Saira’s Story: “something’s changed”

I think of my mind as a mist‑shrouded island—a place dotted with bright patches of thought, separated by stretches of dense fog where paths disappear. The others live on the mainland, about an hour away by plane… and somehow, a few months ago, I moved out here without realising.

At forty‑seven, my eternally misplaced glasses, vanished hats and half‑sentences have been pinned on perimenopause. A new hormonal regime has come in, taken my old mental roadmap, tossed it onto a bonfire, and sent my whole library up in smoke. I hope it knows what it’s doing as I wander through each day, searching for a misplaced ticket to whatever it is I’ve forgotten to cancel.

I lose track of basic things, but often only temporarily. I might forget the name of the place where I was born one evening, then remember it the next morning while brushing my teeth. More alarmingly, I might forget to go to work. This has happened three times already. (I thought it was Sunday, for some reason.)

Can I even hold down a job on the mainland when I’m all the way out here? Sometimes there are no clocks, and I’m not sure where they’ve gone. The new regime is reclassifying them, I suppose.

What I want—what I crave—is one clear hour. Sixty uncluttered minutes. It’s been two months since I’ve completed any piece of work without collapsing into bed immediately afterwards, limbs folding like those of a puppet relieved of its strings.

In search of this blessed hour, I make an appointment with the head nurse at my local GP practice. I’m told I’ve been booked into a “menopause clinic session” lasting a full thirty minutes. This feels luxurious compared with the rushed GP appointment I somehow remembered to attend a few weeks ago: ten minutes that ended with a referral to a psychiatrist. I’m not sure anyone has the time to talk about the rising waters around this island of mine. Yes, the fog is thicker. Yes, I’m concerned about tripping. The shoreline is a few feet from my door and I don’t know if anyone knows that I live out here. But does anyone care?

It doesn’t help that I get imposter syndrome whenever I ask for help (‘Surely someone needs assistance more than I do?’). This is probably quite self‑sabotaging.

Miraculously, I make it to the nurse’s appointment. In fact, I arrive in the waiting room with fifteen minutes to spare. This never happens, and I can see why: I’m in nowhere‑land with nothing to do. I left my phone at home because I couldn’t find it, and I failed to bring a book. I check the charity shelf of paperbacks near the entrance, but the selection of titles is a disappointment. I can feel the dopamine leaving my system, saying, Goodbye, farewell, too bad—you’re being a boring bitch. I panic. I still have five minutes to fill before the appointment, and I’m already sinking. Mist uncurls around me, rising up from the ground. My thoughts are being pulled towards—

Nurse Wendy has short brown hair and square, gold glasses perched at the end of her nose. Her eyes are soft and brown, and her skin is a deep olive colour.

‘So, tell me a bit about what you’ve been experiencing,’ she says.

I look at her and wonder where I ought to start this story.

‘I could start with today,’ I say. ‘I slept through my alarm and woke up at four‑thirty this afternoon. I’d missed work. Thankfully, there was an email saying the student was ill and couldn’t attend our session. But that was luck. I’ve missed loads of appointments with the GP here because I overslept or forgot I had one.’

‘Well, I’m glad you made it here today. It sounds like you’ve been having a difficult time. How have your sleep and mood been generally?’

‘Something’s changed. My sleep is all over the place. My mind feels like it’s full of heavy fog, and I feel anxious a lot, with racing thoughts. But I thought that was my ADHD. It seems to have got worse. I get mood swings and feel tired all the time. I also forget what I’m trying to say or do. This mainly happens in the second half of my cycle, and it’s especially bad near my period.’

‘Can you tell me how your periods have been? Do you have a regular cycle?’

‘I had three periods one month. Two another month. Lately, just the one, but it’s heavier and longer than it used to be, say, a year ago. It’s not predictable anymore. It used to be, but not now.’

‘Everything you’re describing indicates that you’re likely to benefit from HRT. Is there a history of women reaching menopause early in your family?’

‘Some. I asked my mum. She said my younger sister started menopause at forty‑three. But my mum had hers at fifty‑one.’

‘So, there is a history.’

‘Yes—and my younger brother has ADHD, but we never thought I had it because I was good at school. I now think I do, and I have these forms…’ I show her some print‑outs about the NHS Right to Choose scheme for adult autism and ADHD assessment.

‘You think you have it?’

‘Yes, because it’s got so much worse with perimenopause, and that can happen with women with ADHD, because the drop in oestrogen affects dopamine production.’

‘OK. And do you think HRT is the right thing for you?’

I sigh, a deep sigh of relief. ‘Yes. Absolutely. I had problems before, but I could manage. If I can manage again with the help of HRT, that would be amazing. I’m seriously worried I’ll lose my job at the moment. I don’t understand what’s happening to me.’

‘We can be relatively confident in classifying what you’re going through as perimenopausal or menopausal symptoms. If your periods have got heavier and longer, that suggests you’re moving closer to them stopping completely. The hormone changes are affecting your everyday ability to function, which means HRT may help. Do you have any questions about the different types of HRT available?’

‘Yes—how does a woman know if she needs oestrogen, oestrogen and progesterone, or oestrogen, progesterone and testosterone?’

‘Do you have a womb?’

‘Yes. I wish I didn’t.’

She laughs. ‘All right. You’ll need oestrogen and progesterone. If you have a womb, you need progesterone to protect the lining of your uterus from thickening. This reduces your risk of cancer. A woman who doesn’t have a womb can have oestrogen on its own.’

‘And testosterone?’

‘That’s for much further down the line, if you’re still having difficult symptoms like low libido. There aren’t any testosterone products licensed for women in the UK but it’s sometimes used off‑label. We don’t need to think about that now.’

‘I read that testosterone can help with brain fog.’

‘There’s some emerging evidence to suggest that, yes, but not enough for NHS professionals to prescribe it. Have you read about the different ways the hormones can be taken? There are tablets, patches, gels…’

‘Which is the most natural, or closest to natural?’

‘There’s an oestrogen gel, which you rub onto your thighs each evening after a shower. Then you take progesterone tablets from day fourteen of your cycle. Other ways of taking progesterone can have more side effects. Do you think you could manage taking something for only part of the month?’

‘I didn’t used to know what day of my cycle it was, but I have a period‑tracking app on my phone now, so I think I can manage that.’

‘OK. Let’s start there, and you can come back to see me in two months. Keep tracking any symptoms on your phone app.  Would you prefer two months or three? It takes around three months to feel the full effects of the oestrogen, but we can meet before that to check whether you’re having any problems with the type of HRT you’ve been prescribed.’

‘Two months, please. Wendy, I’m so glad I remembered this appointment. You’ve been so helpful. I’ve been so scared by how I’ve been feeling, but things seem a lot clearer now.’

‘I’m glad you came. I know how strange all of this can feel. Menopause can be very confusing. Just when you think you have your life sorted, it comes along and messes things up.’

‘I wouldn’t say I had my life sorted. But it was better than this.’

‘We’ll see if we can get it back on track, shall we?’

Nurse Wendy asks me some questions about my family history in relation to heart disease, high cholesterol and diabetes. She’s satisfied with my responses and suggests that HRT could actually help protect against these things (which do run in my family). She sends the e‑prescription to my usual pharmacy, which doesn’t open until the next morning, and I walk home feeling something like hope…

Maybe I don’t have to live on my island anymore. Maybe I could be rescued by helicopter and carried back to the mainland—go to parties, go to work, like everyone else. But the reality is that I have no idea how the next three months will go, and three months feels like an impossible length of time.

At home, I read about Oestrogel and how long it takes to improve menopausal symptoms. According to the internet, it really does take around three months for the psychological effects of menopause to ease. I might not have a job by then. The mist may grow so dense that no one will be able to find me—helicopter or no. This journal may be the only evidence of my existence on this island. I really hope the Oestrogel has a miraculous effect and transforms my mental health fast. But I know that’s a silly thing to want. Desperate, really.

Tomorrow I will collect my HRT and start treatment. I’ll keep you updated, if my messages make it through the fog. (Reception is poor out here.)