It’s the summer solstice of 2025 and the UK is in the middle of a heatwave. I’m trying to write, keep on top of my film MA, freelance for a film festival and walk dogs. I’m drinking too much and barely sleeping or eating. I speak so fast no one can keep up, jumping between films I want to watch, places I want to visit and articles I want to write. My partner and I are having the most sex I’ve ever had, but he’s far from the only person I’ve got my eye on.
The wood on my door swirls around itself, creating infinite figures of eight. I find a sex-trafficking cult in the dog-sitting agency I work for, but no one else can see it. I feel capitalism’s evil with every cell in my body – I hear it in bland radio pop, smell it in disposable vapes, taste it in artificial sweeteners. I tell my friends I’m starting a housing co-op as they take shifts looking after me. I’m not allowed my phone because I’ll send streams of consciousness to everyone I’ve ever met, trying to improve their lives. I feel the best I’ve ever felt. My friend Becky tells me to call my mum.
When my mum comes to collect me from my partner’s house in London, I haven’t slept for nine nights and I’ve lost 7kg. A retired GP, she has an idea what’s going on and takes me to a psychiatrist. Because she’s looking after me, I narrowly avoid being hospitalised. I’m prescribed the antipsychotic olanzapine, which blocks the effects of dopamine, a neurotransmitter involved in psychosis, and lorazepam.
I'm diagnosed with first-episode psychosis, characterised by delusions, hallucinations and disorganised thinking. Like one in 50 people in the UK, I’m also diagnosed with bipolar affective disorder. Bipolar 1, which I have, is defined by at least one episode of mania – at least seven days experiencing high energy, a decreased need for sleep, racing thoughts and hypersexuality. Bipolar usually develops between mid-teens and early twenties; my manic episode happened at 24, but I’ve always had extreme seasonal mood changes. The average time taken for diagnosis in the UK is an equally surreal 9.5 years.
Antipsychotics are life-saving but, in my case, they act like a chemical straitjacket, killing my emotional and intellectual interiority. I don’t remember July. By August, I’m the most depressed I’ve ever been. I spend six months getting out of bed only if someone makes me. Every second I’m awake, I’m terrified I’ll never be a person again.
Since switching to the mood stabiliser lamotrigine in January, my only lingering symptom is poorer short-term memory (I used to remember daily tasks, now I constantly check my calendar). I've also experienced rapid weight gain from the medication. If my manic episode was triggered by extreme stress, repressed trauma and drugs, I’m hopeful my emergency kit of sleeping medication and a few tablets of olanzapine will prevent another one.
Enter diagnosis two
Before my bipolar diagnosis, I'd been trying to get to the bottom of my period pain. My period pain had been getting steadily worse since I had a copper coil fitted in 2021. It’s so bad on days one to two that, if I’m alone, I bite my hand so hard I leave bruises. In May 2023, my period lasted six weeks. Primarily an annoyance, around week four I thought I should see a doctor. An ultrasound showed 4cm cysts on both ovaries: endometriomas – cysts filled with old menstrual blood that develop as part of endometriosis. I asked whether they would affect my fertility. The sonographer said they didn’t know. I locked myself in the hospital toilet and cried.
In late 2024, I signed a consent form for a laparoscopy: two rounds of keyhole surgery – one to drain the endometriomas, another to remove them – with a temporary menopause-inducing injection in between to shrink them. By the time I got to the top of the waiting list this year, one cyst had grown to 6cm, larger than the ovary it’s on, and I’d grown a third. Still, I was lucky. Like bipolar, the average waiting time for an endometriosis diagnosis in the UK is almost nine years. But the complications didn’t end with a dual diagnosis.
A risky business
My gynaecologist told me there’s some risk to my fertility whether I have the laparoscopy or not. A 2025 paper suggested that endometriomas can reduce fertility by stretching the ovary and causing inflammation, which may damage or destroy immature egg cells. But surgery to remove them risks reducing the number of healthy eggs left.
My psychiatrist also warns me that endometriosis surgery could trigger another manic episode because of the extreme physical stress on the body. Earlier this year, they strongly advised me to postpone the operation because of how depressed I was. The siloed nature of NHS healthcare means that one doctor is focused on my gynae/reproductive health, the other on protecting my mental health. No one can tell me how to weigh one risk against the other, which is both scary and exasperating.
Sujeewa Fernando, VP of the Royal College of Obstetricians and Gynaecologists, reassures me that 60–70% of women with endometriosis conceive without fertility treatment. ‘While there is evidence linking endometriosis with subfertility, a clear causal relationship hasn’t been established,’ he explains. Still, he urges anyone with endometriosis who’s having difficulty conceiving to speak to a healthcare professional for possible referral to a fertility specialist – and anyone pursuing an endometriosis diagnosis (which requires a laparoscopy) not to give up and put up with the condition’s brutalising effects in the here and now because of future fertility fear.
The siloed nature of women’s healthcare
I’m 25. I want to do a PhD and teach at a university. I want to go on holidays with friends, watch stupid content with my partner and spend time with my parents as they grow old. What I don’t want is to have to make a decision between my current mental wellbeing and my future ability to have children. Perhaps the trade-off isn’t that stark – but in our siloed healthcare system, it feels like no one’s able to confirm whether that trade-off is real or reassure me that it isn't.
Dr Liz Murray, a former NHS doctor turned advocate on chronic gynaecological conditions, wants a more holistic approach to healthcare. ‘[The system should] recognise the emotional impact of these conditions, or the fact that if you’ve got one condition, you’re more likely to have the other,’ she tells me. There’s nothing in the Government’s Renewed Women’s Health Strategy that links endometriosis and bipolar disorder – bipolar isn’t even mentioned at all. Dr Murray believes the ‘wishy washy’ strategy continues to ‘miss the point’.
A 2022 German meta-analysis of nine studies found that bipolar disorder was around six times more common in people with endometriosis than in the general female population. But researchers still don’t know whether the relationship is causal, with most concluding that more research is needed to understand why the two conditions so often coexist. There’s no UK data on how many people live with both. I was diagnosed with both conditions quickly because an acute healthcare crisis bumps you up the list. But I have friends with both conditions who’ve had a terrible time convincing doctors to take their symptoms seriously.
Back on the waiting list for endometriosis surgery
I don’t know what my future’s going to look like, but I feel I should keep my options open. My psychiatrist is wonderful and made contact with my gynaecologist, who’s taken my mental health into consideration and recommended that I have only one round of surgery and no menopause-inducing hormones. This should reduce the risk of the surgery triggering mania and eliminate potential psychiatric effects of the hormones.
My experience of healthcare has been mixed. I had to fight to get taken off antipsychotics (you’re supposed to be on them for 12 to 18 months; I was on them for six), because the team prioritised mitigating the risk of future episodes. But I have a good psychiatric team, which can be unusual on the NHS. My gynaecological care has felt more impersonal because there are long waiting lists and I see a different person every time I go for a check-up.
Endometriosis has given me nothing but grief, and my manic episode and subsequent depression stole about eight months of my life. I missed the chance to speak at an academic conference and had to take a break from university. But, if anything, I’m more confident than I was before my manic episode; I’ve utterly debased myself in front of everyone I love – and they still care about me. Bipolar is a lifelong condition and I don’t know if I’m going to have more episodes. That uncertainty is scary. But I’m busy appreciating the everyday ups and downs of my life, having seen first-hand what happens when I lose them.
Bipolar and endo: a double survival guide
If you or someone you know is struggling, my partner found Bipolar UK’s carer’s support information very useful while I struggled with post-mania depression.
Helpful for support and management, they also campaign for a reduction in diagnosis time and improved access to specialised care.
The Make Believe by Hannah Murray
The former Skins and Game of Thrones actor’s memoir explores her manic psychosis after getting sucked into a wellness cult. She very clearly articulates the sense of slowly losing reality – it’s painful, but so well-written.
An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison
A clinical psychologist’s experience of bipolar, this balances personal and professional insights into living with bipolar.
