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Estrogen influences serotonin, dopamine, glutamate, and noradrenaline. It is involved in cognitive function. Its diminishment can impair verbal dexterity, memory, and clarity of thought. Recently, scientists discovered that estrogen is also produced in the adrenal glands, breasts, adipose tissue, and brain. This is astonishing. But so is the extent of the unknown. Peri-menopausal women whose periods may be irregular, who have symptoms, but who are not yet post-menopausal are twice as likely to have depressive symptoms or depression than pre-menopausal women.

ISBN 13: 9780091856502

Peri-menopausal women who were vulnerable to depression during the menstrual cycle are more susceptible to depression when they enter menopause or its hinterlands. This is accepted, but there is disagreement about how to fix it. Studies show both success and failure when women are given estrogen to counter depression. Controversy exists over whether the menopausal transition is a risk factor for the development of depression, I read.

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Because I have a womb—though it is likely of no use for fertility, thanks to the endometriosis—I also take progesterone for ten days a month. This induces the womb to shed its endometrium, which may otherwise thicken to cancer-risky proportions. So I still bleed, and choose to. I knew from my research that the gentlest version of progesterone is micronized, something that my doctor had to look up. Look at me looking at the pile and you will think, Just pick it up.

I look at it, and the thought of accomplishing anything makes my fear and despair grow. Every thought brings on another and that prospect is frightening. All those thoughts. I write that down and I feel stupid and maudlin and dramatic. I feel terrified. I have no reason to feel fear. Still, I set off on my bicycle to my writing studio.

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I hope I can overcome the day. I always hope, and I am always wrong. I have done nothing of use all day. Every now and then, I stop doing nothing and put my head in my hands because it feels safe and comfortable, like a refuge. I look underneath my desk and think I might sit there. There is no logic to this except that it is out of sight of the door and no one will find me.

Even so, when the phone rings I answer it. Then she asks me whether I want to accompany her to a posh dinner, several weeks hence. Because I am a duck: talking serenely above, churning below, the weight on my chest, the catch in my throat, the inexplicable distress.

‘It Feels Like a Derangement’: Menopause, Depression, & Me

This is not her fault. There is no room to spare. I stay there for a while, sitting on my couch, wondering how to face cycling home or leaving my studio or opening the door. All these actions seem equally impossible. It takes a while but finally I set off. I have learned. On days like this, there are only two places to be. One is in my darkened bedroom with my cat lying next to me.

On days like this, she takes care to lie closer to me than usual because she knows and because she loves me. Maybe my darkness has a smell. These are the safe places because everything is quiet. On days like this, I wonder if this is what autism feels like, when sensation is overwhelming. Not just noise, but thoughts, sights, all input.

It is on the bad days that I realize what a cacophony of impressions we walk through every day, and how good we are at receiving and deflecting, as required. Every day, we filter and sieve; on the bad days, my filters fail. I sometimes call these bridge days, after a footbridge near my studio that goes at a great height over the busy A64 road.

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On days like this, that bridge is a danger for me. I am not suicidal, but I have always had the urge to jump. This is a thing with a name. HPP: high places phenomenon. The A64 is the opposite of emptiness, but still, it is a danger. The one that mutes the call of the HPP. I avoid the bridge. I cycle home, trying not to rage at drivers who cut me off and ignore me.

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I have no room for rage along with everything else. Thoughts that would normally flow now snag. Every observation immediately triggers a negative thread, a spiral, and a worsening. On a good day, I can pass a child and a mother and think, How nice.

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  8. Nothing more. It goes on and on. Snagging thoughts that drag me down, that are relentless. When I get inside my house, I cry. I try to watch something or read, but nothing interests me. This is called anhedonia and is a symptom of depression: the forgetting how to take pleasure. The best thing to do is sleep away the day, as much as I can. Toward evening, I begin to feel a faint foolishness. This is my sign. Shame at the day and at my management of it. When I am able to feel that and see that, I am getting better.

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    Now I manage to watch TV, though only foreign-language dramas. Without the filmmaking industries of northern Europe, my menopause would be even bleaker. Foreign words go somewhere shallower in the brain; they are less heavy. But soon I switch it off. I take a sleeping pill to get the day over with, so the better next day can begin.

    Twenty-four hours earlier, I had been wearing a Santa hat, running for five miles through icy bogs on a Yorkshire moor, happy to be doing that for fun, happy to be alive. April 4. Sleep mostly OK; a few days of melatonin after stopping progesterone. Last night I was exhausted but slept badly. Mood difficult but not dreadful.

    Angry and irritated. No bleed after progesterone. Peeling skin. Weepy and panic now.