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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