Continuing with the perimenopause series…

What’s perimenopause been like for you?
For a long time I struggled with heavy bleeding and increased frequency of menstruation due to uterine fibroids, but in my mid-30’s they got much worse. I had one procedure which helped for a little while, and then was approved for a hysterectomy at 40. I’m single with no children, so the OB-GYN was hesitant, thinking I might want children in the future. But the main fibroid was the size of a grapefruit, and my last period had lasted nearly two weeks and was so heavy that sometimes I would stand up from my chair and just feel it gush out of me, so I was very ready to be done with that. My uterus was removed but ovaries remained; I was assured this shouldn’t necessarily mean early menopause. It has been amazingly freeing not to worry about periods anymore!!

What did the surgeries involve? 
The first surgery was a fibroid embolization: they go in through the pelvic artery to the blood vessel that is ‘feeding’ the fibroid(s) in the uterus and inject tiny beads to block off the blood supply and hopefully shrink the fibroid. For that one, I spent the night in the hospital and then went home for a couple weeks of recovery. The procedure fixed the problem for a few years, but then the bleeding picked up again — new fibroids had grown. I could have just had a myomectomy surgery to remove the large fibroid, but they could see there were several more growing along behind it.

As for the hysterectomy itself, there are several ways a hysterectomy can be done. One common way is for the uterus to be removed vaginally, but since I had never had a baby (or even sex) my vagina was too narrow. If the fibroids are small enough, the uterus can also be removed laparoscopically through a small slit in the abdomen. For larger fibroids, they are traditionally cut into small pieces and removed through that same small slit. However, even though nearly all uterine fibroids are benign, it had been discovered that if a fibroid was unexpectedly cancerous, it could spread the cancer if cut. Just before I got to the point of surgery, the FDA ruled that fibroids could no longer be cut into pieces (morcellated). Now, large fibroids are cut up within a contained bag during surgery, but my surgery happened before this procedure became the norm. That left me with the only option of a full abdominal surgery, much like a C-section. 

For my hysterectomy, my abdomen was slit across the upper ‘bikini line’ about 8 inches long, through my core abdominal muscles. I had a friend who delivered a baby by C-section around the same time, and she had a much quicker recovery time. I’m not sure why it took longer for me to heal, except that full removal of the organ must be more traumatic to the body. I was in the hospital for two days and wasn’t allowed to do steps or lift anything heavy for several weeks after the surgery. It was about 8 weeks before I was back at work full-time. 

Those are big deal procedures! Did you have a good support network?
Because of the fibroids, I was poked and prodded a lot, so I quickly had to get over the shame; one can only be embarrassed for so long about all that stuff. (I’m sure women who have had pregnancies know all about that, but it was new for me.) Plus, I wanted to know what was happening, and what my options were, so I needed to get comfortable with the topic. Once I got over my own shyness, I didn’t find there was a stigma talking about the fibroids or hysterectomy. People were happy to share from their experiences and talk through the details. My work supervisor had experienced a hysterectomy around the same age, and she was very supportive and helpful. Several women at church surrounded me to help talk it out and share their advice. 

After the hysterectomy, did you have a sense of loss?
Afterward, my abdomen felt empty, like everything had to shift around and find its new place. I was unexpectedly teary and emotional for a couple of weeks. Physically, I didn’t feel normal again for at least 6 months, and I don’t feel that I’ve ever fully recovered my core strength (though I could certainly try harder at that). Probably because I already had been sometimes made to feel “less than a woman” from not having a partner or children, being faced with a hysterectomy didn’t feel too important, identity-wise. Although it wasn’t that painful for me to let go of the possibility of having kids, during the process I started noticing all the things that might be hurtful to someone with stronger feelings about that, like having to wait for my appointments in the same spaces with happily-pregnant women, and where there were photos of mothers and babies on the wall. After struggling with my periods for all those years, being free of the mess and pain has been so amazing. Now, since I’ve already given up my fertility and my periods, menopause doesn’t feel like it will be such a big deal. 

So now you are perimenopausal, correct? 
Yes. I noticed things were beginning to change in the last year or so, but without a menstruation cycle, it’s difficult to determine what’s happening and what it means. (Actually, until recently, I didn’t even know what perimenopause was.)  

What are your symptoms?
I have had occasional night sweats that wake me, and I have had a couple mild hot flashes during the day. I’ve had some urinary incontinence, probably because I never regained good core strength after my full abdominal hysterectomy. Also, I’ve experienced a couple night-time panic attacks (I think?) where my heart rate and blood pressure increase for no reason at night. (I didn’t know that panic attacks might be connected to hormone levels until I just now, when I looked it up.)

Any tips for dealing with the night sweats and panic attacks? 
Luckily, neither of these have been frequent. I can get by with one bout of insomnia as long as it’s not several nights in a row. If I’m working from home that day, I’ll take a short nap the next afternoon. I try to reduce my stress with exercise: getting out in nature, playing with my dog, and doing yoga. For anxiety, if I start feeling scattered and unfocused, I’ve begun the practice of laying flat on the floor for ten minutes. I set the timer on my phone, cover my eyes, and just focus on breathing. It’s amazing what a good ten minutes will do to reset your mind! If I am having something like a panic attack, which has only happened a couple of times, I can usually talk myself down by acknowledging what it is and taking deep, calming breaths. (Maybe this ability to control it means it isn’t a full-blown panic attack?) A friend and therapist also shared the tip of focusing on your senses — what do you smell? feel? taste? etc. She says to just cycle through those questions until you settle, so I’m keeping that in mind if it happens again. 

What about body image? 
I’m not sure perimenopause has directly impacted my body image since it’s hard to separate normal aging from perimenopause. Due to my hysterectomy and nulliparity, I had already dealt with my loss of fertility / “womanhood”. My hair had started to thin and grey years ago— the thinning is something I specifically struggle with, image-wise— and now there are the wrinkles, age spots, and sagging skin around my face. Weight is another issue. I believe we do ourselves and each other a favor by embracing our aging bodies, so I’m attempting to age gracefully. But it’s difficult to do in a society that fights aging so desperately. How do we care for ourselves and maintain a healthy, positive self-image while also recognizing the beauty and wisdom in our aging? I want to find a healthy balance between botoxing my hands to make them look younger (yes, people really do this!) and throwing up my (wrinkled) hands and saying “Yep, I’m just getting old!” 

Can you say more about how your nulliparity has impacted your sense of “womanhood.” 
Up until I was in my 30’s, I assumed my life would include marriage and children. However, thanks to my shyness, and perhaps because of some risidual shame surrounding sexuality from my conservative church upbringing, I never went on a date until grad school. Since then, I dated off and on, including a few months of online dating, but I just never felt the urgency to find a lifelong partner. I think a part of me just gave up at a certain point, maybe because it was too hard. But I’ve read a little about asexuality and think maybe I’m somewhere on that spectrum. I have sexual urges, but I’m able to satisfy myself and that has been enough. When I date, I mostly enjoy the companionship and the camaraderie that comes from knowing someone really well, going out to dinner and a movie, and having a deep conversation or a good laugh— all of which I can also do with good friends. 

The pressure to be in a romantic relationship comes more from societal norms. There’s this underlying feeling that something must be wrong with me because I’m single. And sometimes I feel that people perceive me as a “half” who should be focused on finding my “other half.” Well-meaning friends have made unsolicited comments like “I’m sure it will happen for you some day, hang in there,” as if I was giving off a sad and unfulfilled vibe just because I’m single. When visiting a new church, there’d often be no place for me to fit in because the only Sunday school class for people my age would be for “young families.” And I absorbed some of these messages: for example, I hesitated to buy a house on my own because that was something that was supposed to happen after marriage. These are all little things but they add up to create this feeling that I’m the weird one, the odd one out. Sometimes, it’s been painful.

Sometimes I wonder what I’m missing, like when people say that they only learned love and true unselfishness through being a parent. But listening to my married friends and their struggles, I can see that we all struggle in different ways. Except for the extreme solitude of the pandemic, I really do like living alone, managing my own schedule, budget, and decisions. As an introvert, this solitude gives me time and energy to put back into my community and volunteering. As I age, my biggest worry is the loss of that independence. I wonder, Who will care for me the way that I’m expected to care for my parents? 

If you struggle with going grey, why don’t you dye your hair?
When I was younger, I heard women complain about not knowing how to stop dyeing their hair so I decided I wasn’t going to start. Also, I’m cheap and didn’t want to spend the money, ha! I resonate with what Sarah Jessica Parker said recently when people commented on her grey roots showing: “It almost feels as if people don’t want us to be perfectly OK with where we are, as if they almost enjoy us being pained by who we are today, whether we choose to age naturally and not look perfect, or whether you do something if that makes you feel better.” 

I noticed my hair was thinning significantly when flash photos were taken of me and I could see the light reflecting off the top of my head. There didn’t seem to be a logical reason — I had tests done — so the only advice was to use Rogaine/minoxidil. I tried it for a couple of years; even though it increased my hair growth a bit, I decided that I didn’t want to do that for the rest of my life. (There are supplements, but they’re expensive.) At this point, I use good quality hair care products and try my best not to damage the hair that I do have. I blow dry or fluff the top of my scalp to try and give it as much volume as possible. (I have wear hats or bandanas outside to keep from getting sunburn on the top of my head.) I still feel self-conscious about it, particularly when I have to watch myself on Zoom these days. I just try to acknowledge that I’m aging and not obsess about it. There are so many more important things I’d rather be doing with my time. 

Emotionally, how has perimenopause affected you? 
Certainly in the last couple of years I’ve felt a bit more scattered and anxious, restless. Brain cells aren’t firing as quickly as they used to. I’m forgetting tasks and appointments that I would’ve easily remembered in the past. I’m more quick to lose patience with people, and I’m more tired. It’s difficult to untangle causation between general aging, being overweight, perimenopause, and the underlying constant stress of the past couple years of the pandemic.  

Has perimenopause impacted your relationships? 
Discussing my fibroid surgery and hysterectomy with other women has, I think, strengthened and deepened these relationships. I’ve learned much more from other women than from medical professionals. I’m glad to be in an intergenerational community through church, and I have close older friends. If women don’t have that, then who do they talk to about these things?

What’s surprised you about perimenopause? 
I’ve heard older women complain about hot flashes, weight gain, and vaginal dryness, but I’m beginning to realize that I don’t know much about the other symptoms, or how they will happen exactly, or if and when I should seek medical help. Menopause and perimenopause are all defined around having periods, just as womanhood is often tied to having children and a sexual partner, so, as usual, I’m struggling to figure out where I fit into this whole thing.

Any good resources to share?  
I haven’t really sought out resources, other than some medical websites, so I’m interested to see what other people suggest. For dealing with general aging and mortality, I got a lot from When Breath Becomes Air by Paul Kalanithi, and Being Mortal by Atul Gawande. In Being Mortal, Gawande discusses how we should take better care of our elderly, and how we should talk more openly about death and dying. It’s important to have conversations with our loved ones about what quality of life means for them, and for us, so that when it comes time to make those decisions on behalf of each other, we’re not left wondering if we made the right choice. And maybe, Gawande’s perspectives do tie into menopause: if we can accept the truths of aging and death, then we can live our best and richest lives in whatever circumstances we find ourselves. 

***

This same time, years previous: the quotidian (1.18.21), homemade grainy mustard, the quotidian (1.18.16), cream cheese dip, day one, polenta and greens.

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

Peposo: beef shanks, garlic, tons of black pepper, red wine.

Golden globes, our way.

This week.

City of Joy.

So that’s where all my ponytail holders are going.

One of these days they’re gonna take a chunk out of my ankle.

Stupid cold.

Frosted Butterscotch.

Taking advantage.

Snow day.

Sick dog; long night.

Pep talk.

This same time, years previous: pozole, no-knead sourdough bread, doing stupid safely, all the way under, just do it, home education series: the things people say, GUATEMALA, snapshots,

Upon the recommendation of my cheesemaking group, I ordered a new book: The Art of Natural Cheesemaking by David Asher. The group warned me that the author was a bit rabid about the right way to make cheese. No freeze-dried cultures, they warned me. No plastic. Only fresh raw milk.

I hesitated — purists irritate me — but finally I ordered the book. And then I read every single page, some of them out loud to my (uninterested) husband, until, just this week, I finished the book. I even read the appendices. Every few pages, I’d shout Now I get it! Or, Listen to this! Or, Can you believe…? The other afternoon when I yelled I’M LEARNING SO MUCH, my younger son who was up in his room teaching himself about binary numbers called back, ME, TOO. Our house was positively glowing from all the lightbulbs going off. Or turning on. You know what I mean. 

Here’s a brief summary of the book:

*Our food system is fear-based and highly industrialized, which means our food is being mass-produced in the most simplified, streamlined way for minimal variety and ease of production. The need for pasteurization comes about, not because raw milk is dangerous to consume, but because our milk is mass-produced from many cows, collected from farms and transported to the plant, processed into a uniform product, then packaged and shipped to stores. It’s how we handle the milk, not the milk itself, that is dangerous. 

*The addition of yellow dye began in the industrialized revolution when they needed a way to mask inferior cheese. Some people have no emotional attachment to yellow cheese, but I do. I made a white Colby and just looking at it makes me feel sad.

*There is no need for added molds and freeze-dried cultures. Just as grain holds all the components necessary to ferment into sourdough — and grapes for wine, apples for cider, and cabbage for kraut — raw milk contains all the good bacteria needed to culture milk into cheeses.  

*Instead of relying on freeze-dried cultures which are expensive, single-strain, and less resilient and flavorful (think GMO vegetables versus heirloom), use natural cultures such as kefir, yogurt, and buttermilk to start a cheese. Another option is to let milk sit out at room temperature to sour naturally, or use whey from a previous batch of cheese.  

*The basic cheeses can be categorized as follows: stretched-curd (mozzarella), alpines (Parmesan and Tommes), washed-curd (Gouda), cheddar, white molds (Camemberts), and blue molds. Learn to make a simple rennet cheese and, depending on how you care for the pressed curd (reheating and stretching it for slow mozzarella, cutting and stacking it for cheddars, letting it sit out to grow white mold for the camemberts), you can make all sorts of cheeses. Each one will be different from the one before, depending on all the little variations that occur during the cheesemaking process. Natural cheesemaking is not focused on conformity. 

I am not ready to toss out my vacuum sealer or dig a cave in my room, but this week I did scrape a bit of blue mold from a piece of sourdough, dissolve it in water, and add the water to a quart of yogurt which I then hung and proceeded as with yogurt cheese. Now it’s aging in the cold room. In a couple weeks, once (if) it grows blue mold, I’ll pierce it all over so the mold can work its way into the cheese.

And I started making kefir. (According to Mr. au Naturel, kefir rhymes with “deer,” so it’s to be pronounced Kuh-FEAR, not KEE-fur. It’s a hard habit to break.)

I got the grains from my friend down the road and quickly fell into a rhythm.

In the morning, I put a small lump of kefir grains — about a teaspoon or so — in a pint jar, top off the jar with milk and give it a quick shake. The next morning, the milk is solid, like jello. I schlub-schlub-schlub the contents into a strainer set over a mixing bowl and stir gently until all the kefir has dripped through and only the grains are left. I pour the kefir into a jar, date it, and pop it in the fridge. The grains go into a fresh jar and I start the whole thing over. 

^{grains in a clean jar}

^{top with milk, then shake}

^{twenty-four hours later}

^{stir through a strainer}

^{grains for the next batch}

The kefir grains keep multiplying, so every week or so I’ll dump half of them in the compost. I also keep a small jar of grains submerged in milk in the fridge. Like so, they should keep for weeks. If I ever need more grains, I just strain them out and start the process and, like a sourdough starter, after a day or two, they’ll be fully activated again. (Just this morning, I opened a small jar of milk-covered kefir grains from back in the beginning of December. The milk didn’t smell sour at all. Maybe a little sweet, if anything. How wild is that??)

The liquid kefir, I use either in smoothies, or in place of buttermilk in baking, or as a culture for cheese. Some people like to drink it, but not me. I don’t like how it tastes funky-yeasty and almost metallic. Purist Guy said you can’t detect the flavor of kefir in the final cheeses, but I’m not so sure. I think I taste something, like there’s a very slight “off” flavor. On the other hand, I might be detecting that because my cheeses are still fairly young. Maybe, after six months or a year, that flavor will disappear, or morph into something more complex. 

And that’s the other thing: it could be that this is just what real — excuse me: natural — cheeses taste like. Yesterday, after feasting on about 20 homemade cheeses (my cheesemaking group met at my house and we gorged), some of which packed a flavor funk-punch, I ate a piece of store-bought marbled Colby and was surprised to realize it tasted like absolutely nothing.

How many cheeses can you count? (And that’s not all of them.)

Because kefir is wildly good for you, and because it’s free, and because I love the concept of letting the milk do all the work — using the cheesemaking methods to tease out the different bacterias, yeasts, and molds that the milk already contains — I’m sticking with kefir for now. I have a hunch it’s the right way to go. And it does make good smoothies as long as I add a couple bananas, a generous scoop of jam, and a bunch of other fruit to mask the flavor. 

You might be asking, why use kefir as a culture and not yogurt? I use yogurt in Alpine cheese and that cheese is sweet and mild, with no weird funk whatsoever. The reason is this: Kefir is a mesophilic culture which means that, if you heat the milk to a higher temperature, above 106 degrees or so, it no longer works. So for my higher temp cheeses, like Alpine, I need to use a thermophilic culture, like yogurt, and for the lower temp cheeses, I need to stick with Kefir. (Or buttermilk! I haven’t tried buttermilk yet, but I plan to.) And some cheeses call for both meso- and thermophilic cultures — they kinda tag-team each other — so technically I can use both Kefir and yogurt for some cheeses, which I fully intend to soon do.

^{a fresh batch, ready to strain}

P.S. I like to pick at Asher, but truth is, his is a fabulous book. I wish I had read it back when I first starting making cheese. In my stack of cheesemaking books (I have five) it’s moved to the top.

^{and so on…}

Kefir

1-2 teaspoons kefir grains
1 pint milk

Combine and give a quick shake. Let the jar sit at room temperature. In the first twelve hours, give it a little shake once or twice, but then allow it to sit, undisturbed, over night. In the morning, it should be thick — it can be cut with a knife, but it feels more watery than yogurt. 

Dump the contents of the jar into a sieve and gently stir, forcing the kefir through into a bowl below and separating out the kefir grains. Refrigerate the kefir to drink, or use in cheesemaking or baking. The liquid kefir should stay good in the fridge for at least a week. (If using for cheesemaking, only store for several days.)

Put the grains in a clean pint jar, top with fresh milk, and repeat the process.

The grains will multiply. If you get too many, it throws off the balance and the kefir will get wonky, so every few days, throw out some of the grains (or give them away). (Or you can just increase the amount of milk, accordingly.) For a pint of milk, you’ll need anywhere from a teaspoon to a tablespoon of grains. More than that is too many. 

If you want to stop making kefir, place some grains in a small jar with fresh milk and refrigerate. Stored in this way, they should stay fresh for months. To use, simply strain out the grains and start the process (it may take a day or two for the kefir to reach full strength). 

This same time, years previous: this is who we are, the quotidian (1.14.19), through the kitchen window, quick fruit cobbler, starting today, inner voices.