A group of eight women gather for a joint consultation with Dr. Kailey Madrona who is a devotée and colleague of the research endocrinologist, Dr. Jerilynn Prior, a professor at University of British Columbia in Vancouver. Madrona explains that she has arranged for the unorthodox group encounter because she will be leaving practice to pursue graduate studies in medical history.

Dr. Madrona leads an open-ended discussion on the physiological changes associated with perimenopause. Following the controversial research of Prior, she emphasizes that the symptoms are owing to the unbalanced rise in estrogen levels during perimenopause—a period leading up to the cessation of menstruation and continuing for twelve months after the last flow.

Some women patients are skeptical, because they have been placed on estrogen ‘replacement” medication, or they have read that their symptoms are owing to the waning of estrogen. The doctor describes the results of various trials about supplmentary estrogen, including the 2002 Journal of the American Medical Association report. She invites them to keep detailed diaries of their cycles and symptoms.

One by one the women return for private consultation, physical examination, discussion and another follow up visit. Although they have reached roughly the same physiological moment in life, they are a diverse group with different symptoms and needs. Darlene, an angry nurse, is suspicious and non-compliant. Beverley, an Asian immigrant is still hoping to become pregnant. A lesbian wishes to control her moods and hot flashes. A very hard-working waitress needs to understand her strange lack of energy. A wiry, lean athelete wants to improve her performance and is irritated by the inexplicable alterations in her abilities. Others are plagued by sweats, nausea, or migraines. They all are confused about sex.

Dr. Madrona listens to them carefully, examines them with special attention to their breasts, not their genitalia, and recommends treatment with progesterone for everyone. She also urges weight gain for most and readily volunteers personal information about her own perimenopause. All but the nurse eventually comply and are relieved of their symptoms. At the end of a year they meet for a pot-luck dinner to celebrate their recovered health and thank their doctor. Beverley is pregrant.


This unusual book is fascinating as much for the fact of itself as for its aplomb, content, and style. Frustrated by the lack of attention given to her research, Prior turned to fiction to communicate her message directly to perimenopausal women. The science is real, says Prior, but the patients are not. The book features endorsements from prominent women scientists and writers, including Drs Ursula Franklin, Susan Love, and Jean Marmoreo.

The novel is written from the doctor’s perspective in first person singular and is thinly disguised autobiography. In fact, in a typographic slip on p. 158, one patient refers to the maternal-sounding Dr. Madrona as ‘Dr Prior.’ Highlighted words in the narrative direct readers to a glossary and reference numbers connect to a bibliography of 138 articles from the scientific literature.

The case histories are plausible and engaging. At times, however, the prose is klunky and the scenarios trite, even as they reveal the doctor’s self-conscious “techniques” for expressing comfort and empathy—touching a hand, repeating a name, sharing a personal tale. Occasionally the endocrinological “teaching moments” dominate in an overly clinical way, but, of course and in fairness, education is the purpose of the prose.

Medical humanities instructors could profitably excerpt one or two of the stories. Complaints about the manners of other male physicians would make valuable talking points. Particularly interesting is the conflictual relationship that the physician-author assigned her protagonist with the unhappy nurse, Darlene. The only patient to challenge the doctor at every step of the way, she refuses to quit smoking or to lose weight; she will not keep her diary or take her medicine, and she uses her own insubstantial medical knowledge to cast aspersions on the doctor’s advice. She drops out. At the end, the gathering learns that she has had what was probably an unnecessary hysterectomy, a cruel punishment for her baffling waywardness. Why did she have to be a nurse?

Being a woman of a certain age, this reviewer enjoyed the book and learned from it, but she had the urge to hide the cover while reading it in public.


Those interested in Dr. Prior's work can access The Center for Menstrual Cycle and Ovulation Research at:


Centre for Menstrual Cycle and Ovulation Research

Place Published

Vancouver, B.C.



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