I wrote this review elsewhere and modified it a bit:

This manga features a fascinating exploration of gender roles and how they adapt over time with a particular focus on the female shoguns' experiences with womanhood as the shogun. The cast includes a wide variety of different personalities, circumstances, and experiences that make each entry in the line distinguishable and engaging. Some are upright people who earn the respect and loyalty they are given, others demand it solely because of their status. Some of the female shoguns are capable leaders with a vision for the nation's future while others are incompetent or ineffective. Many women take on high-ranking positions in the government throughout the generations depicted here. The men are also pretty varied as well. Also, there is plenty of romance. And tragedy. Tragic romances and just other tragedies unrelated to romance. Since the story covers over 200 years, most of the cast will die before the end, which makes a bittersweet experience as you get to know and love each generation. You know it's coming. You know, but you just want them to be able to find happiness.

As for the redface smallpox disease that wipes out the male population, the plot does not jump straight into solving the problem. This makes sense given the limited medical knowledge at the time and isolationist policies that prevented Japan from acquiring the knowledge and techniques needed to deal with the disease. But even when they do, it isn't smooth sailing in implementing the steps needed to do so. This is realistic because people are dumb and scared of new things. Before they learn how to eradicate the disease and innoculate everyone, the disease is pretty mysterious

Frankly, the whole story seems pretty realistic, including the more dramatized events or character beats. The cast seems like real people you might know. The story is tagged as a Shojo, but calling it a Josei is more accurate to the topics and writing.

One complaint that I have is that some characters look similar, so it can be hard to differentiate them unless their names are given, especially the men. The Tokugawa women (i.e. the shoguns), despite most being directly related, are actually pretty distinguishable.

Some of the earlier dialogue is hard to read at times because they are speaking in a more formal style that was spoken at the time, but you will notice that it slowly transitions to a more modern style as the series approaches modern times (though the story concludes long before the current day). I would recommend the anime. Currently, there is only one season, but a second has been announced and I imagine more will follow.