Progesterone intolerance: Loss of enjoyment

• affects 1 in 5 women • likely if you get bad PMS • damaging & avoidable Effects include depression, weeping fits, irritability, aggression, paranoia, guilt, panic attacks, loss of enjoyment, loss of inhibition, self-loathing Progestogens are in... • the contraceptive pill • the contraceptive injection • the contraceptive implant • the Mirena coil • some HRT It's a key treatment for endometriosis. Read more...

This series of posts highlights the effects of progesterone intolerance, from my personal experience. They are not medical advice. Medical professionals: it's important to understand the severity of progesterone intolerance and the damage it can do. If you think you are progesterone intolerant: avoid taking progestogens if possible and find a sympathetic doctor. If your doctor dismisses your symptoms, change doctor.

Loss of enjoyment. It sounds like nothing. An "Oh, dear" at most. For me, this is by far the worst effect of progesterone intolerance – and the most destructive.   Progesterone inhibits reward responses, which give us a sense of pleasure or enjoyment.  Without that, making decisions is extremely difficult (not to mention risky) and life loses its purpose.  Trying to 'fix' that, without knowing what's actually wrong, can destroy one's life.

Progesterone and oestrogen are effectively the two halves of a woman's cycle – oestrogen builds in the first half, up to ovulation, and then progesterone takes over from ovulation to your period. Research into rewards and the menstrual cycle found that progesterone lowers women's reward responses, the "yes!" we get from doing something we like or are addicted to. 'Woohoo!' cried the researchers. 'We can use it to stop women shopping and taking drugs!' But as Emily Anthes's article notes,

If progesterone is blunting the effects of rewards, it could spur women to engage in more pleasurable activities–such as impulse shopping–just to generate the same 'high''.

Amidst the compulsion to see women as compulsive shoppers and beings whose behaviour can and should be controlled, an intensely important issue is entirely overlooked: progesterone lowers women's abilities to experience neurological rewards.  When you are progesterone intolerant, this can become severe and turn into total loss of enjoyment, or "anhedonia".

The reward response is the interior "yes!"   How much one relies on that interior "yes!"  To know you're enjoying an evening.  To know you're full.  To know the caffeine's hitting the spot.  To know the wine is having an effect.  To know you like your friends.  To know an idea's good, to know a plan is worth pursuing and should work.  Meanwhile, the interior "NO", that note of warning, is unreliable: sounding more and more often, more and more loudly, ringing the bells of anxiety, guilt, fear, but could be, probably is, paranoia.

It's astonishing how little can be objectively decided, how reliant we are on that interior "yes" and "no". Perhaps it should not be so astonishing, because whether we like it or not, emotions are how we make decisions:

The limbic system forms an emotional core of the human nervous system ... The limbic brain has retained its function as the decider of valence [during the evolutionary process]. What the cortex does is provide more detailed analysis about what is going on in the world so that the limbic brain can decide what is important and what to do. (Cytowic, 1994: 157, 168)

It's so strange to try function without that interior guidance, without the "yes!" and closing your ears to the constant misfiring "no", like being a computer trying to pass the Turing test, constantly needing to check in with real human beings, who have access to proper feelings, to check you're doing it right.  I need it right now, writing this, to know which personal painful excerpts to include to best illustrate this ("yes") and which are too personal ("no").  And some are exceptionally painful and personal: lacking access to that "yes!" can be disastrous, because that's how we judge things are working.

The food's not working, so you have some more. The wine's not working, so you try another.  The coffee's not working, so you try another.  The relationship's not working, so...  The degree isn't working, so...  The house isn't working, so...  The job isn't working, so...  The natural human response, if something isn't working and is bringing you no enjoyment and no reward, is to change it – but it's working just fine.  It's you that's not "working".  The natural human response, if you are without enjoyment and reward, is to look for it – but it is nowhere to be found, nothing brings it, and you're not yet ready to give up on life, not quite, so you keep trying.  The fruitless pursuit of pleasure can be immensely damaging.

The fact is, the food won't make you satisfied, just full.  The coffee won't make you excited, just jittery.  The wine won't make you happy, just drunk.  The music won't swell your soul, the scenery won't lift your spirits, the hug won't make you feel loved, the evening out won't bring you fun, the joke won't make you laugh, your work won't bring you satisfaction.  That sounds like a desolate list.  It may be horrible to experience, but it is good to know.  Nothing is actually broke, so don't fix it – don't break everything, trying to fix it.

This is easier to do when you know what you're experiencing. If you don't know nothing's broke, if you don't know you're progesterone intolerant, if you don't know your reward responses are being blocked, you think it's all real.  From the age of 19 to the age of 25, that was my reality.  I broke things.  I remember the university coffee shop, sitting in coffee steam and cigarette smoke, trying to piece my reality together out of the fragments of everything I'd broken, trying to make sense of it and stitch my thoughts and myself back together word by word in my notebook.  I was so, so unhappy then.  And it breaks my heart to think it was all so unnecessary, just down to the pill, which I wasn't even taking for contraception, but because my doctor had convinced me it was keeping me stable and that without it I would be even crazier, more manic, more chaotic, instead of magically restored to my sane, calm, happy self within a month.  Instead, I flailed my way through hell, a hell increasingly of my own making, breaking everything in an increasingly desperate attempt to fix it.

You see, when you're anhedonic, you can't feel anything good.  Positive emotions just don't make it through.  But you can feel negative emotions.  And eventually, it's a relief to feel anything at all.

A year ago, I was in the grip of the same loss of enjoyment, anhedonia, but this time with the benefit of knowledge.  I drove to work with the wintery sunlight glistening through mist to gleam on water and catching on twigs, and looked it without response, numb.  The traffic crawled through perfect beauty and stopped; I looked at it and saw a field, a tree, some water.  The car in front would start moving and I would still sit, trying to find the will to put the car back in gear.  I had no reason to.  But I knew, this time, how to live like this: I knew how to stitch myself together with words in my notebook:

So here's the plan.  Hard-won experience tells me that however devoid of purpose life may feel, it does regain meaning at some point, so the thing is to keep the home fires burning – keep things in order & not contribute to any destruction.  So right now I can't imagine being able to write my novel, and plans for a holiday feel remote and blank, and the idea of wanting to earn money for anything in the future is utterly lacklustre because all the pull the future held seems to have vanished, snipped off.
I can't see or feel any purpose.  But I have to believe there is purpose.  And keep working towards my goals so that when meaning comes back, there's a well-kept, well-running, bright life waiting for it, in better condition than before.
There are things I can do by rote.  If this feels a bit like dot-to-dot of How To Live – well, that knowledge was damn hard won, so I'm not going to scorn it.

I wrote myself lists on how to live and followed them.  Lists of work, lists of housework, lists of how to rest, lists of how to socialise.  I put my head down, bereft and purposeless in a life devoid of meaning, and followed the lists.  After a few months, I had the Mirena coil taken out.  I remember the exact moment I first experienced enjoyment again.  I was walking into town to meet a friend, with the same dull list-following sense of duty that had characterised the last five months, and walked past All Soul's College in Radcliffe Square.  The golden gate caught the last of the sunlight, the green lawn of the quad glowing behind it, and my heart gave a tiny flutter, a butterfly twitch, no more.  "That's beauty," I thought, dumbfounded.  "And I responded.  I actually felt it.  I felt enjoyment."

Loss of enjoyment (anhedonia) is an effect of progesterone intolerance. The effects of progesterone intolerance can damage lives, completely pointlessly. This affects 1 in 5 women, so please help raise awareness by sharing this post - and please feel free to share your own experiences.

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Cytowic, Richard E. 1994. The Man Who Tasted Shapes. London: Abacus.
Thanks to Emily Anthes on Wonderland for reporting progesterone reward research
Music: Into the West, Annie Lennox
Painting: Melancholy of a Beautiful Day, Giorgio de Chirico

Progesterone intolerance spotlight: paranoia

• affects 1 in 5 women • likely if you get bad PMS • damaging & avoidable Effects include depression, weeping fits, irritability, aggression, paranoia, guilt, panic attacks, loss of enjoyment, loss of inhibition, self-loathing Progestogens are in... • the contraceptive pill • the contraceptive injection • the contraceptive implant • the Mirena coil • some HRT It's a key treatment for endometriosis.

This series of posts highlights the effects of progesterone intolerance, from my personal experience. They are not medical advice. Medical professionals: it's important to understand the severity of progesterone intolerance and the damage it can do. If you think you are progesterone intolerant: avoid taking progestogens if possible and find a sympathetic doctor. If your doctor dismisses your symptoms, change doctor.

Paranoia is my early warning system that the progesterone side-effects are starting to kick in. It starts as a feeling of vague intuition - I shouldn't be using this soap, I should be using the other one. I should turn down that road, not this one.  In the coffee shop, a quiet conversation between the manager and the waiter alarms me: are they talking about me? Don't they like that I sit here scribbling and drinking coffee, have I done something wrong? I don't have my computer. I haven't checked my email. Something might be wrong, something important, with work, am I in trouble, have I done something wrong?

Sourceless anxiety hunts around looking for something to pin itself onto. Each time it does, I try - quite rationally - to refute that specific anxiety. But that doesn't get rid of the anxiety itself, because that's not where the anxiety's coming from - it's coming from a reaction to an artificial hormone, progestogen, which is still there. I remind myself, instead, that it's not to do with anything, not the waiters, not work, it's just paranoia.

Ironically, paranoia's recursive. When I try to face it directly, it feeds on itself: am I whipping myself into a frenzy of paranoia? Am I actually feeling paranoid or am I just being paranoid about being paranoid? Is it my fault?? HAVE I DONE SOMETHING WRONG? Goblin guilt.

It can be anxiety and guilt; it can be worse. Years ago, in a quiet pub, I began to panic that the door would open - and then it did. My panic would rise - oh god, please don't let them approach me - no, no, they're coming straight for me... Of course they were. I was the bloody barmaid. I had to take anti-depressants just to cope with the terror of serving customers. It would've been better to stop the damn pill, but I didn't know that then.

Years later: living in a shared house, a huge old three-storey thing by the canal, shabby and plain and clean. Late evening. All the housemates were out. My room overlooked the street outside, a busy thoroughfare from the station to the centre of town, safe enough, sometimes a bit iffy-feeling. I grew anxious. I closed the curtains. I sat, trembling. Now I could no longer see if someone were poised to smash their way in. The single-pane shutter windows were fragile. I was being ridiculous; no-one would break in. Frightened, I left the room and went into the corridor, but that was worse - stairs leading up, disappearing into the dark and a houseful of darkened rooms; okay, staying calm - F's room then, same floor, at the back of the house, overlooking the garden, besides, he's a good friend, it's a safe-feeling space. I enter his room. I can't shut the door, because then I wouldn't be able to see into the corridor to be sure it's empty. The staircase dwindling into the dark still unnerves me, but I can't walk up into the house switching on all the lights because to do that I'd have to walk into the dark. Here, I'm standing in full electric light. The curtains are open. I can see myself white-faced and dressing-gowned in the glass. And then I realise - I was wrong all along. There's no-one outside my window, there's no-one upstairs in the house, they're in the garden. Standing there, in the dark, looking in at me illuminated, seeing my terror and seeing that I'm alone. I try to tell myself that there's no-one in the garden but I know they're there. And any moment now... Weeping with fear, I rush back to my room, struggle into my jeans, fumble with buttons, I can't move fast enough, I'm taut with terror waiting for the glass to splinter, I'm yanking on a t-shirt - I bolt into the corridor, out the house, onto the pavement. Trembling. Sordid orange lamplight, people - none of whom are safe. I start to run. The wind is whipping and a giant spider scuttles at me - but it's a leaf - and the next leaf is a spider, or a leaf, and they're chasing me - I run up Walton Street, frightened of shadows and frightened of empty deserted pavements and frightened of the sudden looming shapes of people, I run over the gratings of basement flats sick with fear of what hands are reaching up and grasping for my feet, I run all the way to the bar my boyfriend works at and walk in shaking, trying very hard to act normal.
"I had a panic attack," I say, when he approaches, as if I'm not still having one. He gets me a table and brings me a glass of wine. There are pillars wound with roses, and behind the pillars, there are things hiding. I know there's nothing hiding behind the pillars, that this is a restaurant not a monster den, the same way I knew they were leaves not spiders, that nothing was creeping through the gratings, that there was no-one in the garden, but the fear's still raging and all my evolutionary history demands that I identify the source and fight it or flee it. I convince myself instead that he will fight any monsters that appear and sip my wine until the shaking stops.

That was the last time I took the oral pill. But to control my endometriosis, I use the much lower dose of the Mirena coil, and over the course of six to eight months, the side-effects creep up. This is my advice to myself.

If you think you're being paranoid, you are. If you fear you might not really be paranoid, you're just being paranoid about it, that's paranoia. If you're paranoid that it might not be as bad as you think and you're causing it yourself, that's paranoia. Once you've identified it as paranoia, ignore everything it says, including everything it says about the paranoia. Don't listen to the goblins.

Hard as it is to talk about (paranoia will try to stop you saying its name), it's worth having a few people who know the situation: saying what's happening helps neutralise it, and you can check in with them to get a more accurate perception of things. (Having someone like that at work as well is invaluable.) Plus, then you don't need to be paranoid about what they might think of your paranoid behaviour.

Paranoia is an effect of progesterone intolerance. The effects of progesterone intolerance can damage lives, completely pointlessly. This affects 1 in 5 women, so please help raise awareness by sharing this post - and please feel free to share your own experiences.

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