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.

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).

Last week a NY Times article popped into my inbox. “The only ice cream recipe you’ll ever need,” it said, so naturally, I clicked. 

Turned out Melissa Clark was the one making the bold claim.

Now I like Melissa. Melissa knows her stuff. But a quick scan of the ingredient list revealed that Melissa doesn’t know everything. Her best ice cream recipe had eggs, lots of eggs, and — controversial statement incoming —  I don’t like ice cream with eggs in it. Raw eggs, maybe, but cooked eggs? Nope. I don’t like how they leave the tongue and roof of the mouth coated with a silky, cloying sheen of protein and fat. 

Not that I have any proof of this. It’s just how I feel. 

Also, there is no way a homemade ice cream made with real farm cream and real farm eggs would EVER be as white as the NY Times photo of Melissa’s ice cream. Not that they were claiming to use anything but insipid store eggs, but still. If I made her ice cream, it would look more like frozen orange juice than vanilla ice cream. 

So anyway. Melissa, if you’re reading this, listen up: My vanilla ice cream is the only one you’ll ever need and therefore, I heretofore challenge you, you wondrous dear kitchen goddess of a chef you, to an ice cream duel using farm-fresh cream (and eggs, if you must). Let’s do it proper-like, with a rollicking, friendly churn-off. I bet you five bucks I’ll win.

My recipe is no secret, and it’s not even actually my recipe: it’s Jeni’s of Jeni’s ice cream fame, and I’ve been making it for years. In fact, I’ve made it so much recently that I scribbled the ingredient list, quadrupled, on a piece of scrap paper and taped it to the inside of my spice cupboard.

Why, you ask, have we been eating an ungodly amount of ice cream? Because:

1. We are milking three cows. 
2. SUMMERTIME.
3. It’s delicious.

It’s gotten so bad, in fact, that I’ve turned into an ice cream pusher, tossing random containers at my son sometimes even right after breakfast, and begging him to please finish them off. Or he’ll come into the kitchen complaining that he’s hungry and ask to make popcorn or a sandwich and I’m like, No, but how about some ice cream? Here’s a quart. Eat the whole thing.

Anyway, a quadruple recipe makes a gallon of base which I then store in the fridge.

Every morning and night for two days straight, I churn up a new batch of ice cream: mint chip, cookies and cream, berry crunch, vanilla bean, etc, a schedule which allows the ice cream canister to refreeze between churning sessions. Aside from the wait between churnings, my little ice cream maker had issues with the outside edges freezing faster than the rest of the ice cream and required a bit of side-scraping mid mix. Plus, it only made a quart at a time which made prepping for a crowd a bit cumbersome.

But then Reason 4 happened: friends gifted us an electric ice cream churn (Ebay: most similar, Amazon: kinda similar) and I about vaulted out of my skin with glee.

This new ice cream churn makes a full gallon of ice cream at a time, uniformly freezes it from top to bottom and inside out, and is entirely hands-off (aside from periodically adding more ice as it melts down). I set it on the deck, plug it in, and then walk away and about 45 minutes later it stops. I then divide the ice cream into different containers, swirling in whatever fruit sauces, chocolates, and ripples my little heart desires.

Newsflash: Feeding a crowd is no longer a problem.

***

A few things to note about add-ins…

Chocolate pieces
Do not add chocolate chips. I repeat, do NOT. That’s a rookie mistake. Chips are like waxy rocks when frozen. Instead, melt a cup of chocolate chips with 1 tablespoon of coconut oil over a double boiler. When smooth, spread the chocolate in a thin layer on a parchment-lined cookie sheet.

Refrigerate for a couple hours and then, working quickly (it melts fast), peel up the sheet of chocolate and chop it into small shards.

Store the chocolate flakes in the fridge or freezer and sprinkle/swirl them into ice cream for a perfectly textured bite of chocolate.

Brownies
Underbake a pan of brownies — this is my go-to recipe —  and then crumble or chop them into small pieces and store them in the freezer. Layer/swirl these into the ice cream or, alternatively, use them as an ice cream topping. However, I think they taste better, more a part of the ice cream whole, when mixed in with the ice cream and then frozen together.

Peanut Butter
I’ve tried different peanut butter swirl recipes but the best one so far is just plain creamy peanut butter heated in the microwave until melty and then drizzled into the ice cream. It’s still not quite as good as the peanut butter in Turkey Hill’s peanut butter swirl though, so if anyone is sitting on the perfect copy-cat recipe, tell me.

Marshmallow
Marshmallow minis get chewy and hard in the ice cream — not great — so I tried fluffernutter.

peanut butter and fluffernutter

It was pretty sweet but the marshmallow cream worked much, much better. 

Oat Crunchies
This recipe. So good. The end.

Cheesecake
I haven’t tried this yet but I’m thinking some chopped up homemade cheesecake sprinkled throughout might be kinda awesome. But would the texture get weird in the freezer?

Nuts
I haven’t added any recently — I don’t have any on hand — but I’m on the lookout for smoked almonds and honey roasted peanuts. I think they’d be a lovely addition to a Rocky Road sorta situation.

Oreos
Do not add these to the ice cream while mixing; the crumbs turn the ice cream an unappealing grayish color. Instead, chop, sprinkle, and then swirl into the finished ice cream.

Candy
Butterfingers, Snickers, toffee, peanut butter cups, chocolate-covered pretzels, etc, etc, etc: chop ‘em up and swirl ‘em in!

Butter Almond
Omit the vanilla and add 1 teaspoon almond extract and 1 tablespoon amaretto. Make buttered almonds (1 cup slivered almonds toasted with 3 tablespoons butter and 2 tablespoons sugar and then sprinkled with flaky salt) and layer them into the churned ice cream. (See the whole recipe here.)

Fruit Sauce
I’m still not fully satisfied with my standard fruit sauce. Despite cooking it, adding gelatin, and thickening it a bit with cornstarch, it still gets icy. There’s gotta be some unpronounceable chemical that ice cream companies add to their ice creams to eliminate the icy factor, but I just don’t know what it is.

***

The Final Word: A Cautionary Tale
When serving ice cream with lots of yummy add-ins, it must — I repeat, MUST — be fully frozen.

Saturday, I made a big batch to take to a family gathering. I layered and swirled the ice cream with homemade brownie chunks, warmed peanut butter drizzle, chocolate shavings, and chopped oreos and then popped it in the deep freeze until the evening’s cookout.

I thought for sure the few hours in the freezer would be sufficient time to let it firm up, but I was wrong, wrong, wrong. When I went to scoop it into cones, it was still slumpy soft.

a barely passable scoop: it’s hard to see in this photo just how soupy the ice cream is

The ice cream I’d so looked forward to felt disjointed; the base was unable to support the chewy brownies and creamy peanut butter which gave the ice cream a weird mouth-feel. I was crushed.

The next day, the leftover ice cream had firmed up all the way through and was a TOTALLY different gustatory experience and much more satisfying to eat.

So take note. Don’t make my mistake.

And one more thing: when ice cream is super cold, it may get crumbly. Set it in the fridge for 25 minutes prior to serving, or wrestle it into balls and then let them sit for a few minutes at room temp before digging in. Allowing the ice cream to soften ever so slightly elevates the eating experience exponentially. Trust me.

***

Update, July 2024

• The key to the perfectly emulsified ice cream? After making the base, while it’s still hot, give it a thorough beating with an immersion blender. My ice creams have never been creamier! THIS IS HUGE, PEOPLE.
• To eliminate the problem of icy fruit, soak the fruit in vodka! (Thank you to those of you who pointed me to the answer to my conundrum!). Generally speaking, it’s a cup of minced fresh fruit, a half cup of sugar, and a quarter cup of vodka: macerate for 24 hours, strain off the liquid (and save it — see below!), and then add the fruit to the ice cream at the end of churning. The fruit stays soft and does not taste like alcohol. 
• Skip the Reese’s Pieces. The color comes right off and they’re too crunchy hard in the ice cream.
• If using peanut butter cups, cut them up, even if using the mini cups. A mouthful of a PB cups, no matter how much you like them, is not a good thing in ice cream.
• Salted smoked almonds, chopped up, are yummy and make a good Rocky Road version when added to vanilla ice cream along with marshmallow cream and chocolate flakes.
• Figuring out the correct amount of peppermint extract for mint chip ice cream is seriously tricky. Most recently, I bought this extract which comes with a dropper which has a good flavor. However! I’m giving up on suggesting a specific amount to add. Do it to taste, and, if possible, have several people do the tasting as repeat mint tastings tend to dull the senses a bit. (Update 1/2/25: I broke the code! Per recipe, use 8-9 drops of this peppermint oil. It’s perfection. And one more thing: the problem with the peppermint extract was that it was fairly weak and expensive, so I burned through it far too quickly. The oil is much better.)

This same time, years previous: buttermilk sugar biscuits, strawberry rhubarb pie, the butter conundrum, sugar-crusted popovers, the coronavirus diaries: week twelve, stuffed poblanos, the quotidian (5.28.18), a few fun things, butter chicken, an evening together.