Peri-menopause and Fibroids

I've dithered around writing about this but as the year comes to an end it's been such a big feature, especially of the last few months, that I think I probably ought to if for no other reason that one day I'll hopefully be able to look back and think about how glad I am it's over.

There are a lot more books available on menopause and women's health than - well, ever, I suppose. It gets talked about more on television, and advertised more on social media - at least if you're a woman of a certain age, and most of my female contemporaries will make comments about their hot flushes and brain fog. There's a lot of talk about HRT - who it's working for, who's still struggling to get the right balance with it. But really I don't think much has changed. 

My mother, along with a lot of her contemporaries/sisters/the mothers of my teenage friends had a hysterectomy in her early 40s. It seemed to be the go-to option in the 1990s around here (they would all have been seeing the same handful of GPs, and referred to the same hospital) so there's a lack of family experience to call on. Even if that wasn't the case I'd have been away at university. Then home concentrating on jobs, a relationship that seemed serious at the time, and a busy social life when mum hit that age - I wouldn't have been paying any attention. When my grandmother hit that age my mother was living at the other end of the country raising a young family. Generations aren't gatekeeping this stuff, but we're not necessarily listening to each other either.

Regardless of vaguely progressive policies from employers (we have an App, how great are we!) the reality is still that a lot of women fear for their jobs - juggling teenage children, a suddenly unpredictable body and mind, a potential range of serious health issues that are embarrassing enough that nobody wants to talk about them, and added anxiety about sick leave, making mistakes, and being forced out of the workplace - it's not fun. My work is fairly good - mostly because there are a few middle-aged women around who are sympathetic and supportive. My previous job would have been impossible. 

I don't think the majority of my peri-menopause symptoms have been too bad - the weirdest ones are indigestion, splitting nails, an increased risk of static electric shocks, a need to write a lot more lists to remember what I'm doing, and so far manageable hot and cold flushes. Which is good because my GP hasn't been amazing about it so far. After several appointments with the practice gynecologist who insisted I was too young at 48, and then said any tests would be inconclusive at my age I did end up on an expedited endometriosis pathway. Expedited it still took more than a year to get a hospital appointment. It was not a good year due to extremely heavy periods that closer and longer.

Eventually there was an appointment with an examination and 4 attempts to take a biopsy sample. They failed and I had to go for another appointment for a hysteroscopy which is a perfectly foul procedure involving cameras, a lot of water, and entirely ineffective pain relief (they suggest you take paracetamol beforehand). It's painful, invasive, and undignified - nobody is much inclined to listen - medical opinion has been that a coil would fix everything but nobody (and my god have they tried) has managed to fit me with one. Despite making it very clear that I would not consent to another attempt the consultant was still offering to try until he had to admit that the position of the lemon-sized fibroid they found would make it impossible. 

He did get a useable biopsy sample, it instigated 7 weeks of heavy bleeding that landed me in A&E, I didn't get a blood transfusion but it was a very close thing. My iron and hemoglobin levels have not yet properly recovered. During all this I got a handful of contradictory letters. An appointment to have the fibroid sliced out - they will only do this under a local anesthetic here, then a letter to say it couldn't be done in one go so it was;t an appropriate treatment (relief). I can't have a hysterectomy because of previous scar tissue and other issues that haven't really been explained, there's a thing where they put miniature nails into the fibroid and hit it with an ultrasound but this often doesn't work depending on how firmly or otherwise the fibroid is attached - they have no idea how it'll go until they actually do the procedure. 

A chemically induced full menopause was an option but apparently, that's brutal until the right mix of HRT can be worked out. In the end, I was prescribed a newish drug that should mimic menopause but also has, I guess, an HRT element to it. I have started taking it today - side effects include initial heavy bleeding which I'm honestly terrified of. To me, that means floods of blood and clots every 10 - 15 minutes that make doing anything almost impossible for the 2 or 3 hours a day it often lasts and leaves me desperately tired and emotional as well as anemic. The interim pills I was prescribed have not been agreeing with me though, I have a follow up appointment in March to see how the first 3 months have been and a work week which should provide reasonable toilet access (this is the major consideration at the moment, and very hard to explain to anyone who hasn't experienced this sort of bleeding). It has to be now.

All of it makes me angry about the lack of research, lack of options, and lack of understanding for women in my position. The only place where there's much discussion of the new medication is Mumsnet - it's inconclusive but on balance encouraging - it might work, or at least if it doesn't do everything it promises it might do enough. we're half the worlds population, and a significant proportion of us will not sail through menopause. We deserve better treatment and we deserve it now. 

Happy Solstice and Basler Brunsli

I love deep midwinter and proper dark - I wouldn't mind it being a bit colder but at least it; 's saving me some money on heating, and the solstice seems like a natural time to celebrate - more so this year as my day off has fallen on it. I've been sorting out the last bit of Christmas preparation and that feels right too - this year's business is essentially wound up for me now (personally, not at work sadly).

I might read the first chapter of The Dark Is Rising tonight and follow it through in real time again, or I might not - I'm not putting any pressure on myself to do anything more than deal with the day job until New Year. 

The biggest job of the day has been bagging up all the Christmas biscuits I've been making over the last week or so ready to be given out to people over the next couple of days - lots of them for work. I was having a quick bedtime look through Anja Dunk's Advent book last night (for the rum and oatmeal truffles that a friend really liked and which I made today but not very well I think, I don't love them) when I saw the recipe for Basler Brunsli/ spiced chocolate hearts, an originally Swiss biscuit that has apparently been adopted with enthusiasm in Germany.

I can see why. I made them because they're gluten-free, something my repertoire lacks. I'm going to be adopting them with enthusiasm too. They're quick, simple as long as you have a food processor, delicious, and they keep well.

You need 200g of dark chocolate, 250g of ground almonds, 75g of light brown sugar, 1/2 teaspoon of cinnamon, 1 tbsp of Kirsch or brandy, 2 egg whites, a pinch of fine sea salt, about 2 tbsp of demerara sugar, and some icing sugar for rolling them out with.

Blitz the chocolate in the processor until it resembles coarse sand, and everything else apart from the demerara and icing sugars, and mix until the dough comes together. This is a sticky dough but it doesn't need much handling so it could be worse. Divide your dough into 2, generously sprinkle some of the demerara on your work surface and roll the dough to about 1 cm thick. Cut with a smallish heart cutter - Anja's recipe says it makes 50, I got 30 so I think I was using a larger cutter but I'm okay with that, and place on a baking tray about 1cm apart. They don't spread much which is also nice. Carry on with the second half of the dough and then the leftovers. 

Bake for about 15 minutes at 130C fan oven (which is what I have) 150 conventional. They're ready when they feel dry-ish to touch but are still soft. They firm up as they cool. This is a chewy, crunchy, biscuit with a deep chocolate flavour nicely complimented by the cinnamon and fudgy demerara notes. They're not overly pretty and I like them as a potential mince pie alternative if mince pies aren't your thing but you still want to do a bit of baking. Mostly though they're great with my coffee and looking forward I see this as the fate of any plain easter chocolate that comes my way. 

Suddenly At His Residence - Christina Brand

This is my second nomination for Cross Examining Crime's reprint of the year. I wasn't totally convinced by the first Christina Brand I read, but I really liked 'Suddenly at His Residence', maybe because I was ready for her style and characters, and maybe because this was a slightly earlier book with slightly different mannerisms. 

Sir Richard March's grandchildren have taken their various leaves from blitzed London to gather at Swanswater, the family home for the anniversary of their grandmother's birthday. When she was alive Sir Richard was happily carrying on a suburban sort of an affair with Belle, whom he's now married too. She is tasked with maintaining Swanswater as a shrine to Serefita who had been a glamourous, though maybe not overly talented, ballet dancer.

The grandchildren mostly lost their parents in the First World War so Sir Richard and Belle also stand as parent figures, and for Peta, daughter of the eldest son there's the chance of a sizable inheritance which is making her hopes of a romance with the young family solicitor complicated. There's also Philip, married to Ellen, who's having an affair with his cousin Claire, and Edward, Belle's grandson who has worked himself into the belief that he's got serious Freudian issues to resolve.

Not then a particularly happy family party that gathers. Their various squabbles and the revelation of the Philip/Claire/Ellen situation to an outraged Sir Richard has him deciding to change his will as a matter of urgency. Unfortunately by the morning, he's dead and the new will is missing. The family are forced to concede that one of them is guilty and there's a nerve-wracking time finding out who, and what their motivation was.

I liked this so much because almost everybody is unbearable with the possible exceptions, in my opinion, of Ellen, Stephen, and maybe Belle - the outsiders in the March family. They bicker, suspect each other, plot, come together to protect each other, and generally behave as a family does. Except that one of them is a murderer. Their manners and actions are as callous as you might expect from the same generation today (although a relationship with your cousin would be unacceptable) and the ending is appropriate as well as dramatic - if heavy on the symbolism. 

In short it's a book that really resonated - and heavens, would it make a fabulous change to another Agatha Christie adaptation. I will watch the new one, I'll enjoy it, but we don't really need it, whereas here we have a plot and a set of characters that really do lend themselves to the darker interpretations of Christie we keep getting. 'Suddenly at His Residence' has a genuine emotional punch beneath it's flippancy and I loved it. 

In A Lonely Place - Dorothy B. Hughes

It turns out that it's almost exactly 13 years since I first read 'In A Lonely Place', it's stayed with me ever since, and after this summer's reprint, I've been recommending it to anyone who stands still long enough at work. Kate's reprint of the year awards has been the perfect excuse to revisit. 

Dorothy B. Hughes is a fabulous writer of Noir who deserves the same kind of recognition as Raymond Chandler, but hasn't yet got it. Her books are available, but not in a collectible smart set, or even reliably in paperback. As 'In A Lonely Place' is easily available right now, and also quite short it's a very good place to start though. 

It’s not without faults; the end is sort of rushed and not entirely convincing but basically it’s a thrilling, chilling, very hard-boiled, and nicely twisting story. It opens in the middle of a sea fog with a man watching a woman thinking about how he might approach her, how she wouldn’t be scared – at first. This is Los Angeles in 1947 and a serial killer is on the loose, every month a girl is raped, strangled, and dumped and he’s clever enough to leave no traces. This is the situation when two old war comrades meet, Dix Steele and Brub Nikolais. They flew together in the air corps – for one man the war was the high point of his life and he’s come out without a job or purpose. The other has put it behind him, is married, and an up-and-coming detective. I can’t say anything else without giving far too much away and hope I haven’t done so already.

From the very first page, it seemed clear who the guilty party was going to be, it also seemed equally likely that this was a red herring – which Hughes is a mistress of. She's very capable of wrong-footing me which is something I love in this context. Atmosphere and the ability to create a palpable sense of tension are her other strong points - reading that opening scene as a woman you immediately know how the girl in the book feels walking down a dark street becoming aware of a man's step behind her in the fog. If I ever doubted how his pleasure in her fear is described the internet has since proven over and again that she was spot on. 

It was a slightly different world when I first read this book, I'm not sure I fully appreciated how Hughes captures the misogyny of her anti-hero but it really struck me this time. As a reader I was constantly aware of his mood, his anger, the threat he poses - it's a masterclass.

This is a dark, tense, entertaining read which provides an excellent antidote to seasonal gaiety. You will not regret giving Hughes a chance, it's a perfect bit of Noir. There's also a film version with Humphrey Bogart which is worth searching out after reading the book. It's different but still good. 

Shetland Wool Adventures Volume 5

There will still be time to get a copy of this before Christmas, and I highly recommend it. Mine arrived today - more treats from Shetland which are making me feel as spoilt as I am homesick. 

There's a slight change of format to this Wool Adventures Journal - there's only 4 patterns this time, all of them appealing, but as I mentioned a week or 2 back, the Noness beret is the one that I'm really keen to get started on. There are lots of recipes from 2 excellent cooks - Misa Hay (whose journal it is) and Elizabeth Atia, and some really great articles, plus great book reviews of course. 

One of the featured walks is around my patch of Shetland, and anybody who's stayed at Burrastow House will have the added kick of some familiar views. There's also a piece on Angela Harding who visited Fair Isle and Shetland this summer - she lives in Rutland which is the next county over from Leicestershire and my 50th birthday present is going to be one of the prints inspired by her stay on the westside. 

It's sitting face to the wall at the moment, the framers didn't wrap it and it seemed silly to use lots of my own paper, but I'm very carefully not looking at it until next Wednesday when it's officially mine. The interview with Harding feels well timed - sometimes a thing really does feel like it could have been written specifically with me/you in mind. 

Altogether you get a lot for your money here and support a brilliant local business at the same time. Do check them out HERE

Wild Shetland - Brydon Thomason

I thought I'd be taking the weekend off from blogging, but there was something amazing waiting for me when I got home and in turn I can't wait to share it with you. It's also made me feel like December really will change up the litany of bad news that November contained. Fingers crossed anyway.

The book is a review copy of Wild Shetland from published by the Shetland Times. It's currently reprinting so I'm feeling even luckier to have been sent a copy. Brydon Thomason is a photographer and wildlife guide in Shetland - follow his Facebook page for samples of his work - this collection is fabulous. 

It's a splendid coffee table book for anyone with an interest in nature photography or Shetland, it's also a seasonal guide to both the biggest, best, and most iconic wildlife you might see in the islands along with some of the smaller things you might ordinarily overlook. It also has plenty of elegantly presented information about both subjects and place. 

I will always think of Shetland as home, and much as I miss the summers with their long hours of daylight and the few luminous hours of twilight in between, in many ways it's the winters I miss most, both for the rare calm days of grace, the dark, and for storms you can't ignore. Winter might well be my favourite section of this book.

Anyway - if it sounds like something you might like - and I cannot enthuse enough about some of the images in here - keep an eye on The Shetland Times website for when it's back in stock. You can order through Waterstones too when it's back in stock but they don't do the lovely wrapping that The Shetland Times does when they send things out.