Going Menopostal by Amy Alkon: Exclusive excerpt and giveaway

+ Your June horoscope | And Just Like That ... season 3 on Thursday, May 29

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Are you Going Menopostal?

Amy Alkon digs into what you really need to know

This is an exclusive excerpt of Going Menopostal. Reproduced with permission from author Amy Alkon (BenBella Books, 2025).

THE EMPEROR’S NEW LAB COAT: Calling out the bad science behind medical practice standards for menopause and perimenopause

In 2016, when I had that first hot flash and began my dive into research on menopause and perimenopause, I noted a disturbing parallel with the saturated fat debacle: researchers clinging to scientifically unwarranted beliefs about menopause and perimenopause—dismissing any pesky evidence that called their beliefs into question.

Doctors, reasonably, don’t think to question the scientific basis of the research behind the menopausal and perimenopausal practice standards their department requires them to go by. (Who would imagine a respected medical institution’s treatment requirements would have anything but a solid scientific foundation?)

I, however, was able to see the often-unscientific underpinnings of menopausal and perimenopausal research and medical care—not because I’m some sort of genius, but because I’m a medical outsider, coming in largely cold to the subject matter.

I approach medical science taking nothing for granted—including the foundational beliefs in a field: those “facts” everybody in the field “just knows” (like all those gastroenterologists “just knowing” ulcers were the fault of the patient for having that stressfest of a job and marital problems, too). I look not just at current studies but dig into medical history, starting with the first findings in the field and working my way up to the latest research and thinking.

Still, I was cowed by what a huge and truly terrible responsibility writing and publishing this book would be. If I’m in my usual neighborhood, behavioral science, and I do a bad job assessing the research, somebody might say the wrong thing to their boyfriend and kill their relationship. If I get medical science wrong, somebody could be harmed or maybe even die. I struggled with what to do, and then it occurred to me: In writing this book, I wouldn’t be without a scientific net. I would do what I do with every science-based book I write: send chapters and sections out for fact-checking by experts in each area—researchers whose scientific rigor I respect—and beg them to “hand me my ass” in any places I might’ve erred or fallen short.

Ultimately, I wrote this book because I couldn’t live with not writing it.

No, I don’t wear a white coat, and the last time I held a stethoscope, it was plastic and I was six. What I do have to offer you are the benefits of my drilling down in the research to find the most powerful, efficient ways for us to stay strong and healthy throughout our lives. You deserve what I was able to get for myself—evidence-based care to ease the life-chomping symptoms of menopause and perimenopause. You deserve to join me in flipping the bird to the inevitability of ill health in old age.

Going Menopostal: What You (and Your Doctor) Need to Know About the Real Science of Menopause and Perimenopause by Amy Alkon was released May 20, 2025

WHAT IS PERIMENOPAUSE?

“Peri” is the ancient Greek word for “around,” so perimenopause is the time around menopause—basically the on-ramp to menopause. It can start as early as a woman’s mid-30s and can last from three to 10 years (or more in some women) and ends when a woman goes into menopause.

What marks the start of perimenopause? Well, there’s the standard, widely accepted but physiologically incomplete view—leaving out women just starting perimenopause and feeling newly crap-o-ramous—and then there’s the more physiologically precise view that reflects what those women actually go through, hormonally and symptomatically.

The standard view is myopically menstrual cycle–focused, and it comes from a collaboration of researchers called STRAW, the “Stages of Reproductive Aging Workshop.”

The STRAW panel announced that perimenopause starts when women begin having persistently irregular menstrual cycles—or as they call them, “variable.” “Variable” means that the number of days one menstrual cycle lasts varies from the length of the next by seven or more days. “Persistently” means this fluctuating-length thing repeats itself (at least once within a span of 10 cycles). For example, in May, a woman’s period comes just 28 days after her previous one, but in August, she gets her period only 20 days after the one in July.

Now, STRAW’s description of irregular menstrual cycles isn’t wrong. And healthy women with regular menstrual cycles do eventually experience irregular cycles in perimenopause. But STRAW’s claim—that ONLY upon menstrual cycles getting irregular is a woman in perimenopause—fails to take into account the hormonal changes occurring before cycles get irregular, documented by gynecologist Nanette Santoro, Dr. Prior, and other researchers.

These early hormonal changes ignored by the STRAW team trigger a set of symptoms (detailed below) in still-regularly-menstruating women that should lead doctors to diagnose the start of perimenopause (and determine the appropriate treatment, if necessary). However, because STRAW ignores the inconvenient evidence that conflicts with their foregone conclusions on timing, and because STRAW is baked into practice standards, the perimenopausal symptoms these changes trigger are a medical no-man’s-land—not traceable to any particular cause.

Diagnosis: Inexplicable medical mystery! (Just the thing for emotional tranquility when yoga, meditation, and maniacally raking the sand in your desktop Zen garden aren’t doing the job!)

9 CLUES YOU ARE IN PERIMENOPAUSE

Figuring out whether you’re in perimenopause—diagnosing yourself so you can get your symptoms treated appropriately—doesn’t take years of med school, a slew of blood tests, or a mini MRI in your she-shed.

In fact, you probably mastered the special diagnostic skill this requires some years back—in nursery school, when you learned to count. That’s really all it takes. You skim a quick list of perimenopause symptoms, tally up how many you’re experiencing, and see whether you hit three.

Detecting whether you’re in perimenopause does take a lab, but that lab is you.

The earliest perimenopause symptoms are mostly forms of menstrual cycle suck gone much suckier: the result of a brewing storm of hormonal unrest in you in the earliest days of perimenopause.

The very simple task at hand? Going through that “quick list” I mentioned and counting up the number of symptoms you’re experiencing that make you feel like you need an exorcism instead of an Advil.

Endocrinologist Jerilynn Prior, MD, puts it more technically: “Perimenopause begins with changes in experience” in your body and brain as a woman in your “midlife” years. (Midlife starts around age 40, though there are women who go into perimenopause in their 30s—or in their 50s.)

Take swollen boobs—no stranger to any woman who’s ever shopped the period products aisle. Before perimenopause, it’s normal for the breasts to swell during the weeks before flow, Prior explains. The changes pointing to perimenopause? Your boobs see no reason to limit this swelling business to PMS time. They might even be swollen most of the time—and much more swollen and sore than you’re used to. (For a while in perimenopause, I had to sleep in a bra so I wouldn’t wake myself screaming when I rolled on my side and had boob-to-sheet contact.)

Prior and her colleagues came up with this list of changes you can use to self-diagnose perimenopause. You’re in what Prior terms “Very Early Perimenopause” if you still have regular menstrual cycles about a month apart, yet experience any three of the following:

1. New onset of heavier and/or longer menstrual flow.

2. Shorter menstrual cycle lengths (25 or fewer days between periods).

3. Breasts that are newly more sore, swollen, and/or lumpy.

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Well, this is exciting. On June 1, we’ll randomly select one paid Midst Substack subscriber to win a copy of Going Menopostal.

If you haven’t already become a paid subscriber, you can do it now. Paid subscribers gain full access to all Midst Substack content and are automatically entered into giveaways like this one.

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Your June 2025 horoscope

By Mandy Wilde

June always carries a duality with the quicksilver energy of Gemini giving way to the tides of Cancer. This year, that transition is louder, richer, and more emotionally charged than usual, as Jupiter, the planet of growth, wisdom, and expansion, shifts signs on June 9, leaving curious Gemini and plunging into Cancer’s deep emotional waters. Essentially, we are turning the tide with Jupiter this June!

After a year of Jupiter in Gemini, we now move into a cycle that asks us to go deeper, not wider. Cancer doesn’t care how clever you are, it wants to know where you belong, who you trust, and how you’re protecting what matters most.

This theme gets its first full flush of illumination under the Sagittarius Full Moon on June 11. It’s a classic moment of truth, if you will. An emotional crest built on what we believe to be possible. But with Jupiter newly in Cancer, the target shifts. It’s not about the far horizon anymore. This Full Moon asks us: Do you believe that you’re actually living? What have you learned that now needs to be embodied in your home, your rituals, your care for others?

Mid-month, things take a stranger turn. June 15 brings a square between Jupiter and Neptune, now in Aries, which can fog the mirror. On one hand, this energy can flood us with visionary inspiration, reactivating a dream or spiritual calling that had been shelved. On the other hand, it can overwhelm or mislead. You see, Cancer and Aries don’t blend easily, so this square might pressurize us into chasing an ideal without considering the emotional cost. Watch for over-promising, illusion based choices, or collapsing boundaries. If it sounds too good to be true, wait it out.

Then comes June 24’s quincunx between Jupiter and Pluto, a less obvious but deeply consequential moment. Jupiter is trying to nurture and protect, while Pluto in Aquarius is working through power systems, innovation, and social reform. They’re not speaking the same language, and that dissonance may surface as discomfort with change or mistrust of larger movements. This isn’t a crisis point, but it IS a nudge to adjust. The tension may be subtle, but it exposes what no longer fits.

June 25’s New Moon in Cancer closes the month on a regenerative note. Here, we get a chance to set new intentions in the emotional body, to rebuild where we’ve been too hardened, to soften where we’ve held ourselves back. It’s a moment of nesting as strategy, no as retreat. Jupiter’s presence in Cancer amplifies this lunar new beginning, suggesting that the most meaningful growth in the coming year may come from tending to what we once abandoned, like our inner world, our ancestral wisdom, our right to feel safe and seen.

In short, June is a month of emotional redirection. The sky is asking us to stop broadcasting and start receiving. To move from clever to caring, from knowing to remembering, and above all, to trust that deep nourishment. I mean ultimately, it is that which expands our lives.

Aries (March 21–April 19)

This month shifts your attention inward, Aries. You’re craving more safety, more depth, and more nourishment but not in a loud or obvious way. The kind of growth that’s available to you now starts behind closed doors, in the rooms where you feel safest. Your home life, family connections, and emotional history become the ground for transformation.

Taurus (April 20–May 20)

Taurus, you may feel more support for the expansion of your voice and the sharpening of your mind. You’re being asked to stretch how you think, how you speak, and how you connect with others. Ideas want to flow more freely but only if they’re grounded in emotional truth. It’s about being heard in ways that feel healing, not performative. You may feel pulled toward learning something new or re-engaging with your local community. Take notice of those around you who seem to be either helping you soften or they drain you. Pay attention to the difference. True colors are being shown.

Gemini (May 21–June 20)

Happy Solar Return Gemini! This month reorients you toward stability, not speed, and that might feel unfamiliar. You’re usually the one gathering momentum, but now you’re being asked to fortify what you already have. For you, this is a season of values, both emotional and material. What are you building that will last? What’s worth investing in, not just financially but energetically?

Cancer (June 21–July 22)

There’s no mistaking the shift happening for you now. Jupiter’s arrival in your sign signals a year-long stretch of personal expansion, but this is only the beginning. You’re being asked to show up for yourself in a new way. Not just as a caretaker or nurturer, but as a whole being with needs, vision, and fire.

Leo (July 23–August 22)

This month slows you down in intentional ways. You’re entering a liminal space where dreams get incubated, where healing can happen behind the scenes. It’s not so much about producing as it is about preparing. But don’t be fooled by the quiet here, because it isn’t empty, it’s rich with meaning.

Virgo (August 23–September 22)

This month, your vision starts to widen. You’re being pulled toward new connections, new circles, and maybe even new dreams. This is a time to think about where you belong, and where you no longer do.

Libra (September 23–October 22)

You’re stepping into a more public version of yourself this month, but not in the way you might expect. The focus isn’t on performance, Libra. Who are you when you stop people-pleasing and start standing in your truth?

Scorpio (October 23–November 21)

This month calls you to look toward the horizon, Scorpio. Whether that means literal travel, spiritual deepening, or expanding your worldview, one thing is clear: your soul is craving more than the familiar. You’ve outgrown the small story and ready for the bigger one.

Sagittarius (November 22–December 21)

June brings intensity for you Sagittarius. It’s like a spiritual plunge into what’s really motivating you. The surface level answers don’t cut it anymore. You’re being invited into the undercurrents of your desire, your fears, your emotional attachments.

Capricorn (December 22–January 19)

Capricorn, I need you to hear this for real, you’re not meant to do it alone. That’s the message ringing loud and clear this month. It might sound simple, but for you, letting others in can be the bravest act. And now, it’s necessary.

Aquarius (January 20–February 18)

This month wants to bring you back into your body. You’re often way up in your head as the visionary, analytical, future-focused individual you are!. But now the work is simpler, deeper, more immediate. Aquarius, ask yourself: How are you tending to your everyday life? What’s the state of your rituals, your energy, your nervous system?

Pisces (February 19–March 20)

You’re returning to yourself this month as a version of yourself that no one is expecting. Pisces, you are one one who thrives when rooted in creativity and joy. You’ve been doing deep work behind the scenes. Now, you’re ready to shine a little.Allow yourself to enjoy being so radiant! Don’t shrink from visibility just because it feels vulnerable. The world needs your light, exactly as it is.

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And Just Like That … here’s where we’ll be on Thursday …