Un-tracking menopause: How not using self-tracking technologies mediates women’s self-experiences in menopause

Abstract

Self-tracking in general, and by women in particular is increasingly researched. In the literature, however, women’s interactions with selftracking technologies in menopause—a change that (almost) every woman will go through—is largely taken for granted. This paper addresses this lacuna by asking whether and how menopausal women use self-tracking technologies, and how this (non-) usage mediates their self-experiences. In doing so, it elaborates on another understudied phenomenon: the constitutive significance of “un-tracking”—that is, of various shades and levels of not using self-tracking technologies—in menopause. Most of the 13 interviewed women in this study reported that they stopped, drastically reduced, or resisted self-tracking in menopause. By framing the discussion of these accounts of “un-tracking” within the tradition of post-phenomenology and a phenomenology of situated bodily self-awareness, we show that these women experience their bodies as (1) wise and eu-appearing, (2) unmoldable and dysappearing, and (3) longing for disappearance. Herein, their experientially mediating un-tracking practices are temporally and socio-culturally contextualized in complex ways and bear substantial existential significance. This study establishes the potential harmful ways in which self-tracking mediates self-experiences, as well as the fruitful ways in which un-tracking may do so. Against the background of this observation, this paper makes an appeal to take a step back from uncritically celebrating self-tracking in healthcare contexts, and critically evaluates whether (the promotion of) using (more) self-tracking technologies in these contexts is desirable to begin with.

Keywords

gender and health phenomenological approaches technology in healthcare

Introduction

Bodies and selves are subject to constant change. Self-tracking devices and apps may be used to understand, monitor, support, control, provoke, and reverse these changes (Lupton, 2013, 2014). Following sociological (Lupton, 2013; Petrakaki et al., 2021; Wyatt, 2003) and post-phenomenological approaches (Ihde, 1990, 2002; Verbeek, 2006), a substantial research corpus investigates how such self-tracking shapes the ways in which we experience and deal with ourselves and our bodies (Ajana, 2017; De Boer and Slatman, 2018; Kristensen and Ruckenstein, 2018; Lupton, 2014). Herein, women’s self-tracking is increasingly studied. For example, various scholars examine the co-constitutive influence of menstruation, ovulation, and pregnancy tracking devices (Barassi, 2017; Della Bianca, 2021), but also of using feminine weight loss apps and gendered Fitbits (Esmonde and Jette, 2020; Lomborg et al., 2018; Lupton, 2018).¹ Within this literature on self-tracking, a change that (almost) every woman will go through is largely taken for granted: menopause.²

Menopause may come with a diverse range of experiences. Aside from irregularity and cessation of menstruation, menopausal women may experience, among others, hot flashes, a drier vagina, high blood pressure, insomnia, fatigue, and mood swings. In addition, they may also take medications, such as hormone replacement therapies or sleep medications, to mitigate these experiences; however, these medications may also have additional side effects. Anthropologist Margaret Lock has famously argued that such menopausal experiences are not universally shared but should be understood as differing (somewhat) between individual bodies as well as between cultures. In arguing that structures of menopausal experiences may be deciphered within and across groups, she establishes that menopause can be explained in terms of “local biology,” a culturally variable biological phenomenon (Lock, 1994).

Given this diverse (individual and cultural) range of menopausal experiences, there is a plethora of technologies that menopausal women may use to track this transition, such as specifically designed menopause apps³, and more broadly applicable apps for tracking menstruation, sexual functionality, sleep, and mood apps, as well as Fitbits, or digital heart rate meters (Roberts and Waldby, 2021). With this broad range of technologies that women may use in monitoring their menopause, it is surprising that an exploration of self-tracking—and the impact that tracking may have on these women’s body and self-experiences—is largely lacking in scholarly literature.

This paper addresses this research lacuna by first asking the exploratory question of whether and how women use self-tracking technologies in menopause, and second, by analyzing how this (non-)usage mediates and shapes the ways in which these women experience their bodies and selves. Of the 13 Dutch female interviewees for this study, 11 were recruited through online advertisements, and four were selected out of a larger interview study on menopausal experiences. Seven women in this study reported (present and/or past) self-tracking practices, from calorie counting to counting steps, and from tracking periods to monitoring sleep cycles. For some, their self-tracking practices seemed related to their menopausal experiences (e.g. in calorie counting or tracking periods), while for others, it was not. However, for some others, it was not clear whether their tracking practices were related to menopause. Furthermore, most of the interviewed women currently do not self-track during menopause and/or explicitly resist and/or deliberately stop their self-tracking during menopause. These women engage in—what we call—“un-tracking” their menopause, something that turns out to significantly influence (and to be influenced by) their self-understandings. While the constitutive force of this un-tracking of self-experiences is an understudied phenomenon, the discussion of these women’s accounts is framed within the tradition of post-phenomenology (Ihde, 1990, 2002; Verbeek, 2006) and within a phenomenology of situated bodily self-awareness (Leder, 1990; Merleau-Ponty, 2013; Zeiler, 2010). This dual theoretical philosophical framework enables us to unravel the empirical complexities involved in these women’s constitutive un-tracking of their self-experiences in menopause.

In presenting and discussing these results, this paper starts with the assumption that activities and self-experiences do not take shape in a (technology-human) vacuum but are influenced by and influencing larger socio-cultural contexts (Lupton, 2013). Just as menopause may be understood in terms of “local biology” (Lock, 1994), technologically mediated self-experiences in menopause may also be assumed to take shape within a specific socio-cultural context. As such, we show whether, and how menopausal women do not use technologies, resist usage, or never begin using, and how these varieties of non-use influence these women’s self-experiences. And we show how this constitutive relationship is, in turn, also shaped by (and shaping) larger cultural beliefs and norms, and social relations and conventions beyond the technology–human interaction (Ihde, 1990, 2002; Rosenberger, 2014; Verbeek, 2006; Zeiler, 2020). By researching socio-cultural technological mediation, this paper not only contributes to an enlarged understanding of how un-tracking in menopause may shape—and is shaped by—women’s self-experiences but also advances our understanding of the ways in which women’s technologically mediated bodies and selves in menopause are understood and produced in “local” (Western) cultures (Lock, 1994).

Against the background of the discussion of the empirical results, the final section of this paper addresses the issue of (promoting) the use of (more) self-tracking technologies in healthcare contexts. In revealing how menopausal women’s un-tracking practices bear existential meaning, this paper prompts the question of whether the current celebration of self-tracking in healthcare contexts is appropriate, and whether we should not (also) celebrate un-tracking practices. Here, we agree with Deborah Lupton’s argument that “techno-utopian discourses concerning the possibilities and potentialities afforded by digital health technologies do not acknowledge the complexities and ambivalences that are part of using [or not-using] self-monitoring technologies” (Lupton, 2013: 1). In the last part of this paper, we make an appeal to explicitly attend to these (existential) complexities in promoting the use non-use of self-tracking devices.

Un-tracking and technological mediation

The aim of self-tracking may be to simply collect information out of curiosity or remember certain aspects of life and the body, such as mood fluctuations, food intake, and exercise routines. However, the goal of self-tracking may also be to discern patterns from this collected information, reflect on these patterns, and thereby try to change them (De Boer, 2022a). Over the last decade, self-tracking through digital devices such as apps and wearables has become increasingly popular in the context of health (Lupton, 2013, 2016). Various proponents of health self-tracking argue that it empowers users. It would help individuals gain insight into themselves and their bodies and, as such, assist in taking control of habits, lifestyles, health, and illness (Lomborg and Frandsen, 2016; Topol, 2015).

However, rather than merely interpreting self-tracking as a means to achieve insight into one’s body and help develop healthy lifestyles, studies in (post-) phenomenology and philosophy of technology argue that technologies such as self-tracking devices shape the ways in which people come to understand themselves and their lives (De Boer and Slatman, 2018; Kristensen and Ruckenstein, 2018; Verbeek, 2006). Verbeek, in particular, formulates a well-rounded idea of such technological mediation. People’s actions, experiences, and perceptions “are not only the result of individual intentions and the social structures in which human beings find themselves [. . .], but also of [their] material environment” (Verbeek, 2006: 366). In other words, “how the world appears to humans” and “how humans act in the world” are always, to a smaller or larger degree, constituted and transformed by artifacts, such as technologies. Technologies, in this sense, mediate our experiences and practices.

At this point, it is important to note that technologies are not neutral intermediaries. Feminist technoscience has emphasized that technologies are normative (see a.o.: Højgaard and Søndergaard, 2011; Zeiler, 2020). Technologies not only (help to) bring about various suitable, acceptable, or desirable practices and experiences (Rietveld, 2012; Rosenberger, 2014; Verbeek, 2006), but, as Højgaard and Søndergaard (2011) frame it, “normativities of socio-cultural categories work on, in and through human beings, [and] technologies enact and are enacted in these processes” (p. 348). For example, many menstruation tracking apps are normative because they show how one’s menstrual cycle aligns with or deviates from a typical cycle—thereby implicitly communicating that this average is the ideal. Through reminders that one’s ovulation is about to start, it also teaches users that fertility work is the responsibility of women (Hamper, 2022). By using a menstruation app during menopause after a life with painful pre-menstrual syndrome (PMS), it assures users that a desirable future without menstruation is about to start. Depending on the user and the context in which it is used, then, a self-tracking app may produce, alter, or add to the user’s perception of what it means to be a good biocitizen and a woman.

In this paper, we are interested in how this contextualized, normative mediating meaning of self-tracking technologies shapes women’s self-experiences in menopause. Indeed, while self-tracking in menstruation and menopause is presumably related, they may also be (very) different. The potential group of menopause trackers is, on average, older than menstruation trackers, and as such, the former may be less digitally savvy than the latter. And while menopausal experiences overlap with menstruation experiences as it entails the irregularity of menstruation, the plethora of possible menopausal experiences—for example, hot flashes, a drier vagina, or insomnia—are also rather distinct from menstrual ones. More significantly, however, the socio-cultural connotations surrounding menopause are distinctive from those in women’s fertile years. During menopause, women have to grapple with not only that they are perceived as (getting) old and less attractive and feminine but also that they are seen as wise (Hvas and Gannik, 2008). These socio-cultural constructions of menopausal women, then, may influence the ways in which they (do not) use self-tracking devices and how these devices influence their self-experiences in their (non-)tracking practice.

Note that, in examining the particular constitutive power of self-tracking technologies for self-experiences in menopause, this paper understands technological mediation in a rather broad sense. In the literature, the mediating force of technologies is typically understood as coming to fore in actually using technologies (Ihde, 1990; Verbeek, 2006): in touching or interacting and communicating with the technology at hand—albeit in different ways, in varying degrees, and more actively or more passively. This paper, however, adopts a critical approach to technological mediation that may also—or perhaps pre-eminently—include and address ways of non-usage, or hesitancy and resistance toward using technologies (Lupton, 2013; Mol, 2009; Oudshoorn, 2011; Petrakaki et al., 2021). However, many studies that center on the question of technological mediation and that address how technologies inhibit, constrain, or paralyze our actions, also of using the technology itself, generally concur that such inhibitions originate in some form and degree of technological usage (Selwyn et al., 2005). Moreover, the few studies wherein technological mediation, even in non-usage, does not originate in usage, tend to explain non-usage merely in terms of material deficiency, as a stage toward adapting and using technologies (Briggeman and Whitacre, 2010), or as something pathological and abnormal where non-users are characterized as cognitively deficit, digitally illiterate, technophobic, hipsters, and ideological radicals (Andrés-Sánchez et al., 2021). In line with this, Wyatt (2003) claims that we can make a distinction between different types of non-users: the “have nots” (those who have no access) and the “want nots” (those who reject or resist) (p. 76). However, rather than only dichotomizing the category of non-users, Wyatt also contends that it is important to consider non-users and former users as a relevant and complex social group, “as actors who might influence the shape of the world” (p. 78). In this paper, then, we take this latter claim to heart and study the mediation of self-tracking technologies in menopause for women’s self-experiences as something that may also include un-tracking—that is, various shades and levels of not using self-tracking technologies.

Situated bodily self-awareness

To actually understand this constitutive power of self-tracking technologies in menopause, we do not only have to understand technological mediation but also have the concept of self-experiences. That is, it requires examining how women experience and become aware of themselves to begin with—within and beyond the human-technology interaction. In this paper, therefore, we will draw on a phenomenological concept of situated bodily self-experiences to unravel the mediative meaning of self-tracking technologies in menopausal transition.

Phenomenology emphasizes the centrality of embodiment in understanding people’s experiences. People’s ways of experiencing the world and themselves are shaped within and through the mode and limits of their embodied existence: their sensory capacities and motor-abilities, and the ways in which their bodies appear to themselves and others. The body, in this sense, is the sine qua non for self-experience and one’s being-in-the-world. Our body is never only an object to us; it is our lived reality—it is, as the phenomenologist Merleau-Ponty (2013) writes, our “anchorage in a world” (144).

Despite the tacit givenness of the body, it can appear to us in different ways. Merleau-Ponty (2013) outlines what bodily self-awareness means, even if one does not reflect on how to position or move one’s body. For example, when a person is able-bodied, they typically do not think about the actual movement of the legs and arms while running; it is transparent and automatic. Here, they are pre-reflectively aware of their position and movement of the body while running. Pre-reflective bodily self-experience is what makes it possible for me to engage in activities without thinking about locomotion—it takes the form of an “I can” (move my legs and run) and of the body as “mine.” This capable body that is mine is thus largely absent to us—it disappears from our reflective radar exactly because it is that from which one moves and is positioned in the world uninhibited (Leder, 1990).

This pre-reflective self-experience is very different from bodily self-awareness when one attends to their body as a thematic and reflective object of experience. Such is the case when one, for example, has an ill, painful, or otherwise inhibiting body. When having heart palpations during menopause, for example, one cannot take the running body for granted anymore: one becomes acutely aware of (some) bodily feelings while running—of the heart pounding, chest moving, and one’s breath—which then obstructs one’s ability to run. Using the Greek word for “bad,” such negative reflective self-awareness may be termed “dys-appearance” (Leder, 1990). But, as Zeiler (2010) points out, becoming aware of the body does not always take a negative form—an “I cannot” (see also Young, 2005)—but may also be positive, for example, in sexual pleasure or wanted pregnancies. In using the Greek word for “good” or “well,” she argues that these bodies “eu-appear” (Zeiler, 2010).

Note that in all these bodily appearances, there are forms and degrees of bodily estrangement and mine-ness present. Even though the body in bodily disappearance typically takes the form of “my” body that allows one to move unobtrusively in the world, it may also appear alien in that it is a “forgotten” body. In a dys-appearing painful body, moreover, one may feel estranged from one’s body as it is a hindrance—something that does not allow one to emerge in the world (Zeiler, 2010). But in such dys-appearance, the body may still be “mine”—albeit perhaps only parts of it, and not always—and in varying degrees. Then, in bodily eu-appearance, the body typically does not show up as strange to me. However, in the example of wanted pregnancies, a pleasurable tickle may reveal an ambiguous bodily subjectivity: the pleasurable pregnant body that is mine only appears because it originates in the movement of another being that is not me but is wholly in me (Young, 2005; Zeiler, 2010).

As with technological mediations, bodily self-awareness is, of course, not shaped in a vacuum but always in and through a larger context. After all, specific modes of bodily self-awareness only arise in relation to a range of past, present, and future activities and experiences (De Boer et al., 2015). For example, one is reflectively aware of the legs moving and the heart pounding because one has set the goal of getting fitter and running regularly. Moreover, bodily self-awareness is shaped within and through socio-cultural contexts. Such shaping can entail concrete (imagined or real) others: when one is stared at while running—or has the feeling that this happens—one may become more self-reflective (Zeiler, 2010). It is important to note here that feminist phenomenology in particular has shown that such concrete contextual co-constructions always already involve shared norms and societal power relations about gender, age, and illness (De Boer et al., 2015; Young, 2005; Zeiler, 2020). Consider that a woman may have set this goal to run because of the shared gendered, ableist, and ageist norm that it is good to be slim, fit, and young (De Boer and Slatman, 2018). Through socialization, such norms about bodies even become part and parcel of the ways in which one experiences one’s body (Zeiler, 2020). Against the background of this notion of inherently situated self-experiences and of the idea of these experiences being mediated by technologies, this paper explores the meaning of self-tracking technologies for the ways in which menopausal women experience themselves and their bodies.

Researching self-tracking in menopause

In this empirical-philosophical study about women’s self-experiences in (not) using self-tracking technologies, we analyzed the interviews that the first and second authors (interviewers) conducted with 13 Dutch menopausal women. During a quantitative study on the use of self-tracking technologies in menopause, 11 women indicated that they were interested in participating in the present qualitative study. Two of these women dropped out of the study before the scheduled interview, therefore, nine were eventually interviewed. Because the researchers felt that including more interviews would benefit the richness and quality of the empirical material, four other women were interviewed about their self-tracking experiences during a larger qualitative study on bodily experiences in menopause.⁴ All the interviewed women were familiar with self-tracking devices such as a Fitbit or tracking apps, but they did not necessarily use (or used) these technologies. Seven women narrated how they currently track their bodies and lives or have done so in the past, but most of the interviewed women stopped, reduced, resisted, or have never begun with (their) self-tracking. All the interviews were semi-structured, took place at the interviewees’ homes or at another place of their choice, and lasted between 45 minutes and 2 hours. During the interviews, women were first asked to narrate their experiences (or lack thereof) with tracking devices before and during their menopausal transition. The interviewer then asked (follow-up) questions about themes that are relevant to this study (e.g. self-tracking, in specific contexts like in sports, eating; sharing of self-tracking data, and intensity of using self-tracking devices). We obtained ethical clearance for this study from the ethical review board of the university to which the authors are affiliated. Informed consent was obtained from all the study participants. The interviews were in Dutch and transcribed verbatim. Upon transcription, the interviews were anonymized. Quotes used in this article were translated from Dutch to English by the first author. All the women in this study live in The Netherlands, albeit their cultural background may differ (one woman stated that she had an Antillean background, an another woman said she was born in Germany). Such info is only recorded when respondents share this info on their own initiative.⁵ They self-identify as menopausal—from 1 year into this transition up to 10 years—and have menopausal symptoms. Most of them experience hot flashes, night sweating, and increased body weight, but some also experience symptoms, such as heart palpations, mood swings, depression, anxiety, a drier vagina, or stiffness in joints and muscles. It is significant to note that none of the interviewed women take (or have taken) hormone replacement therapy (HRT)—a treatment that may influence their menopausal experiences and their tracking practices.⁶ The age of the participating women ranged between 48 and 63. The names of the women referenced in this article are pseudonyms.

In analyzing the data, we used a qualitative interpretative phenomenological research method (De Boer, 2016). This method is especially suitable for uncovering what self-tracking means for these women because it strives for openness: for describing and interpreting (self-)experiences and sense-making processes in their own detailed, changing, and embodied terms within the subject’s context (Smith and Osborn, 2015). First, open codes were attributed to excerpts from the interviews related to self-tracking and self-experiences. These codes grasped these phenomena on a general level and in descriptive terms. For example, “no self-tracking: technology does not fit self-experiences,” “self-tracking leads to more bodily awareness,” and “fear for what self-tracking shows about one’s body.” Based on these codes, more general storylines involving self-tracking and self-experience were drawn out. By building on the academic literature in (post-) phenomenology and feminist technoscience (Højgaard and Søndergaard, 2011; Merleau-Ponty, 2013; Verbeek, 2006; Zeiler, 2010, 2020), this analysis resulted in a concurring identification of three ways in which menopausal women experience themselves and their bodies while (not) using self-tracking technologies: (1) the wise eu-appearing body, (2) the unmoldable dys-appearing body, and (3) the longing disappearing body.

Results

Counting steps, tracking periods, and monitoring sleep cycles were some of the self-tracking activities that many women in this study reported or something they did in the past. It “was just fun,” they explained, or a habit. These women also stated that it helped them to better understand themselves and their bodies, and that it supported them—if they deemed it necessary—in changing their bodies and routines. While most women referred to such self-tracking practices before they went into menopause, a few women narrated that they also tracked activities and experiences during (the beginning of) their menopausal transition (or suspected that they did), for example, in period tracking. At first sight, then, these women’s accounts seem to be in line with existing studies where the concept of technological mediation seems to be bounded by a certain temporality and configuration of use, and where the co-constitution of self-experiences is understood as taking place in an interaction between humans and used technologies (Ihde, 1990; Verbeek, 2006). Interestingly, however, almost all interviewed women that have self-tracked conveyed that they substantially reduced the frequency of their self-tracking activities in menopause, and/or the number of aspects that they tracked. Many even stopped their self-tracking altogether. And yet others never began—although they may have considered it. Below, we outline how these women un-tracked, and interpreted the meaning of their un-tracking activities for their contextualized self-experiences.

The wise eu-appearing body

When asked if they engaged in self-tracking, various interviewees responded in a similar fashion: “I do not need those apps anymore. [. . .] it [apps] cannot tell me anything I do not know about myself” (Marylin); “I just know now what is or isn’t good for me” (Hermoine); “Pff. . . this old twig holds no mystery to me” (Oona). It seems that, for these women, the rationale behind practicing self-tracking is to acquire knowledge about one’s body and self that is otherwise not accessible (Ihde, 1990). However, in hinting toward having acquired a certain level of direct, first-hand experiential knowledge about themselves and their bodies—“it holds no mystery,” “I just know now,” and “I do not need those apps anymore”—they deem self-tracking (to a large extent) superfluous, consequently reducing or stopping their tracking activities. It is interesting to note that many of these women reported obtaining this self-understanding in menopause. One of these women is Hermione, who has self-tracked her food intake since puberty. She elaborates:

I’ve always struggled with my weight and I always made a point of looking as good as I can. [. . .] That’s why I dieted a lot and yes, then calorie counting is just part of it. [. . .] In the supermarket, I always looked at the backside of packages [at the ingredient list] to see what’s in it. [. . .] And I had times when I noted down everything I ate on my phone [in the Notes app]. (Hermoine)

However, when the conversation continued about her (supposed) current practices of counting calories in menopause, she said:

But now, I am not that strict anymore. I let it go a bit. And anyway, it’s not necessary anymore, because I just know now what is and isn’t good [for me]. It comes with the years, huh, wisdom?! When my stomach growls, I eat, and when I’m full, I stop. Simple! [. . .] And you see, it paid off: I am exactly where I want to be [in terms of weight]. [. . .] Now that I am this old woman, [. . .] it [self-tracking] is just not necessary anymore. I know now what is good for me! [. . .] Eating healthy, I know what it is now. I don’t need to count anything for that. [. . .] No, I don’t need that overview anymore [on her phone in the Notes app]. [. . .] Wonderful, huh?! (Hermoine)

In this quote, Hermoine refers to a rather direct knowledge of her body when it comes to nutrition and food: stomach growling means that she has to eat, and having a “full sensation” means that she has to stop eating. And “eating healthy” is something that she knows without tracking calories. We may interpret this knowledge as a kind of positive bodily self-awareness wherein she is better attuned to the menopausal body. Here, Hermoine’s “eating” body seems to eu-appear to her in the form of a better, more straightforward self-understanding (Zeiler, 2010).

It is significant to note that in her account, Hermione seems to suggest that her positive bodily self-awareness develops around the time she went into menopause, or as she euphemistically says, “Now that I am this old woman.” “Wisdom,” she explains, “comes with the years.” In doing so, she seems to tweak a common cultural representation of menopausal women: as wise and old (Jones et al., 2012). While this cultural understanding of menopausal women is typically used in the context of women’s (perceived) bodily decay and non-normativity—they are often seen as (more) wise and introspective (only) when their bodily strength, capability, and beauty (allegedly) diminish—Hermoine’s newfound wisdom seems to relate to novel bodily abilities instead of inabilities. After all, her novel self-understanding enables her to react better to her bodily (nutrition) cues, thereby allowing her to keep the weight that she wants. Second, as Hermione seems to allude to an experience of attuned bodily self-awareness that came “with the years,” it may be somewhat misleading to interpret this positive experience as an “eu-appearance.” That is, Hermione’s utterance may suggest that her body appears only positively to her because of and through the (bodily, life) experiences that she acquired throughout the years (Dahlberg, 2019). This means that, rather than that her body “just” appears to her positively during menopause—something that leads her to un-track—her positive bodily appearance seems to presuppose acts of “getting to know” her body “with the years.” In this sense, her un-tracked body, instead of eu-appearing, may be better understood as—what we call—eu-acquiring.

To stop with a self-tracking device is, of course, not a neutral technology–human relationship. Indeed, Hermoine seems to experience her self-tracking activities as not desirable—at least not in retrospect. That is, her quoted account of not needing “that overview [on her phone] anymore” tellingly ends with the statement: “wonderful, huh?!” It may be interpreted that this positive qualification of non-self-tracking is related to an experienced bodily “mineness” in her novel bodily attunement (Zeiler, 2010). Such experiences of bodily “mineness” also seem to surface in explicitly referencing her body as “hers” while explaining why she does not self-track: “my stomach,” “I’m full,” and “what is good for me.” By implication, then, self-tracking for Hermoine seems to indicate not only a less (or non)wonderful experience but also a body that is less (or not wholly) “mine.”

The unmoldable dys-appearing body

Rather than being able to work with and change their inhibiting bodies, many women in this study stated that they cannot alter their uncomfortable menopausal bodies. For example, some women say their hot flashes come as they please and that there is—as Ally states—“nothing you can do about it.” Elsie changes her food pattern, but it does not make her lose the weight she has gained during her menopausal transition. Deborah is not able to fall asleep quickly, no matter what she tries. These women seem to be unable to change their inhibiting bodies. For most of them, self-tracking—with its supposed promise of enabling one to change one’s bodies through the knowledge it offers—often appears as a fruitless exercise. That is, the otherwise inaccessible knowledge that self-tracking offers appears useless for these women. Ally, for example, has a lot of hot flashes—sometimes even three times per hour, all day long. They are, as she says, “unbearable.” She has considered tracking them in a specially designed menopause app but eventually did not do so. She elaborates:

Even if I note it [her hot flashes] down [in the app], what would it bring me? Even if I can make some sense out of it, when they come, why they come, or something. [. . .] It doesn’t matter whether I know where they came from. What do I gain from this [knowledge]? If it would mean ‘hey, if we have a clear picture of it [her hot flashes], then we can organize medication or something,’ well, then I would do it [track her hot flashes]. But I cannot do anything about it; it’s there. Doesn’t matter if I know more about it, [. . .] I rather do not know. There is absolutely nothing you can do about it. [. . .] It [her hot flashes/menopausal body] is just there. [. . .] So, I do not want an app to track my hot flashes. (Ally)

Ally’s menopausal body dys-appears to her: because of her hot flashes, she has become explicitly aware of her body in a negative way (Zeiler, 2010). Even more, in referencing her hot flashing body as an “it” that is “there,” this dys-appearance seems to impose a sense of alienation toward her body. All the while, her menopausal body appears to resist (positive) change; indeed, she “cannot do anything about it.” For Ally, then, self-tracking is far from empowering. The increased self-understanding that self-tracking may offer does not help her to take control over her body and/or enforce change (Lomborg and Frandsen, 2016). Given her statement that she “rather [does] not know,” it may even be interpreted that for Ally, self-tracking actively confronts her with the realization that she feels powerless over and against an inhibiting and unmoldable menopausal body (also see Christoforou, 2018).

Yet, for Germaine, such an understanding of an unmoldable body (and self) precedes the effort to actually change her inhibiting menopausal experiences. In her interviews, she seems to indicate that her experiences, to a large extent, cannot be molded into the logic of self-tracking apps (or vice versa, that self-tracking apps cannot be molded onto menopausal experiences) to begin with. As such, self-tracking does not offer the (kind of) knowledge needed to try to change her body and life—and therefore seems “pointless” to her. In offering such pointless knowledge, then, it seems that the rationale behind the engagement with self-tracking technologies is not failing but rather the engagement itself. Germaine narrates her self-tracking experiences as follows:

No, [I did] not [self-track] my menopause. What would I need to track, anyway? It’s so hard. With those hot flashes, that I know, yes. Okay, so I would track how many [per day she has] and when they come. [. . .] But there is no logic: they come as they please, it seems. I cannot make any sense of it. [. . .] I need more info. Was I in a [bad] mood? Was I standing, running? All these things matter, you know [regarding the frequency of hot flashes and when they come]. But such an app cannot make a logic out of it; there is no formula for it or something. (Germaine)

Then, when the interviewer asked her whether she tracks other symptoms that may be connected to her menopausal transition (sleep deprivation, heart palpitations, and depression), she continued:

“With that stuff, I am always in doubt. Is this the menopause? [. . .] So when I do not sleep, is this the menopause, or is this just stress from work. [. . .] With depression, is it not my grief [for her father]? With menstruation you bleed or not, that’s easy, but with menopause, it’s so unclear.” (Germaine)

Germaine stated in her interview that she takes sleeping pills that help her fight her insomnia; therefore, she may not regard her body as unmoldable as such. Rather, what Germaine seems to point to in the above quote is that she feels that her menopausal body is incompatible with the practice of self-tracking in various ways, and that, in this sense, self-tracking may not help in altering her body. Regarding hot flashes, she hesitantly states that to discern a “logic” in these symptoms that would help her handle and possibly change menopausal’s symptomatic appearance, she would need to contextualize her hot flashes. That is, she would need to know how she was feeling when she got them and what she was doing at the time. However, in stating that “an app cannot make a logic out of it, there is no formula for it,” she seems to hold that apps are able to process and make sense of such contextualized and non-formalistic knowledge. According to Germaine, then, self-tracking hot flashes seem to defy its purpose, as menopause apps cannot offer proper and useful knowledge about this symptom. In this sense, she feels that her menopausal body cannot be molded properly onto the logic of self-tracking apps (or vice versa), and thus, cannot help her to change her menopausal body.

Then, with regard to tracking other kinds of symptoms that may or may not be connected to menopause—depression, heart palpitations, sleep deprivation—Germaine seems to contend that she does not know whether she would then actually track menopause, or just her work stress and grief. Here, rather than ascribing the inability to track menopause to the inaptness of menopause-tracking apps or the complex causation of hot flashes, she attributes it to the uncertainty surrounding menopausal’s symptomatic appearance to begin with. For Germaine, then, not only can her menopausal body not be molded into self-tracking apps (or vice versa). To her, the menopausal transition itself cannot be molded into the practice of self-tracking menopause because of the vagueness surrounding its symptomatic appearance. For Germaine, then, it does not seem to matter how the appearance of her body may be phenomenologically qualified within and through a tracking practice: as positive (eu), negative (dys), or retreating into the background (dis). What is more important for her is to feel/observe what kind of body—menopausal or otherwise—may appear (or not) through self-tracking.

The longing, disappearing body

Interestingly, some of the women who have to deal with the supposed unavoidable discomforts of menopause—and then reduce, stop, or never begin self-tracking—report that self-tracking makes (or would make) menopause more inhibiting. Amanda is one of them. She says:

So, I do not want to think about it [her menopause] all day. In my opinion, if I do not track it, I think less of it, and then I am bothered less by it. You get it? So, eh. . . I know that if I watch television at night, then they [hot flashes] would come three or four times. If I would then grab my phone, note them down every time, then I think I will get more and more [hot flashes]. [. . .] Same with sleep; if I would look at my sleep cycle every morning, I think I would wake up more and think about sleep so that I cannot sleep. [. . .] It’s a downward spiral. (Amanda)

Amanda’s account of self-tracking begins with a longing: she would like her bothersome menopausal body to (partly) disappear from her reflective radar (Zeiler, 2010). Such a desire involves an experience of her body that retreats into the background—that is, “absent” in our conscious experience—and does not obstruct daily life (Leder, 1990). So, while Amanda’s menopausal—sleepless, hot flashing—body always already dys-appears to her, she suspects that in self-tracking, her body would dys-appear even more. She points out that in explicitly self-tracking—“grabbing her phone” [. . .] “and noting it down”—she is forced to be more conscious about her inhibiting body, and this negative awareness would make the severity of her symptoms worse. Amanda’s words seem to allude to the fact that a certain degree of bodily disappearance and forgetfulness is needed to widen the scope of her body’s possible action: “then I am less bothered by it.” Engaging with self-tracking technologies would then obstruct this disappearance, namely by foregrounding her body through conscious and active self-tracking activity (De Boer 2022b; Leder, 1990). Thus, while for many women in this study, the explicitly focused attention on the body in self-tracking at least bears the promise of changing the body toward a more capable one. For Amanda it is exactly this focused attention to her body that would incapacitate her even more.

Note that such a longing for a disappearing body does not have to be prompted by a currently inhibiting menopausal body. Two women in this study adhered to their fears that self-tracking may evoke. For them, self-tracking bears the possibility of discovering that one’s body and self are going to be incapacitated in the (near) future. Consider Robin’s statement:

No, not that [self-tracking]! I would have something like, what if it tells me something bad? Like what my mother had. [. . .] That’s my biggest fear: to become like her, [with] depression, horrible sweating, [. . .] forgetfulness. [. . .] Then keep [track] of, you know, all these facts [her own mood, when she has hot flashes, what and when she forgets certain things] and then you see on your screen [the visualizations of self-tracking apps], yeah, so this is a downward slope. [. . .] and you may not even feel it yet. Horrible! (Robin)

Rather than an actual bodily dys-appearance in the lived present that prompts a longing for a bodily disappearance, Robin’s longing for bodily disappearance seems to be induced by her fear that her menopausal body may very well dys-appear in the (near) future. While the fear itself seems to be already instigated by the menopausal experiences of her mother, it is the practice of self-tracking that seems to make this fearful future a more “real” or tangible possibility. She seems to contend that in self-tracking, one is able to discover that one is indeed on the verge of actually becoming incapacitated. She says, “Then you see on your screen, yeah, so this is a downward slope. [. . .] and you may not even feel it yet.” For Robin, then, swearing off self-tracking seems to adhere to not wanting to be confronted with the possibility of a body that may at some point actually dys-appear, albeit her body, in fearing for such dys-appearance in the future, arguably already dys-appears in the present as well. Her resoluteness in not self-tracking, in other words, seems to adhere to her wish to hold on, at least to a certain extent, to a disappearing body as a (central) future possibility. Note that, just like with Hermione, Robin’s body does not “just” appear to her in a certain way during her un/tracking practice. Rather, her bodily dys- and dis-appearance seem to be stretched out into her future (as a longing or as a fearful horizon). In this sense, these are experiences that may (or may not) approach her through the un/tracking practices (Dahlberg, 2019). Rather than an appearance, her bodily experience may be understood as a—what we term—dys- or dis-approaching.

Significantly, Robin’s longing for a dis-appearing or dis-approaching body may not only be prompted by the legitimate wish to secure the scope of one’s present actions (or to adjure a limiting scope) for the future. In her interview, Bodine seems to hint that the desire for an absent body is of existential significance. She says:

But I refuse to deal with it [her menopause transition] too much. [. . .] If you do all those things with it [self-tracking her menopausal symptoms], then you become your menopause. Then you do not have it [menopause], but you become it [menopause]. [. . .] But I do not want that. [. . .] I live here. (Bodine)

Bodine’s words show that matters regarding identity and selfhood need to be considered to understand what self-tracking means in menopause. Granted, Hermione also seems to refer to her non-self-tracking menopausal body more as “hers” than her self-tracking body (see the subsection on “The wise eu-appearing body”). But for Bodine, it seems that dealing with her uncomfortable menopausal body through self-tracking bears the risk of being absorbed by menopausal discomforts and of “becoming” her transition. In this sense, she would lose (parts of) her identity and self altogether. While such a loss may be threatening in itself, it may be interpreted that the stigma surrounding menopausal transition adds to this sense of ominous loss (Nosek et al., 2010). In becoming your menopause, we may argue that Bodine would not only lose (parts of her) selfhood, but that she will lose it to a condition that is silenced, ridiculed, and not taken (that) seriously (Duffy et al., 2011). Then, by thinking about her menopausal transition as an object—something that you “have,” a “that”—or as spatially apart from her (sense of) self—“I live here.” By not engaging with her menopause “too much” through self-tracking, Bodine seems to be able to maintain her sense of self.

Discussion: The significance of situated un-tracking in menopause

This paper addresses two understudied phenomena in the literature on self-tracking: the constitutive significance of not using self-tracking technologies—of un-tracking—for women’s self-experiences in menopause. While for the women in this study, the rationale behind self-tracking seems to range from possibly satisfying one’s curiosity, being a habitual practice, and helping to change their bodies and lives, it turns out that, for these women, self-tracking largely defeats these purposes. Many interviewed women self-tracked in the past—and some still do. Most women in this study resist, reduce, or stop their self-tracking practices during menopause. For some of them, self-tracking seems superfluous as their bodies appear as more comfortable objects to which they are well-attuned to now that they are in menopause—that is—now that they are older and wiser. For other women, self-tracking seems fruitless, as their inhibiting menopausal bodies appear (to a large extent) unmoldable. This means that they feel that they cannot change their bodies based on the self-tracking output and/or that their bodies cannot be molded into the logic of self-tracking technologies. Finally, self-tracking itself may also be experienced as inhibiting by some of these women, as tracking their lives and bodies confronts them (too much) with their present and future incapable bodies and selves.

What stands out in these women’s accounts, first, is that these women’s experientially mediating non-self-tracking practices are temporally and socio-culturally contextualized in complex ways (Dahlberg, 2019; Lock, 1994; Rosenberger, 2014). This temporal dimension pertains to the fact that self-tracking may make these women’s bodies actually more inhibiting in the present, but also to the fact that self-tracking may confront women with a familiar and fearful future where their menopausal body may very well dys-appear to (or dys-approach) them (Dahlberg, 2019; Zeiler, 2010). In this latter case, then, refraining from self-tracking seems to be instigated by tracking activities that make this future all-too-real, as well as a desire to maintain the very possibility of a disappearing body in the foreseeable future. Moreover, this study reveals that various socio-cultural contexts influence not only how self-tracking devices are used and not used but also how and whether self-experiences are shaped in and through this use/non-use. These women’s self-experiences are, for example, shaped by everyday interactions with themselves, others, and the world around them, and by shared understandings and norms of what it means to be a menopausal woman and to be (not) beautiful, fit, and healthy. Such socio-cultural co-constructions do not only play a role in reflecting on what self-tracking technologies can and cannot do—for example, that self-tracking technologies do not incorporate everyday goings-about and therefore do not add to the knowledge of when and where hot flashes may appear. It also shapes how women review and understand their body and self—for example, in perceiving oneself as wise or well-attuned to one’s body in menopause—and, as such, whether, and how they (do not) use self-tracking devices. Such socio-cultural understandings may also co-construct the ways in which menopause as a condition is understood—as something vague and enigmatic—and as something that cannot be tracked. Technological mediation, in this sense, does not only pertain to a circular movement wherein self-tracking technologies shape and are shaped by self-experiences, but also wherein socio-cultural and temporal contextualization’s are intricately interwoven within this co-constitution (Lock, 1994; Verbeek, 2006).

What is further striking about these women’s situated accounts of technological mediation is that they provide a deeper understanding of the possible nature and potential extent of the constitutive power of this mediation for self-experiences. Remember that, in the literature on technological mediation, the focus is predominantly on actively using technologies. In analyzing the technological mediation accounts of menopausal women, this paper underlines the importance of researching former and non-users, as well as those who resist using (but may be users, anyway). This study shows that these women are neither simply using nor not using self-tracking technologies. Rather, their ways of being and becoming aware of their bodies and selves is mediated by (and mediates) stopping, refraining, reducing, or explicitly resisting self-tracking. In other words, these women’s self-experiences are co-constituting by—what we call—their un-tracking activities. As such, this study not only points to possible (perceived) limitations of when and where self-tracking defeats its purpose of eliciting change, it also—and perhaps pre-eminently—reveals the extent to which technologies such as self-tracking devices may co-constitute self-experiences. Indeed, certain ways of using self-tracking devices, of understanding oneself, of perceptions of what menopause is (and is not), may indeed compel one to stop or resist these self-trackings. But within and through stopping and resisting these activities—in un-tracking—these technologies may still severely co-construct self-experiences.

Note that what makes this phenomenon of constitutive un-tracking even more significant is that it seems to bear existential implications for these women. Self-tracking may indicate for some women an (somewhat) alien or estranged body, for example, a body to which one is not well attuned. However, un-tracking seems to implicate a body that is (or at least, hopefully would be) experienced as more “mine,” that is, for instance, directly understandable and not fearful. Moreover, we have seen that un-tracking menopausal symptoms may even involve adjuring the risk of losing parts of oneself and “becoming” one’s menopause. In this sense, technologies may even affect the ways in which we experience ourselves and our bodies when we resist or not use them.

Given that self-tracking is increasingly popularized and celebrated in health contexts (De Boer 2022a; Topol, 2015), this study’s analysis of when and where self-tracking defeats its purpose to elicit change for women in menopause may be used to improve self-tracking technologies. Here, one can think of possible ways to track more every day and non-quantifiable information and make it insightful in order to better understand the nature and causation of menopausal symptoms, such as hot flashes.

In our view, however, this study especially makes an appeal to us to take a step back from the process of technology development. In advancing our understanding of the extensive ways in which self-tracking technologies, even in un-tracking, mediate (and are mediated by) self-experiences, this study may prompt us to critically ask and evaluate the impact of this increased use and value of self-tracking in health contexts on people’s self-experiences. As such, this study raises the more general question of why people self-track or not, how it shapes their self-experiences, and how these women may be guided in making their lives and self-experiences better through tracking and un-tracking. Ultimately, then, this study may contribute to taking a stance against (promoting) the usage of self-tracking technologies in healthcare contexts (See also: Lupton, 2013). After all, by teasing out lived experiences of un/tracking, it not only reveals self-tracking as a potentially harmful practice, but also shows that un-tracking may be a potentially positive one: as beneficial for people’s self-awareness, for preserving their sense of self as apart from an inhibiting condition, for alleviating their anxiety about uncertain futures. Indeed, instead of being the mere negation of tracking, un-tracking is a meaningful and fruitful activity in and of itself. Thus, rather than celebrating and popularizing self-tracking in health care contexts, this study may function as a stimulus to foster un-tracking: to encourage people to not turn (too quickly) to self-tracking technologies, and to facilitate ending and resisting self-tracking practices.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Nederlandse Organisatie voor Wetenschappelijk Onderzoek (NWO VENI 201F.003; Marjolein de Boer).

ORCID iD

Marjolein de Boer

Notes

Author biographies

Marjolein de Boer is an assistant professor of Medical & Health Humanities at the Department of Culture Studies at the University of Tilburg, The Netherlands. Her empirical phenomenological research focuses on women’s experiences of and representations about illness and medicalizations situations, for example in breast cancer, infertility and menopause.

Marieke Hendriks has a MA in Health Humanities (Tilburg University, The Netherlands). She was involved in this study at Tilburg University as a research trainee and interviewer.

Emiel Krahmer is a full professor in communication and cognition at the Tilburg School of Humanities and Digital Sciences, and co-academic lead of the Academic Collaborative Center on Digital Health & Mental Well-being at Tilburg University. In his research, he studies how people communicate with each other, and how computers can be taught to communicate in a similar fashion.

Jenny Slatman is professor of Medical & Health Humanities in the Department of Culture Studies at Tilburg University, the Netherlands. She has published widely on issues of embodiment in art, expression and contemporary medical practices.

Nadine Bol is associate professor of health communication in the department of Communication and Cognition at Tilburg University. Her research expertise lies at the intersection of digital technologies, health communication, and vulnerability, centering on how digital health technologies impact vulnerable populations and create (new) digital inequalities.

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