The Starts and Ends of Creation

As the tide rises, the effectiveness of my ADHD medication descends.

The Starts and Ends of Creation
Photo by Farzad Mohsenvand / Unsplash

My ADHD medication isn't as effective during the last half of my menstrual cycle. Which is kind of inconvenient, as that's two weeks out of every month. Or, you know, half of my lived life. When I asked a doctor about it, his response was pretty incurious,

"Basically, estrogen is very friendly to Adderall and progesterone is very unfriendly to Adderall. During the second phase of the menstrual cycle there is a lot of progesterone. We don't really know why any of this is."

And it seems no one is trying to find out. This drug that calms my mind and keeps me from staring at walls is just not as effective for a significant portion of the human population for a significant amount of time. And that's just...not being addressed by research. But medical research has never been interested in bodies like mine. So I just smiled and said, "Okay!" 

I was diagnosed with ADHD this year. Which means I went 35 years without knowing I had it. Read about my diagnosis here.

But it wasn't really okay.  When we lack solutions, it's comforting to understand the story. So I went home and did some reading. It's a story that'd make Mary Shelley proud - all rotting bodies, blood and a tiny ovarian cemetery. You know Shelley loved a good cemetery

This story starts in the ovaries. Oocytes, undeveloped eggs, are kept in these little tiny sacs called follicles. During ovulation an ovum, or matured egg, bursts out from its follicle. It starts its journey to the uterus. The egg leaves behind a little empty, broken sac. 

Once the egg is gone, that little empty sac closes in on itself and becomes a new thing entirely. Its cells form a new structure, a corpus luteum. This new structure is yellow. Corpus means body. Luteum means yellow. Yellow body. The corpus luteum produces hormones, estrogen and pots and pots of progestorone. Did you know hormone means setting in motion? Hormones are just signals wrapped up in molecules.

Those hormones are used to send the message that it's time to build up the endometrium. This is the nutrient rich blood lining in the uterus a fertilized egg first calls home. Which is all just kind of cool, right? The egg's previous home building its next home is a kind of biological hospitality.

Section of the ovary. (After Schrön.) 1. Outer covering. 1’. Attached border. 2. Central stroma. 3. Peripheral stroma. 4. Bloodvessels. 5. Vesicular follicles in their earliest stage. 6, 7, 8. More advanced follicles. 9. An almost mature follicle. 9’. Follicle from which the ovum has escaped. 10. Corpus luteum. (1918) Anatomy of the Human Body

If an egg isn't fertilized and pregnancy doesn't occur, the corpus luteum begins to disintegrate. This happens a few days before menstruation begins. As it whithers, its cells produce less and less progesterone. Eventually, there's too little of the hormone to sustain the bloody home its built. The endometrium sheds and mentruations starts.

The corpus luteum is gone, but not forgotten. It leaves behind white scar tissue. This mass is called corpus albicansWhite body. The scar tissue is made of cartilage, a connective tissue found in the larynx, joints, the tip of an ear. When babies are born some of their bones are made of cartilage, hardening into bone later. The scar tissue stays in the ovaries for a few months until it disintigrates too. 

Corpus albicans doesn't seem to serve any purpose. It secretes nothing, buildings nothing, becomes nothing. Once it falls apart, little immune cells come in clean up the cells it left behind.

All of this living and dying inside of me every month sounds about right, really.

During the luteal phase, progesterone rises, peaks and falls back like a tide. I've not always known a hormone knocks me into waters so vast it feels like I'll never see land again. I've just known that every month, I'm there again. And sometimes the water reflects stars and sometimes it's so stormy I can't keep the salt out of my mouth. Always I can't find my way out until the new phase begins.

As the tide rises, the effectiveness of my medication descends. I always seeem to have more ideas during this time but can never understand where to set them. I start a dozen essays and have a thousand new ideas I can't quite close. At the peak, I am sure I will never finish anything again - a piece of writing, a spoken sentence, a thought. I can see the beginning of things but cannot concieve their ends.

I feel when the progesterone ebbs because I can see to the end of ... well, everything I've seen from the beginning. It's funny, isn't it? That the hormone my body needs to sustain another life is the one most likely to make me feel like I might drown. I guess babies live in water and mothers do not.

This week, the progesterone flowed and my medication foundered. I felt particularly vulnerable to every cycle, not just my menstrual cycle. Days and nights were too short and too long. My circadian rhythm, the biological clock that keeps our sleep-wake cycle on a 24 hour loop, forgot how to tick. Did you know that most cells have their own circadian clocks? Do my cells keep time when I cannot?

The weather cycle was too hot. The geologic cycle too slow or maybe too fast, I couldn't tell which. Even the dishwashing cycle left me despondent. Although I can't really now remember why. I stared at walls and walked in circles. Another well-worn cycle. I wondered if the moon cycle could move the water in me too. Maybe if I asked very nicely, it'd keep the tide pulled back longer next time.

And then this morning, when I woke up, I could see past a beginning. I was bleeding. The luteal phase was over. I took my 15 mg of extended release Adderall. Without progesterone in the way, I felt it calm my thoughts and steady my focus. For the next two weeks, I'll get to the end of as many things as I can. 

I can't stop thinking about the new bit of scar tissue sitting inside of me. Made of the same material that helps bend my knee and forms embryonic skeletons before bones begin.

The corpus albicans doesn't really do anything biologically necessary. But I do think it does something. It marks the place where a beginning started before finding its end. Markers matter. That's why we've got cemeteries full of them. Each corpus albicans lasts for a few months, there are always a few in various states of decay inside of me. White bits of never-bone. Little deaths nestled in between all those potential starts.

My body and I seem to be on opposite creation cycles. I can find the end when my body is producing beginnings and I get lost in beginnings when it's working towards its ends. Or maybe we're working together in a way I can't quite grasp. Death feeding life and life feeding death. The starts of creation and the ends of creation. Over and over and over again.