are a few tales that are more medically detailed. Monica Lalanda’s piece (“When My Biological Clock Stopped Ticking”) provides an easy to understand medical and personal—having gone through perimenopause—story from her medical training (as a Spanish emergency medicine doctor and medical cartoonist) and as a woman. She shows dueling images of a woman over 45 enjoying her confidence, career, activities and independence from grown kids vs. the bodily changes (e.g. “cover those white hairs,” “hot flashes?” “vaginal dryness,” “you are a health ticking bomb”). She shows her three phase menopausal process: “1. OMG, am I pregnant? [when her period was “late”]; 2. OMG, I will never be pregnant again! [she’d never have another adorable baby which suddenly seemed all around her]; and 3. FFS, bring that blooming menopause on! … Then I had a six-month long ‘period.’” (29) Other women weren’t talking about what they were going through; was it shame, taboo, fear of sharing? Her mother & mother-in-law almost never talked about it. She concludes with her advice … well worth reading. (31) Monica Lalanda is the founder and co-manager of the Spanish-language medicinagrafica.com the sister site to GraphicMedicine.org. Just as the editor did with her prior graphic work (Taking Turns: Stories from HIV/AIDS Care Unit 371 (Graphic Medicine Series, The Pennsylvania University Press, 2017)), in her Menopause piece (“Burning Up”) she shows a page of one person (Peggy Mason, PhD Professor of Neurobiology, University of Chicago) speaking to the reader; in this case with a technical explanation of perimenopause starting with the hypothalamus. Professor Mason says, “Hot flashes essentially are withdrawal symptoms from exposure to estrogen.” (33) MK follows with a very funny take on the “purpose of this odd bodily phenomenon.” In Susan Merrill Squier’s & Shelley L. Wall’s “Surgical Menopause—in Ten Postures” each page has one to three postures of Squier’s menopause. It’s medically technical (e.g. second posture is an ovarian torsion (when ovary twists around its stalk) episode; and fourth is receiving a transvaginal ultrasound sighting an ovarian cyst. (91-92) This piece includes a hear-no, see-no, or speak-no image of Squire, when surgical treatment is discussed with the possibility cancer could be found.

Jennifer Camper’s piece (“A Slow Intermittent Leak”) is written as a fictional tale starting with Randa (protagonist) metaphorically finding a slow leak in the pipe of her bathroom sink next to her partially filled box of tampons. She’s marked her periods with a star on her calendar with her last one ten months earlier. Randa recollects her first period was memorable surprise because it was the first! “She joked that the money she used to spend on tampons was now spent on marijuana and ma’amoul [from the Arabic verb “amala’” “to do;” date/nut-filled semolina cookie an Arab treat].” (58) What to do with the last box of tampons? Burn in a ritual? Give to niece when she starts menstruating? (59) Giving up on waiting for a plumber who never seems to arrive, she goes to a café to overhear hypocritical men who have no problem crudely discussing cleaning up the blood from a (murdered-by-the-boss?) co-worker but are shocked and appalled when they hear young women speak about their period. Randa uses her invisibility to great effect. And she decides to keep the remaining tampons for any visitors who might need them.

Maureen Burdock (“Menopause”) provides a beautifully drawn colorful mythological tale from a triple Goddess—Maiden, Mother, and Crone—as stages with the goal of “embracing and celebrating life.” ). “When a woman stopped her menses, it meant she kept all of that vitality WITHIN. Instead of using her magical power to gestate babies, she was FREE to create ANYTHING she chose.” (8) This piece shows a triad symbol of interlocking spirals for life appearing several times under different context.

Menopause’s editor provides resources (four books, three articles and five online) at the back of the book. Also helpful would have been the addition of identified resources within any of the contributors’ stories. For example, there are three resources partly-identified in “(A)Men-O-Pause” by Dana Walrath. Walrath’s tale is both personal and much broader about mother earth, paternalism, climate change, environmental destruction, among other topics. Walrath’s story is only twelve pages—while the references are perhaps 500 pages give or take—and the twelve page contribution to Menopause doesn’t provide an expansive enough discussion for all her points to be adequately justified or explained.

Menopause‘s story tellers not already mentioned, include KC Councilor (“Cycles”), Leslie Ewing (“Zen and the Art of Menopausal Maintenance”), Joyce Farmer (“Antique Restoration”), Ellen Forney (”Ready, Set, ‘Pause’”), Ann M. Fox (“#crockpotrunner: a not-finished tale of becoming a mid-life athlete”), Roberta Gregory (“The End for Now”), Rachael House (“Climacteric Calamity”), Leah Jones & Cathy Leamy (“An End Is Not the End”), Sharon Rosenzweig (“My Menopause Story”), Joyce Schachter & Jessica Moran (“Are You Sexually Active?”), Emily Steinberg (“Paused”), Nicola Streeten (“2.14 am – 4.43 am: Let Me Introduce Myself”), A. K. Summers (“Desertification”), Kamiko Tobimatsu & Keet Geniza (“Kimiko Does Menopause”), and Carol Tyler (“Invisible Lady”).

Menopause is the nineteenth book in the Graphic Medicine Series published by The Pennsylvania State University Press. Thirteen of the menopause stories are in color and twelve in black and white. I listened to the virtual book launch on August 20, 2020 sponsored by the wonderful Chicago Illinois bookstore Women & Children First. I look forward to more stories on menopause.

MK Czerwiec, RN, MA, is the artist in residence at Northwestern University’s Feinberg School of Medicine. She has served as a Senior Fellow of the George Washington School of Nursing Center for Health Policy and Media Engagement and as an Applied Cartooning Fellow of the Center for Cartoon Studies. As mentioned earlier she wrote the graphic memoir Taking Turns: Stories from HIV/AIDS Care Unit 371 (2017). She coauthored the Graphic Medicine Manifesto (2015), both published by Penn State University Press. Full Disclosure: MK is co-curator of GraphicMedicine.org. She is a member of the Editorial Collective of the Graphic Medicine Series of Penn State University Press. She is also a friend of mine and was the first person I heard give a talk on Comics & Medicine (now called Graphic Medicine) back in 2011 at C2E2 (Chicago Comic & Entertainment Expo). She invited everyone at her C2E2 talk to the  June 2011 Comics & Medicine: The Sequential Art of Illness Conference; the second—first in the United States—international interdisciplinary conference which “explored the past, present, and possible future of comics in the context of the healthcare experience.” The conference was in Chicago; and she was one of the main organizers of the event. I’ve been hooked on graphic medicine ever since.