From The New York Review of Books:
Menopause: the ceasing of menstruation or the period in a woman’s life (typically between forty-five and fifty-five).
I stare stupidly at it. It’s nothing much to look at. It’s only a small pile of clothing: the shorts and tank top that I wear in bed, which I have thrown onto the floor before getting into the shower. I stare stupidly at the clump because I can’t pick it up. It’s astonishing I managed to shower, because I know already that this is a bad day, one when I feel assaulted by my hormones, which I picture as small pilots in those huge Star Wars armored beasts that turn me this way and that, implacable. On this morning, I wake up with fear in my stomach—fear of nothing—and I know it will be a bad day.
For a while, I thought I could predict these days. I have had practice. This is my second menopause: the first was chemically induced seven years ago to treat my endometriosis, a condition that has riddled my insides with adhesions of endometrial tissue, and stuck my organs together. The adhesions are exacerbated by estrogen; the drug switched it off. (The same drug can block other hormones and is also used to treat pedophilia and prostate cancer.) I hated that menopause; it was a crash off a cliff into sudden insomnia and depression and a complete eradication of sexual desire. “The symptoms will last six months,” said the male ob-gyn, with a voice he thought was kind but that sounded only casual. They lasted far longer. The nurse giving me the first injection said, “He keeps prescribing this stuff, but women hate it.”
This menopause is the natural one. I’m two years in. It doesn’t feel natural. It feels like a derangement. With each menopause, I have chosen to take hormone replacement therapy (HRT). The first time because I wanted my sleep back. This time because I spent a year researching menopause for a magazine article, and because I have weighed the risks and judged them acceptable, and because I know what happened last time, when I was broken. The two occasions when I asked for HRT are the only two on which I have cried in a doctor’s office.
Every Wednesday and Saturday, I take two 100mg transdermal patches of estradiol (a form of estrogen). I fix them to my abdomen, swapping sides each time. They never fall off, though I go running for hours at a time and sweat. This is the maximum dose of estrogen, and it took about a year for me to understand I needed this amount, a year of peeling skin, sore tendons, poor sleep, awful sadness, inexplicable weeping, and various other “symptoms” of menopause that you can find listed if you look beyond the hot flashes and insomnia. (I don’t know why Americans say “flash” instead of “flush”; I prefer the British-English word, less fleeting than a flash, a better fit for that rise in temperature, violently sudden and overwhelming, that makes you feel as if you had never been cool or would be again.) Estrogen is more powerful and more wide-ranging than is assumed, and its removal or diminishment brings effects ludicrously understated by “the change.”
. . . .
I can’t pick up the clothes. I can’t explain the granite of that “can’t” to anyone else, the way it feels impossible to beat. Look at me looking at the pile and you will think, Just pick it up. For fuck’s sake. But I don’t. 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. A privileged freelance writer who does not have a full-time job that requires her presence in an office and can be indulgent of what the medical profession calls “low moods.” In fact, plenty of menopausal women leave their jobs, endure wrecked relationships, suffer, and cope. Or don’t. But I don’t feel maudlin and dramatic in the bathroom, or on any other of a hundred occasions over the past two years. I feel terrified. I have no reason to feel fear. But my body acts as though I do: the blood rushing from my gut to my limbs in case I need to flee, leaving the fluttering emptiness that is called “butterflies,” though that is too pretty a description.
Still, I set off on my bicycle to my writing studio. I hope I can overcome the day. I always hope, and I am always wrong. A few hours later, I find myself cowering in my workspace, a studio I rent in a complex of artists’ studios, scared to go downstairs to the kitchen because I can’t bear to talk to anyone I might find there. 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. I shouldn’t, but I am hopeful that I can manage it and mask it, and I haven’t spoken to my mother for a few days and would like to. It goes well for a few minutes, because I’m not doing the talking. Then she asks me whether I want to accompany her to a posh dinner, several weeks hence. She doesn’t understand when I ask to be given some time to think about it. “Why can’t you decide now?” I say it’s one of the bad days, but I know this is a mixed message: If it’s that bad, how am I talking on the phone and sounding all right? Because I am a duck: talking serenely above, churning below, the weight on my chest, the catch in my throat, the inexplicable distress. I try to explain but I’m also trying hard not to weep, and so I explain it badly.
. . . .
It takes a while but finally I set off. I know where I’m going. 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.
The other place to be is in unconsciousness.
. . . .
I sometimes call these bridge days, after a footbridge near my studio that goes at a great height over the busy A64 road. 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 French call it “l’appel du vide.” So very Sartre of them: the call of emptiness. The A64 is the opposite of emptiness, but still, it is a danger. Today I don’t have the filter that we must all have to function: the one that stops us stepping into traffic or fearing the cars or buses that can kill us at any time. 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. 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. Nothing more. Fleeting. Unimportant. On a bad day, I see the same and think of my own infertility, how I have surely disappointed my mother by not giving her grandchildren; how it is all too late, and what have I done with my life, and my book will be a failure and today is lost and I can’t afford to lose the time. It goes on and on. Snagging thoughts that drag me down, that are relentless.
Link to the rest at The New York Review of Books
PG claims no expertise on this subject, but has family members, female and male, who have had severe mental illness and knows the illnesses are real and can be disabling.
It took him some time to fully understand that our perceptions of the world can be strongly affected, even changed by the tiny, complex and transitory biochemical reactions that constantly occur between our brain cells. If some of those cells fail to operate properly and the chains of chemical interactions become disrupted, an individual can have her/his most fundamental thoughts disrupted, sometimes in substantial ways.