• the quotidian (6.10.24)

    Quotidian: daily, usual or customary;
    everyday; ordinary; commonplace

    When the sign points to pie.

    Cream two ways: cheese and butter.

    After my breakfast post, my younger daughter set me up.

    A plate of veggies and don’t you dare try to tell me otherwise.

    Surprise carbonation: here’s to hoping I don’t have glass bombs in my basement.

    What I do have: nifty storage!
    (for some of the bottles anyway)

    You know you make ice cream frequently when you refreeze the salted ice.

    Flower planter.

    Worm snack for the chickies.

    He designed an interactive arduino light display for his senior table.

    I think he likes me.

    My running route: so green my eyes hurt.

    Weekending.

    This same time, years previous: what are you good at?, pepper jack cheese, the coronavirus diaries: week 66, the quotidian (6.10.19), ba-BAM, pulling the pin, a photo book, delivery, the quotidian (6.10.13), Jeni’s chocolate ice cream, how we beat the heat: mint tea concentrate.

  • perimenopause: HRT

    A few weeks back I had a routine checkup with my medical provider, a certified nurse practitioner who specializes in women’s health and sees me and both my girls and my mother (how’s that for wholistic intergenerational healthcare!). When I told her that I hadn’t had my period for 2-3 months, she asked if I had considered hormone replacement therapy. 

    Me: Not really. Tell me more.
    Her: When you begin to go through perimenopause, sex hormone levels drop and all sorts of problems crop up so take HRT to not have problems. 
    Me: But why does HRT have a bad rap? Didn’t they determine that it causes cancer?
    Her: That study was flawed in a number of ways and the data was misinterpreted. There may be a slight increase in risk of breast cancer, but it’s like 1 in 1000, so not even really worth mentioning, and the health benefits — improved cardiovascular health, bone health, mental function, etc, etc — far outweigh that teeny risk. Add in the improvements to quality of life —
    Me: I’ll do it.

    And then I went home and thought of a million questions: 

    • I haven’t felt that terrible with perimenopause to start with, so would I just complicate things for myself with HRT?
    • Would HRT revert me to a moody ragey PMSy woman? Would I feel bloated? Gain weight? Get nauseated? Start my period? Get cancer?
    • Could I just quit if I didn’t like it?
    • Did I really want a patch on my belly for the next decade (or two or three)?  
    • How long was I supposed to stay on HRT anyway? 
    • How much would this cost?

    But there was the flipside to consider, too. In recent months my hands have begun to ache. Some days the pain is so bad that it hurts to pinch my thumb and index finger together to zip my wallet closed. Early onset arthritis, I told myself. But my provider said that achy joints are a sign of dropping estrogen. If I went on HRT, would the pain disappear?

    Sleep! HRT — the progesterone, specifically — dramatically improves sleep quality.

    And then the long-term benefits were pretty impressive. Without estrogen, the body — because estrogen is found in all the body’s systems — becomes inflexible and brittle, from skin to bones to brain to heart. The way my provider described it, HRT felt like a comprehensive and necessary vitamin, and not taking it sounded bleak.

    So she sent me to get a blood test to determine that I am indeed transitioning from the reproductive phase to menopause (I am), and I picked up my medicine at the pharmacy: 1 month of twice-weekly estrogen patches for $50 and a 3-month supply of progesterone pills (one a night) for $40. 

    Still, I hesitated. I didn’t know anyone my age who was taking HRT. Who could I talk to about this? 

    That’s when I had the brilliant idea to email women my age who worked in medical professions. I sent three emails. One didn’t know anything. Another said she didn’t know much, but she was hesitant about it. But the third was on HRT — ding, ding, ding! She couldn’t answer all my questions but her experience was positive, and just talking to another human about it, and getting affirmation for my concerns, was enough.

    That same morning, I mustered my resolve and slapped on a patch.

    And then I dove into the research, because apparently I’m the sort of person who acts first and considers second. (Which isn’t entirely true but I have noticed that I absorb new information better when it is paired with experience.)

    Podcasts
    Menopause: How your Body Changes and What You Can Do. If you are a female over the age of 16, or if you know someone who is — aka EVERYONE — give this a listen. We gotta get educated.

    The #1 Menopause Doctor: How To Lose Belly Fat, Sleep Better, and Stop Suffering Now. Good, good stuff.

    Books
    The Upgrade: How the Female Brain Gets Stronger and Better in Midlife and Beyond by Louann Brizendine. I actually read this book last year, and because Brizendine spends a lot of time discussing hormones, I was already aware that the science around hormone treatment (as I’d understood it) was changing. I think it’s largely because I’d already read this book that I was so quick to start HRT when it was suggested to me.

    The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts by Mary Claire Haver (who is the doctor interviewed in the podcast mentioned above). I bought the book and am reading it now. Five stars (so far).

    Here are a few tidbits I’ve picked up from my readings/listenings. (Remember, I’m not a doctor so don’t quote me on this stuff without doing your own research first!)

    *The symptoms of menopause go far beyond the loss of a monthly cyle and hot flashes. Others symptoms include: UTIs, brain fog, frozen shoulders, hair loss, anxiety, vertigo, weight gain, heart palpitations, etc. (I think there’s a list of about 25-30 symptoms.) 

    *The Big 2003 Study — the one that halted 70-80% of HRT sales overnight — was flawed and misconstrued. For example, consider the interpretation of absolute and relative risk: in the study, a woman’s chance of developing breast cancer while on a placebo was 4 in 1000, and a woman’s chance of developing breast cancer while on HRT was 5 in 1000. As relative risk, that’s a 25% increase, but as absolute risk, that’s 0.08%. The media released the first number and just like that women’s health care suffered a massive setback.

    *Humans are one of three species to go through menopause; the other two are whales (short-finned pilot and killer). It’s only in the last hundred years or so that women have begun to consistently living 30-40 years beyond their reproductive years.

    *Women were not included in human randomized control trials until 1993.

    *There is not an insurance code for menopausal office visits: just for the boobs and the babies. 

    *Even if a woman has a history of breast cancer, that does not preclude her from taking HRT. (Women with breast cancer are most likely to die from cardiovascular disease; breast cancer has a 90% survival cure rate.)

    *The window for getting on HRT is the first 10 (some say 5) years after menopause. Women who start HRT within that window have been shown to have a lower risk of heart problems, osteoporosis, stroke, and dementia. 

    *Traditional treatments for high blood pressure and heart disease work for men but not for women. What does work for women in preventing these diseases is estrogen.

    *Progesterone, which needs to be taken in conjunction with estrogen for women who still have a uterus (because if they only take estrogen there is an increased risk of endometrial cancer), helps with sleep and has anti-anxiety effects. 

    *Quite a few women (I think I read there’s a spike) go on antidepressants in their 40s and 50s, medicating for depression when, in fact, what they are suffering from is a decrease in estrogen.

    *Many common midlife female medical problems — frozen shoulder, UTIs, high blood pressure, joint pain — are usually treated as isolated getting-old issues. Women are sent to specialist after specialist without ever being told (becuase in many cases their doctors don’t even know) that their issues are all common symptoms of a rapid decline in estrogen brought about by menopause.

    *Women often notice a slight loss of belly weight with HRT. There are a number of reasons (Haver talks a lot about visceral fat in her book), but one common sense reason is that women on HRT don’t have hot flashes so they sleep better which means they feel better which means they have more energy to exercise and aren’t as tempted to self-soothe with food.

    *Weight-training is crucial for women in their second stage of life. Be strong, not skinny. Our bodies desperately need the bone and muscle mass.

    The patch is like a bandaid: peel off one half and adhere it to your skin,
    and then peel off the second half. Once on, it doesn’t budge.

    So what’s been my HRT experience? I’m in my first month so I’m still adapting to the therapy, but here’s what I’ve noticed:

    • For the first three days, I felt fantastic: energetic, sleeping well, happy.
    • Day 4: I threw up twice. I freaked out, but in hindsight it was just a random unrelated bug.
    • Day 9: I got my period. It lasted about 12 days, with three days of cramps at the start that were bad enough to require medication.
    • I’ve had a couple bouts of shouty rage similar to how I used to always kick off my PMS every month, probably caused (I’m learning) by the surge of estrogen. (It used to be that when I noticed I had a sore throat from yelling at everyone, I’d look at the calendar and be exactly 14 days out from my next period.)
    • I’ve noticed a little edginess (like my pre-hot yoga anxiety), but mostly I’ve felt calm.
    • Sleep is still up and down. I fall asleep pretty quickly and sleep hard, at least for a few hours, but the dreams are so wildly vivid that I feel like they actually disrupt my sleep. For the last couple mornings I’ve been waking between 4 and 5.
    • I think I have less of an appetite, or at least “the munchies” aren’t as intense.
    • I may feel a little bloated. (Then again, it could be the ice cream.)

    Another side effect of starting the therapy: two of my friends have started HRT in the last couple weeks, and another is scheduling an appointment with her provider. We all mirror each other with our “are you serious? you mean there is treatment for what I’ve been feeling?” incredulity, and the hope to go with.

    ***

    I’m gathering HRT stories, so if you’ve taken HRT, or made an educated decision not to, I’d love to hear about it via the comments or a private email to jennifer@jennifermurch.com.
    xo

    This same time, years previous: old rag, the quotidian (6.6.22), how do you want to be when you grow up?, energy boost, the family reunion of 2017, the quotidian (6.6.16), a better grilled cheese sandwich, on pins and needles, chocobananos.

  • yoga sol

    A week ago, one of my girlfriends invited me to do hot yoga with her. I could come for free on her pass, she said, just to try it out. 

    Okay, sure, I said. I hate being hot. Tell me more.

    The class is an hour and fifteen minutes, she said. The room is 105 degrees. Get there early. There’s no talking. You will sweat a lot; bring a towel to put over the yoga mat so you don’t slip. If you can’t hold the poses, don’t worry; just being in the room is a challenge. Hydrate ahead of time.

    Sounds like fun, I said dryly.

    The night before our 9:00 morning class, I dreamed that I hadn’t left for the class in time and so I had to miss it. But then in the dream I realized it was a dream, so then, relieved, I got to go to yoga class after all. Everyone was so squished together on their towels that we couldn’t move our arms, and the room wasn’t very hot, and people were talking too much. What’s the point? I wondered. And then the instructor came up behind me, twisted my legs into a painful position and sat on them. I loudly swore at her, and she immediately turned on my friend and chewed her out for bringing me. I interrupted, telling her it wasn’t my friend’s fault but rather hers for sitting on my legs and we both apologized and moved on. Also, everyone was naked from the waist down.

    The next morning, I couldn’t shake that dream. I felt jittery nervous, anxiously checking the clock, collecting two towels and an extra shirt, chugging water. Lots of people do this all the time, I told myself. You’ll be fine.

    At the studio, the instructor had me sign a waiver, and then she gave me instructions. Only sip water if needed. If I get tired, just stand in place or lay down. Except for the opening breathing exercises, try to only breathe through the nose. If I get overwhelmed or dizzy, I can step out of the studio but should sit on the bench right outside the (glass) door so she can keep an eye on me.

    I asked her how she got into hot yoga and why she likes it. She said she fell in love with it the first time she did it: the absolute focus, the meditation, the physical challenge. A busy, stressed teacher at the time, the classes provided a release, a complete mental break, from her regular life.

    And then my girlfriend arrived and we went into the studio and —

    The HEAT. It was fierce, almost scary. I’ve never felt anything like it. Everything in my body told me to run, get out, leave, and I had to mentally force myself to stay still, to unroll my mat, to spread out my towel, to breathe. Within minutes my skin was slick with sweat.

    And then the instructor came in — it was just my girlfriend and me — and we began. The instructor talked nonstop, demonstrating an action when necessary but mostly relying on words to get us to do things. For the next 75 minutes she explained, described, encouraged, and corrected while we reached, stretched, twisted, arched, pulled, balanced, dipped, and tucked. The heat felt like a protective blanket around my body, holding me, and loosening and softening my joints, as I pushed my body to contort into unfamiliar positions. 

    Just breathing was difficult. I wasn’t out of breath but I couldn’t talk — all my energy was focused on my body as I drug myself from one position to the next, sweat streaming down from my nose, my fingertips, my ankles, the tips of my hair. 

    At the end, we stretched out on our backs, and the instructor dimmed the lights and gently set iced, lavender-scented towels into our hands. I draped the towel over my closed eyes — heaven. After a few minutes, we gingerly sat up. 

    What the hell was that, I said. My girlfriend laughed. “You did it!” Slowly, we got to our feet — I felt light-headed and incredibly weak — and then we rolled up our mats, gathered our things, and walked out into the air conditioning. 

    In the bathroom, we took a celebratory selfie, and I examined my underwear: yep, soaked through! On the drive home, I felt euphoric and mildly disoriented. More exhausted and spacey than anything, really. 

    Back home, I peeled off my clothes — I could actually wring water out of my bra! — and then showered. I drank a quart of water, fixed myself a good lunch, and then, shivery cold, I snuggled up on the couch with a cup of coffee and my computer and wrote this. 

    This same time, years previous: try and keep up, so much milk, the coronavirus diaries: week 65, in the bedroom, black lives matter, berries for supper, the quotidian (6.4.18), this is us, brown sugar rhubarb muffins, the quotidian (6.3.13).