Pausing for Menopause and Midlife Changes

A food-filled life is suppose to be gloriously glamorous, brimming with decadence, and overflowing with addictive deliciousness. Food writers don’t often discuss their physical challenges, especially lady issues.

Last week’s lively conversation about the Mediterranean Diet and culture got me thinking about midlife and menopause. Thanks to all who weighed in with context and personal stories. We agree about certain things, including the idea that no one likes to diet.

Diets aren’t fun and may also have unintended consequences. For instance, my husband had a friend who ate so many carrots that they developed orange-ish skin. One of my aunts took to drinking vinegar to keep her weight down. She remains skinny to this day and still has a sour disposition!

Silliness aside, in 2019, after turning 50 and finishing a successful, albeit hectic, book tour for Vietnamese Food Any Day, I noticed a funny bulge in my lower right abdomen area. My primary care doctor pressed on it and determined that I had a hernia. She sent me for blood tests, plus an ultrasound and consultation with a surgeon.

I’d never had surgery before. Women don’t typically have hernias. Between healthcare appointments, I freaked out and consulted with Dr. Google, who informed but also freaked me out even more.

I talked to my family. My dad lived with a hernia for decades. My brother managed his hernia without surgery too. My husband cautioned against lifting heavy objects.

Turns out I didn’t have a hernia. But I did break down in front of the earnest surgeon who reviewed my ultrasound and then said, “You don’t need an operation. Tell me what’s going on.”

I unleashed a garbled up story of my stresses and described how I ate and drank too many things in weird combinations because I’m curious and my work requires it. My blood tests showed that I was in the midst of perimenopause. I needed to slow down and change how I ate. The surgeon looked at me and said, “You know what to do. You can heal yourself.”

After sharing the news with my husband, he reminded me that he faced life changes during his fifties. “I think of it as my ‘man-o-pause’!” (It’s technically called andropause.)

Midlife has a knack for dealing you blows. You reconsider how things have been for the first half of your life and how you’re going to get through the next half, hopefully with more joy than pain.

Calling All Midlifers!

I began reading up on menopause and asking other women (family, friends, and acquaintances) about their menopausal experiences.

My mom said that menopause was a western notion. “We didn’t know about it in Vietnam. It didn’t exist. It’s just life. Keep busy and you’ll manage.”

Mom is such a bad ass. I’m a Vietnamese American wimp.

One of my sisters, a doctor, primarily experienced symptoms in the evening when her hormones tended to cycle. Whether or not it’s shared genetics or simply psychosomatic, I had most of my perimenopausal symptoms after five p.m. — Hormonal Happy Hour!

My neighbor said that her family and the elementary school kids she taught endured her wrath before she resorted to hormone replacement therapy. A 77-year-old lady shared her mother’s O.G., drug-free tip: put an an ice cube on your tongue to get through a hot flash.

Menopause initially confounded and confused me. The terms thrown around — perimenopause, menopause, post-menopause, were distinctive but the experience itself was often wholly discussed under the “menopause” umbrella. What phase was I in? Was I confused because I had menopause foggy brain?

I waited for hot flashes and night sweats. They thankfully didn’t happen.

However, I had other symptoms like tingly legs (paraesthesia), itchy skin, insatiable thirst, intense headaches, and random skin rashes and breakouts. Did I have a dread disease? Relief arrived from googling “fill-in-the-blank-symptom and perimenopause” to realize a potential cause and effect.

There were days when I felt tired. There were stretches when I felt like my BEST self ever.

Biocultural differences and a personal path

As I kept researching menopause, I kept returning to my mom’s response. Research papers have been written on western perceptions of menopause as a negative departure from youth, fertility, and productivity. Other cultures perceive menopause as part of the life continuum. No one denies that there are bodily changes going on, but how you deal with them matters.

For example, Traditional Chinese Medicine handles menopause as a kidney deficiency and imbalance between yin and yang. In Japanese, the term konenki (menopause) denotes a time of renewal and energy.

The very helpful North American Menopause Society’s guidebook (cover below) clearly states that there’s no cookie-cutter menopause experience. While there are similarities, each person has their unique path.

Among my goals was to achieve and maintain a healthy weight, but I didn’t want a restrictive diet.

Cooking and Eating for Menopause

Many dietary suggestions for dealing with menopause point to the Mediterranean diet. That may be easy for some but I didn’t fully identify with it. I needed healthy habits that I could sustain for the long haul.

The Mediterranean diet’s basic parameters — lots of vegetables, whole grains, a little meat, and minimal processed foods made sense but was applicable to many other culinary traditions too. I also looked into anti-inflammatory foods (hello ginger and turmeric!).

What did I enjoy? What would make me feel better? What worked for me intuitively, based on my life experiences?

I naturally found answers by playing around with Vietnamese food. My strategies involved:

• Crafting satisfying vegetarian versions of Viet classics

• Using less animal protein in iconic dishes without compromising flavor

• Adding easy vegetarian sides to meals to pump up the plant-based quotient

Perimenopause got me developing recipes that resulted in Ever-Green Vietnamese. If you have the book, you’ll know that incorporating more plants into my lifestyle helped me get through that phase and shed about fifteen pounds.

I thought it would be hard to do because I was reframing how I cook and eat. But it turned out to be creative and joyful. I found happiness in pushing meat to the side and making room for more vegetables. I did it on my terms, within the scope of my cultural preferences.

Two weeks ago, I went to a gynecologist for the first time in decades. My goal was to explore post-menopause and hormone replace therapy (HRT). My lady friends and I have been discussing our options. Even though I didn’t have classic symptoms, did I need HRT for a smoother, more vibrant road ahead?

The doctor asked about my peri- and post-menopausal situation, including my eating and exercise routine.

“How much soy do you eat?” she asked.

“There’s always tofu in my fridge,” I said. “I grew up with it. Years ago, I wrote an Asian tofu cookbook.”

“You probably had less severe menopause symptoms because you’ve been eating soy for most of your life,” the doctor said.

Wait up. If you can impact symptoms with lifestyle choices, why is there so much chatter and emphasis on drug therapies? My friends and I talk about HRT. Ladies at the hair salon do too. The 2024 Super Bowl prominently featured an ad for a menopausal drug. Gen-X 🔥 flash are 🔥.

“Making lifestyle changes to lower stress, get routine exercise, sleep well, and eat healthily definitely help lessen menopause symptoms,” the doctor said. “But if you’re a busy working mom, you’re likely not going to take that advice. HRT does help some women. But for you, I suggest you wait and see.”

I left her office feeling validated about the choices I’d made.

Five years ago, I was scared. My body forced me to pause to reflect, take care of myself, and plan for the future.

Transitioning into post-menopause, I feel more aligned with konenki and have experienced a renewal with greater energy, empowerment and liberation. I’m not done yet but I think I can find my way.

Coming Up: Tofu Mini-Series

Circling back to the gynecologist’s comment about soy, I do happen to know something about the subject. I’ll be launching a tofu mini-series — Tofu Thursdays or Soy Sundays, depending on the day the dispatch lands in your inbox.

Why? Because people talk about including tofu in healthy habits but few people tell you how to do it. The mini-series will last a month or so and be mostly for paid subscribers.

Regardless of gender or phase of life, if you have specific tofu questions, ask away.

If you have menopause or andropause stories, do share! For instance, ow did you deal with symptoms?

[December 2024 follow-up]

Months after this dispatch, I wrote about my decision to go on hormone replacement therapy and what that like. Read about it and share your insights with all of us here: Menopause Revisited: The HRT edition.