How Hormones and Menopause Impact ADHD Women | Dr. Louise Newson

We see so many women who are neurodivergent and get worse during perimenopause and menopause. And a lot of people like hyperfixate. They get quite obsessive. They can ruminate. They can worry. They can think a lot more. And the reason I'm so confident that a lot of it's related to hormones is 'cause I see people improve. You know, they don't do anything else to them other than rebalance their hormones. And they're like, "Wow, I feel like my brain's been freed."

Dr. Louise Newson is an award-winning physician, Sunday Times best-selling author, and leading menopause specialist. Today, she speaks about her one mission: spreading awareness of women's ADHD, hormones, and the negative impact they can have on menopause and perimenopause.

Menopause, many people think, is just a few flushes and sweats. Actually, the main symptoms affecting people during menopause, but also perimenopause when levels are really fluctuating and changing, are symptoms affecting the brain. So a lot of people find they have brain fog, they have poor memory, reduced concentration, irritability. They might have poor sleep. They get these symptoms and then their period comes and they feel fine again. And then the second half of their cycle, they find it harder to concentrate, harder to do things. And if they've got ADHD, they often find that their symptoms worsen. We find that when women have the right dose of hormones, especially testosterone, actually, then a lot of their ADHD symptoms really improve.

A woman gets a diagnosis of ADHD and they're reading they need to exercise more to combat the executive function challenges, but you're saying they should consider other options first, and what might those be?

Often, if I think symptoms are related to hormones, then...

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This episode is dedicated to any late-diagnosed neurodivergent women who were made to feel crazy by a medical doctor but always knew that their hormones were responsible all along.

Dr. Louise Newson, what an absolute honor to have you grace the ADHD Chatter studio.

Ah, well, I'm delighted to be here. Feels great. Feels very comfortable.

They are comfy, aren't they? Really comfy. Trying to... Yeah, the risk of falling asleep is is there, but no, thank you so much. I want to start with a bit of a a blunt question, I suppose, and that's why should somebody watching or listening stick around for the next 50 minutes or so? What can you teach them and how is that going to help them?

I want them to think differently about hormones and how they affect the brain because a lot of people don't even know what hormones are, or what if they do, they think about periods. And I'm not really wanting to talk about periods other than how hormones change with the cycle, but I want to be thinking about how hormones work in the brain and how they can affect our brain function in ways that people probably haven't thought about before.

Okay. What is an example of a way that they could affect the brain that the, the sort of layman might not have thought about before?

So, the hormones really that I'm talking about are estrogen, but a good form of estrogen called estradiol, progesterone, and testosterone. And they are made in the female brain and the male brain. So, they are actually made in the brain. Whereas, if you, most people, even lots of doctors will say, "Well, they're just made in the ovaries." But they're not. So, they're neurosteroids. They affect the way the brain works. And that's really important because they work with other chemicals in the brain, other hormones in the brain, other neurotransmitters. And once you understand the science of how hormones work, when we don't have them, i.e., we're menopausal, or they're fluctuating, i.e., we're perimenopausal, or they're dropping very quickly just before periods, then you can easily join the dots and think, "Ah, that makes sense." Right. Okay.

And you're obviously a menopause specialist. What, so what does a specialist such as yourself know more about someone who is just aware of menopause? Like, what, what makes you a specialist?

Well, mainly because I see so many people. I've got a huge amount of clinical experience and knowledge, and I've sort of dedicated my career really thinking about menopause, but it's extended more actually to thinking more about hormones. But I've got quite an unusual career in that a lot of menopause specialists are gynecologists. I have nothing against gynecologists, but I'm not a gynecologist. I'm a general physician, but I've also got a pathology degree as well. So, I'm very interested in the study of disease. Um, and if you know why the body works, it helps you understand what diseases occur and why they occur. So, at a sort of cellular, molecular level. Um, and then I've done a lot of hospital medicine and lots of specialties, and then I was a GP for 25 years, but also a medical writer. So, I've written a lot of evidence-based medicine. I've written four books on evidence-based medicine. So, I'm quite geeky and scientific as well. But I'm also, well, I'd like to think a good doctor in that, you know, my patients are essential to everything that I do. Very different when I qualified in '94. It was very much, you gave that green piece of paper, you know, the prescription that they used to give you, literally give it to a patient, ask no questions, off they go. They would take the medication or not, I suppose, but it was nothing in context of how does the patient feel, what are they experiencing, why might they be feeling like this? And so now it's so different, thankfully. So, I'm very patient-centered in the way that I practice medicine, but with evidence-based as well.

Right. Okay. Quite clearly a specialist. Yeah. So, the, obviously I was fascinated to to chat to you about the the link here between menopause, hormones, and ADHD. M. Um, just from a human level, having a hormone cycle, how does that impact how one's ADHD might show up?

Yeah, hugely, actually. And it's interesting because if I'd had this conversation with you 10 years ago, I probably would have gone, "Oh, I don't know that it does have an effect." But it definitely does. Thinking about how the hormones work and when our hormones fluctuate or change, it affects so many cell processes. But when I see people in the clinic, they maybe have been diagnosed with ADHD or they think they've got ADHD, but often it's got a lot worse. And menopause, many people think it's just a few flushes and sweats, something that people just get through. Whereas actually, the main symptoms affecting people during menopause, but also perimenopause when levels are really fluctuating and changing, are symptoms affecting the brain. So, a lot of people find they have brain fog, they have poor memory, reduced concentration, irritability. They might have poor sleep. Um, they often have low mood, anxiety. So, all of those things are indicating that the brain isn't working properly, if you see what I mean. And then a lot of people say that they get these symptoms and then their period comes and they feel fine again. And then the second half of their cycle, they find it harder to concentrate, harder to do things. Um, and if they've got ADHD, they often find that their symptoms worsen and then they improve, and there's a sort of cyclical nature. And during perimenopause, hormones are all over the place. So, it can really make an effect. Um, and I prescribe hormones to rebalance the hormones because we know that when people have the right dose and type of hormones, it does two things: it improves symptoms, but it improves future health. And increasingly in the clinic, we find that when women have the right dose of hormones, especially testosterone, actually, um, then a lot of their ADHD symptoms really improve. They find it a lot easier to process. They're a lot clearer in their mind. They can think better. Um, and, you know, in medicine, a lot of it is pattern recognition. You know, you see and and then you think, actually, wow, why is that working? How is that happening? And then you look at how these hormones work in the brain and you think, well, it's, it's, you know, it all makes sense, but it's just been ignored, really, because a lot of psychiatrists, as you know, deal with ADHD, gynecologists tend to deal with menopause or period problems, so there's like no connection. And then, you know, I see so many women who have been given amphetamine-type drugs, but their symptoms have started in their 40s when they've been getting other symptoms. And, yeah, it's just, like, I just think, why are we not looking at the bigger picture and seeing what, what's going on? What were the changes going on in the brain and treat those first, really?

So, do you think it is a bit of a travesty that the, the conversation of hormones isn't even mentioned when a woman is going for an ADHD assessment?

Yeah, it's an absolute disaster. I was doing some training of some psychiatrists. Um, I won't mention which clinic, but it's a clinic that the NHS have commissioned, um, because obviously ADHD services are so stretched in the NHS. So, I was training, there's about 150 psychiatrists on the call, and I love teaching psychiatrists because they really get it. They understand it. And at the end, so many of them are saying, "Yeah, that's like women I see all the time. It's wow, wow, wow." They're like, "Well, why don't you prescribe some hormones?" "Oh, no. We're only commissioned to prescribe these drugs." Like, I mean, I'm sure you know more than me, but that is the pathway. That is what NHS are funding them to do. And I'm like, I can't believe that. It's just, it really plays with my mind because in my mind, I'm a holistic doctor. You know, if someone comes with a headache, it could be loads of different reasons. I'm not going to just give them one treatment. Like, that's not how we're trained. So, I was really shocked even to hear that. And then they said, "Oh, yes, but we could say go back to the GP and maybe see the GP for an assessment of their hormones." Well, firstly, people can't make an appointment because it's, you know, it's really hard. And secondly, you might not see a GP who understands. And thirdly, these are medical doctors. They should be trained in how hormones affect the brain as well. So, I, and we see it a lot. There's a lot of women who, you know, it depends on who you get referred to, but so many are under psychiatrists and they're not being asked about their hormones. And I just think it's completely wrong because in medicine, you want to treat the underlying cause if you can.

So, following on from that, if someone, a woman gets a diagnosis of ADHD or they suspect that they are ADHD and they're and they're reading they need to take X, Y, or Z medication, they need to exercise more to combat the executive function challenges. But you're saying they should consider other options first. And what might those be?

Yeah. So, often if I think symptoms are related to hormones, then I'll always give the hormones back to a physiological response, but looking at nutrition, exercise, everything else as well. But I don't know how many menopausal women you've spoken to, but often if you say to them, "Just go and do a bit more exercise, just go and sleep a bit better, just go and eat better," they'll probably bite your head off. And, and I would have done eight years ago when I was perimenopausal because you just feel shattered. You feel exhausted. So, often when the hormones are rebalanced, then you can look at everything else. And, you know, I'm absolutely not here on the podcast to say, "Just have hormones and you'll be fine," because it's not like that, but having hormones can absolutely make a big difference. So, all we do, we're very fortunate, we have the right hormones now, um, which are exactly the same biochemically and physiologically in the body. So, some people might be thinking of hormones thinking about contraception, and those are very, very different because they've been chemically altered, and that's really important to know the difference because when we give hormones, we give, we're just replacing exactly the same, giving like for like, and that makes a huge difference on the brain actually because, as I've said, these hormones are neurotransmitters, so chemicals, as you know, that have give a message from one area of the brain to another, but they also work with other neurotransmitters in the brain in a positive way. Whereas if you have synthetic hormones, as in contraception, then they can block the action of the natural hormones and also negatively affect other neurotransmitters as well. So, having the right dose and type is really important. Um, and we're very fortunate because, you know, in the NHS as well, we can prescribe the hormones individually, so each person can have the right dose and type for them. And sometimes if people have PMS, premenstrual syndrome, or PMDD, premenstrual dysphoric disorder, we might just give hormones for those few days because there's a big drop, especially of progesterone, but also of estradiol, before periods. So, sometimes just giving a few days of hormones, natural hormones, to top up and replace that big drop can make a massive difference the way people work and function.

Just sort of continuing on that theme, how, in the dark have women been kept still in relation to how much, despite all of the, I imagine loads of scientific research that has come out, still, how much have they been kept in the dark about how much hormones affect their mood?

Yeah, absolutely. But I think actually doctors have been kept more in the dark than women. You know, I mean, women have been just denied so much good medicine for such a long time. Um, and the problem is there's lots of other drugs that can do all sorts of things to to people, including women. But basic physiology has been there for decades. You know, when, when hormones were discovered in the turn of the 1900s, so 1930s, um, there was such a move to try and market them and think about bleeding and periods that any good research was just forgotten. And then women, as you probably know, weren't included in any studies of any drugs because we're too complicated because we've got our hormones. But actually, isn't that so important that we study them? So, that's been very frustrating. Um, and then women have known, like for a long time, even when the contraceptive pill came out in the '60s, a lot of women were saying, "I don't feel right. I can't think clearly. I feel very low in my mood. I feel more anxious." And doctors were saying, "No, no, no, you're not going to get pregnant, you must take this." And then they looked and changed the dose and various things, but it's still happening now, um, that women are being given medication without knowing, not knowing how the hormones work, but also just, I think, because when people talk about estrogen and progesterone, it's about periods. So, then you're constantly just thinking about the womb. Whereas thinking about these hormones that work in every single cell of our body, they affect the way that our cells function, is really important. And I think women understand more because 95% of women have PMS, premenstrual syndrome. And it's been normalized for so long where you just, "Oh, don't go near her, she's hormonal." Like, "Oh, she'll be a bit irritable," or she might be a bit forgetful just before her periods. Well, actually, let's think about what's happening. And if those hormones are dropping, why aren't we giving them back? You wouldn't say to a man, "Oh, once a month for a few days, you're just going to feel a bit bad." Like, it's just unacceptable. But there so much has been normalized, I think, and trivialized. And it doesn't really help that the hormones are sometimes referred to as sex hormones, and they're not about sex. They're not even about gender because men have them too. M. But it's because there's been this misunderstanding, but the role of on the brain is so crucial to understand. Um, and, you know, psychiatrists, psychologists, anybody who deals with the brain should be knowing about the role of hormones in the brain.

M. I think one, firstly, it's so interesting. I think one of the biggest injustices that I've come across since starting this podcast is that the first study on how ADHD medication affected, or how hormones affected the response to ADHD medication in women, was done last year. Yeah. Only last year in 2024. It's awful, isn't it? That's so women were taking ADHD medication on the advice of their doctor and not recognizing why one week it, it was kind of working, one week it was making them feel terrible. Yeah. Because it wasn't studied.

No, I know. Is there a, I mean, how much of that do you see in your field of work? The, the injustice with women just not getting the, the light in study?

It's huge. I mean, I qualified in 1994, and that was the year that women were first, um, they recommended that women should be used in clinical studies. So, if you think all my undergraduate knowledge is based on studies done on men, and that's a lot of the way that I've been prescribing for many years, and you just think this is absolute madness. And then most of the studies on hormones have been done on the reproductive tract, and then you think, actually, this is ludicrous as well, because the hormones are so important. And even now, people are quite scared of hormones because they think, "Oh, HRT equals breast cancer," which it doesn't. It's older types of hormones. The ones we prescribe are literally just replacing. And a lot of people don't prescribe them. So, they don't see the effects, or they don't want to see the effects, often as well. But women are really knowing, and they're not stupid, and they can often see this change throughout their cycle. Um, and it's interesting, isn't it? If you think about ADHD, so many more women in their 40s are being diagnosed. Um, and it might be that their symptoms are just being uncovered more because of the hormonal chaos that's going on. But it, it just seems really wrong to me that people are given a label when you haven't looked at the bigger picture. And it's, I mean, I don't need to tell you, you're an expert in ADHD, but it's, no two people with ADHD have this are the same. So, it's all very well having a diagnosis, but in my mind, as a doctor, the most important thing is getting the right treatment and treating the underlying cause, looking very holistically. And it really worries me when I see these clinics that are just a conveyor belt. You know, they're just sort of a number really in a queue, and you're just treated in a certain way, and it's very formulaic. I'm not sure that's helpful for people.

No, obviously not. It's a, it's like I say, a travesty. It's not a word I use often, but it generally is. The injustice and the, the sort of sensitivity to injustice, it's, it's such, it's felt so strongly in the community. Um, and, and it comes up often on this podcast, females not the frustration and the, you know, they're grappling for understanding, but they're being let down by the people that they're going for to advise.

I agree. I mean, I did a podcast with one of our doctors, Sumi, who's, um, she's incredible. I don't know if you've heard it. She's got ADHD, and she was self-medicating herself, um, when she was actually a doctor in America. She didn't know what was really going on, and, um, she started to take some antidepressants and thought, "Well, maybe that will help a bit." And then she took a bit more and just thought, "This isn't right." But she had no one to talk to, absolutely no one to understand at all. And it was only really when she was, um, trying to get pregnant and realized that some of it could be related to her hormones. And it wasn't actually until she, she started with HRT, then added testosterone, and then she was like, "This is transformational. I've never been able to think like this before." But you don't know what you're missing until you have it back. And that's, that's the real travesty that the only, the minority of women globally who are menopausal are prescribed HRT, and even less are prescribed testosterone. And, you know, there is data, testosterone in men and women with ADHD can really make a difference. And you're like, "Well, in medicine, you can try something." I'm not saying that everybody's going to get better with hormonal treatment, but a lot of them do, and it's just madness that they're not able to access safe hormones.

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Taking this into account, all of all of what we've just spoken, is there a particular time of the month when someone's ADHD might be most manageable, and how does that correlate to the hormone cycle?

Yeah. Um, so if you think you might have done it in biology many years ago, but the sort of average cycle, and not that any woman's average, is 28 days. And in the first half of the cycle, you get an increase of estradiol, progesterone. And then in the middle, there's like a peak where, where women ovulate, produce an egg, and there's a peak of estradiol, progesterone, and testosterone, actually. And then the second half of the cycle, progesterone goes very, very high, estradiol goes a little bit high, and then they both fall off a cliff, and then that triggers a period. So, often with the brain, as you know, the brain likes homeostasis, everything the same, everything calm. So, any change. So, lot, some women find as they ovulate in the middle of the month, they might find that their symptoms change. But it, it classically is just before their period when they've got that big decline because the hormones work to, um, improve the way the cells work in the brain, the, the energy production. You know, they, we've got receptors on mitochondria that produce energy in every single cell. Um, and also just the way that the hormones, um, work in the brain with all the other, you know, like I've said, the other neurotransmitters like serotonin, dopamine, glutamate, um, melatonin, all of those are really important, obviously, for our mood, our memory, our sleep, our cognition. So, this fluctuation can really trigger symptoms. So, often it's before a period, but it can vary so much between women, but they often do notice there's a cyclical variation.

Being a late-diagnosed woman, I mean, it's confusing enough trying to grapple with this, this understanding of of how you operate and coming to terms that you've gone for so many years not understanding why. Yeah. And how important do you think it is for, for a late-diagnosed woman who has had so many years of feeling misunderstood, both by others and herself, to go on this journey to understand the impact that hormones are having on her behavior?

It's crucially important. It's so important and it's so neglected because, like I say, a lot of people just dismiss hormonal changes when people are young, or it's normalized. And then as we age, um, our ovaries don't work as well because we're only born with a finite number of eggs. So, our hormone levels start to really fluctuate in perimenopause. So, perry just means around the time of menopause, and menopause means when periods stop. But that can last for 10 years or so. And I see quite a lot of women who still have regular periods, but they're suddenly getting these symptoms, especially affecting their brain. And unless you've got that knowledge, or unless someone sits down and explains to you what's going on, or you track or monitor your symptoms, it's very easy to blame other things or think there's something else going on. Um, and, you know, like I said, a lot of people I see have waited, often many years, to get a diagnosis. They've got a diagnosis, but it's so obvious it's related to their hormones, but it's very hard. You know, I had symptoms eight, nine years ago, and it's a bit embarrassing being a menopause specialist, but they lasted six to seven months until my middle daughter made my diagnosis for me, which is very kind of her. But when you're with yourself 24/7, you just accept any change and you don't always notice any change, or you put it down to something else. And so often with women, it's like, "Oh, well, she, it must be really hard for her. She's got three children and she works full-time and she's, you know, got parents or whatever." And it's like, hang on, there must be something else that's going on. And I, if you haven't got that knowledge, then it's very hard to know. And if you're locked into a medical system that's telling you X, Y, Z, not telling you about how hormones work in the brain, then you're not, it's not going to be on your radar at all. And then the other, the travesty I think is that so many women who are younger are given contraception, and then their brain function actually worsens. And I see it a lot with my children, their friends are given contraception, and then they're given antidepressants, and then they're not being able to think properly. And I'm just thinking, "Oh my goodness, if I could," and I do see quite a few of them as patients, "give them natural hormones, it can make a massive difference." And that's what I think. It's all very well me, age 54, having hormonal changes. But actually, if you're in your 20s and 30s, that's your whole career could be different. Your whole pathway could be very different if you had the right understanding, knowledge, and the right treatment from the right person. Um, and, you know, one in about one in 30 women under the age of 40 have menopause at a young age. So, no one's too young to be perimenopausal or menopausal either. So, these hormonal shifts are so important for people to to recognize, but it's actually really important for women to recognize themselves and then go and seek help rather than expecting a doctor to diagnose because a lot of them won't.

What you mentioned young women are given contraception and it affects their, what contraception are you talking about? Any type of contraception?

So, the tablet contraception, so the combined oral contraceptive pill, the progesterone-only pill, the implants. They will all, they're all synthetics. They've been chemically altered, which basically means if something's been chemically altered, it's not going to have the same beneficial effect on the cell because all our cells have receptors. It's a bit like a key and a lock. So, they've got the lock waiting for the key, the hormone to fit in, unlock, and then you've got these lovely biological reactions going on. You can imagine if it's been, if it's been altered a bit, it might go into the lock. You know, if you've had a dodgy key cut, it fits in and then it doesn't quite unlock. And that's what happens with, um, these synthetic hormones. So, they block the natural hormones having an effect, but they also don't have the lovely biological reactions going on. And there's some studies, not many because no one's really done good studies in women, of course, that women who have contraceptive pill will have lower levels of serotonin in their brain because estradiol will improve serotonin. So, if you block estradiol, you're going to reduce serotonin levels and dopamine and other neurotransmitters as well, which is really important. But a lot of younger people, they're just blamed. "Oh, it's because, you know, they're students," or "It's all because, you know, they're they're young and they've just got immature brains," or whatever. Um, but again, thinking about what we're doing to the brain, which is such an important organ, is so crucial.

Have you noticed a correlation between a woman who starts experiencing menopause symptoms and as a consequence of that, they really start to struggle and, and I suppose you could, the feedback I've heard is life gets too much and the menopause has been the trigger. Yeah. And then that is what led to an ADHD assessment. Have you noticed the correlation there?

Absolutely. The effect of changing hormones on the brain is huge, and often things just get very overwhelming. People often catastrophize. People often find that they're very, very anxious, and they worry about things that they wouldn't have worried about before. Their short-term memory is not as good. Their recall is not as good. A lot of people worry that they've got dementia. They know that something's not right, but they don't know what to do. They can't fix it. Um, anybody that's listening who's had brain fog, it's just the hardest thing ever because you know you should be able to function, and you can't. It's really, really disconcerting, and it's very, very isolating. And a lot of people are too scared to talk about their symptoms, or they go and get help and they're misdiagnosed with depression, and then they're being medicalized with the wrong medication, and that's can often make things worse as well. So, people really scramble. And, you know, we also know, like, as I've said to you, you can have low dopamine with the low hormones, and then people aren't having that reward. So, then they're thinking about drugs or, um, alcohol, or any addictive behavior to try and get that dopamine, and that's not going to necessarily help. But they don't know that it's not helping because they're so desperate to get help. Um, you know, we did an addiction survey last year, and it's, it's shocking, actually, the number of people that are turning to alcohol to try and numb their symptoms, but also drugs as well. And, um, you know, that, that is really scary, and it just highlights that as a medical profession, we're letting these people down because they don't know where else to go and get help.

Gosh, have you got any advice? If someone's listening and they're, and they, they're thinking, "This is coming. I haven't got to menopause yet. At the moment, I feel I've got my ADHD under control. Yeah. But this is scary what you're saying. I know it's coming. Yeah. You got any advice for someone? How do they sort of weather that storm?

Yeah. So, the first thing is, everyone's different. So, like, I'm painting a really negative picture. Some people are fine, or they think they're fine. Most women do have some sort of symptoms, but not everyone has huge symptoms. But the most important thing is to have that knowledge. So, obviously, I've, uh, created Balance App, which is a free app, so people can actually record their symptoms, and that's can be really useful, actually, just to have a log of symptoms because sometimes you, you, you don't know unless you do it every three months or so, and then you can see, is there a change? Is there a pattern? Is something else going on? If people have periods, they can monitor it with their symptoms, uh, and periods as well. So, that can be really helpful. But it's also getting others to know what's going on as well, because it's, and it's not just at home, because most of us spend more time with work colleagues than we do at home, but just to let people like recognize some of the symptoms that might be occurring as well. And then it's also thinking about, well, if I do have symptoms, what am I going to do? And when am I going to get help? Because a lot of people think with menopause, two things: they often think they have to have flushes and sweats, which most of us don't have, so you don't have to, or they have to wait until they're really experiencing a lot of symptoms that are very badly affecting the quality of their life. And, you know, no one gets a badge of honor for suffering with symptoms. So, we know that the earlier people can have treatment, the better. Um, so, it's really about being proactive rather than just reactive, um, I think, is so important. And if someone's decided that they do want hormones, then making sure that they see someone who understands the right dose and type because about 50% of people who come to our clinic are already taking hormones. They're not coming because they want to just see us. They're coming because they know they're still having some symptoms. And like I say, the addition of testosterone can be, makes such a difference that often people think testosterone is just for libido for women, and if your libido is okay, then you don't need it, or, um, but actually the way that testosterone works on the brain, but also progesterone is a very calming neurohormone as well. Um, and a lot of people might have had a hysterectomy, their womb removed, or they might have a Mirena coil and be told they don't need progesterone, you know, whereas actually a lot of people when they take natural progesterone, they sleep better. Their way they think is a lot calmer. They're a lot less anxious. And I'm sure that has this quite positive effect on women with ADHD as well.

M. Is it possible therefore that someone who's going through the menopause and therefore their life gets really hard as a consequence of that, and then they get an ADHD diagnosis in response to that hardship? Do you see a correlation in those chain of events?

Yeah, there's a lot of people that are, I think, misdiagnosed. And like in medicine, you just want to, they take a really good history, work out what's going on, but treat the underlying cause, and then see what's left. So, I would wouldn't rush and diagnose ADHD in somebody who was having hormonal changes. And I'm not saying all hormonal changes will cause ADHD, but they'll often cause symptoms suggestive of ADHD or worsen it. And so, it's a lot more natural to have the replacement hormones that are fluctuating and causing this these changes in the brain rather than giving another drug, if you see what I mean. And it's so many women that just don't join the dots because often, like if you look at the definition of menopause, it's a year since the last period. Like, it's, it's a rubbish diagnosis. Like, why does someone decide it has to be a year after someone's last period? It's just stupid, actually. Um, but actually, when we think about what it is, it means the hormone levels are low and they stay low. But like I've said, this perimenopause, this time before when hormones are really fluctuating, this chaos in our brain can often trigger a myriad of symptoms that will often be dis, you know, misdiagnosed as ADHD. And that's, I think, so awful because women are suffering and without thinking about what are the hormonal shifts, is there anything I can do to to replace those hormones? And that's what's so important, I think, for women to get that knowledge so that if they're being made or or given a diagnosis or referred to someone, you can say, "Well, actually, could I think about having hormones first? Could I consider having those hormones?" And it's often multi-pronged. Like, nothing or very little in medicine is just one cause and effect, other than, you know, if I cut my hand, I put a plaster on it. It's one cut, fine. But when it's the hormones, they have an effect on everything else. As now, they have an effect on other hormones in the body, but also the way that we function. So, many people who are perimenopausal are not sleeping well. They're feeling more tired. They've got low energy. They've got muscle and joint pains. So, they don't want to exercise. So, it's not just the hormones, their lifestyles have changed as well. And so, looking at all of those things together, and then seeing what's left, is so much more important than rushing to make a diagnosis. And it's very interesting, actually. I'm on a WhatsApp group with some ADHD specialists across the world. So, there's a great specialist in Darwin, Australia. There's a gynecologist, would you believe, who specializes in ADHD in Sweden, and then loads of GPs. And it's so interesting the chat because they, we're all seeing similar patients. We're all seeing similar effects. Even the gynecologist in Sweden, she's saying the biggest effect is with testosterone when it's added to HRT, but I can't talk about it because the gynecologists don't want to believe it. And the, um, psychiatrist in Darwin is being really converted. It's great. I love converting other doctors. And he's just going, "Yeah, this all makes sense. Why didn't I think about this before?" And it's just great in medicine, you learn so much from experience. And then actually, in the chat a couple of days ago, people were putting loads of papers in about the role of hormones in the brain, roles of estradiol, progesterone, testosterone, how they work in the brain. And everyone's just going, "Wow, wow, wow, this is great." And I think it's so important that as a doctor, you're really open-minded. And I, it's also, I think, the way that we talk to patients because so often people think, "Well, they've got a disease, they've got a label, therefore that's it. I'm not interested as a doctor because I've done my diagnosing bit." Whereas actually, for that individual, it's not so much what they're labeled as, it's how are you going to treat? How's it going to affect my life? What's, what are the things? And I think, well, I, I'm sure you agree, but ADHD is can be a superpower if it's done in the, if it's channeled in the right way, if people have the right information. And what worries me is that obviously there's this plethora of clinics now, there's a huge number of waiting people waiting, and they almost think that to have the diagnosis is going to transform their lives. And I worry about that, actually, because I worry about medicalizing people the wrong. Okay. I worry about medics, doctors giving people false expectations, actually. And actually, a lot of so much or so much of it is about knowledge and looking at intrinsic and extrinsic factors that make a difference. Um, rather than just waiting, waiting for a label. Like, what do you do with a label? Like, it's, it might be helpful to tell people that you've got a condition like ADHD, but actually, how, like, two people with ADHD are not the same. So, it's not like just putting people into a slot and making you feel better. It's, it's far more than that. Um, and that's why I think thinking about what's going on in the brain, what are the factors that are changing, what's gone on, what's going on with this person's life, and how much is treatable with hormones, and, and, and it's not just women, actually, because men have low testosterone, and that's often not addressed, or it might be addressed in the wrong way. So, I think it's so important that doctors wake up to the fact that hormones have a role in the brain, and that women and men do, so that they, when appropriate, can ask for the right treatment.

Yes. You get the diagnosis and it's very much like, "Well, what now?"

Yeah, absolutely. And that really worries me. You know, I was saying to you before we recorded, you know, my daughter the other day, I'm sure I've got ADHD. I'm sure she has, but having a label or waiting on a really long waiting list to have a drug that she may or may not benefit from, is it going to help her? And actually, she's more worried thinking about it than actually looking at tools to help. She's going to help when she's, you know, catastrophized 'cause she's got so many things on her to-do list and she can't focus, or she hyperfocuses and then forgetting everything else. You know, sometimes in medicine, you, we forget sometimes it's the basic things we need to do rather than reaching for our prescription pads. And I feel like it's a bit weird 'cause I'm talking about prescribing something, but they are just natural hormones. It's very different to giving a synthetic drug.

I've spoken to lots of psychiatrists and doctors and psychologists on this podcast, and so many of them are advocating and and pushing for the emotional dysregulation aspect of ADHD to be included in the assessment process. And some people think, as we mentioned earlier, with different context, is a travesty that it's not. However, do you think that emotional dysregulation, which is rife in the ADHD community, Yeah. But that can be connected to menopause?

Absolutely. If you think very basically, our hormones all derived from cholesterol. So, cholesterol is not all bad. It can form our cell membranes. But it's, it's really important. So, cholesterol forms progesterone. Progesterone then forms testosterone, which then forms estradiol. But going further up, progesterone also forms cortisol. And cortisol are stress hormones. So, it's a bit like a seesaw, really. If you've got more stress and more stress hormones, you're likely to have less progesterone. And that's why often progesterone, having the right balance and do dose, is quite calming as well. And what worries me sometimes is that a lot of, um, emphasis is put on what's gone on in the past, like previous events, trauma. And it's, and of course, these things have an effect on the brain. But they're exemplified and worsened if we don't have the right hormonal balance. If you've got too much adrenaline or adrenaline, cortisol going on, it, it's going to make that brain more hyperaware, hypervigilant, but also that worry, that reactivation of maybe some negative things that are going on. Um, and then it's just almost people are, I don't know, not really labeled, but I think so many people will say, "Oh, well, it's, it's related to previous trauma. We understand why that's happening." But actually, lots of people have trauma. Not everybody has symptoms that's going to then cause a problem in the future. But thinking about that balance of hormones is so crucial, and thinking about how the hormones affect, like I say, cortisol and cortisone, you know, it's just this direct pathway, but also, like I said before, about how they affect different neurotransmitters in the brain. So, like noradrenaline, adrenaline, dopamine, serotonin, all of those have a really important, crucial effect. And I think so often in, in the brain, people think about one area or one chemical without thinking about how they all interfere with each other. So, I think, you know, doing a, doing a proper assessment is crucially important. But I do feel sometimes that is a bit too much, not blame, but emphasis maybe put on to previous events that could have triggered something else. And I don't even, I don't know sometimes that's helpful because then people aren't being treated in the right way. It's sort of, it's almost like associated with something that's happened in the past, and of course that's going to affect their brain, that's going to affect their processing, but actually with the right treatment, it doesn't all have to be related to previous events. Does that make sense?

Yeah, it does. Yeah. I suppose where do you draw the line? When do you need hormone therapy or when do you just need therapy?

Yeah. Yeah. I guess one is trying to dig deep into something that might have happened in your early years, and one is a natural response to a physiological issue. Now, sorry to interrupt with an ad read. I know it can ignite rage, but a brief word from our sponsor. You'll hate slow talkers like I do, so I'll keep this snappy. If you've ever wanted the specialized support of a highly qualified, world-renowned, Harvard-educated ADHD psychiatrist right there with you at all times, now's your chance. The one and only Dr. Ned Hallowell, ADHD specialist and best-selling author, has worked with some of the brightest minds in the ADHD world to develop an app that makes his knowledge on how to manage ADHD and stress accessible to all. Features include customized and tailored daily exercises to stimulate the cerebellum and proven to help manage those trickier aspects of ADHD. Four sessions of virtual ADHD individual coaching tailored to your needs. A self-EMDR program, a cutting-edge treatment for ADHD to help target that unwanted stress and anxiety with two personal coaching sessions. Lastly, if you've not officially been diagnosed yet, the app offers several reliable self-administered diagnostic assessments of ADHD that can help you see if you actually have ADHD. And the

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Back to the episode. In terms of there's a big topic at the moment in this community that is of high interest and that's ADHD, which is the dual diagnosis of ADHD and autism. Yeah. How does menopause come into it? Yeah. How does it differ? How, how is it different in the way that it clashes with the traits of ADHD compared to how it might clash there? It's all there. Like hormones get everywhere and it is all we see so many women who are neurodivergent and get worse during perimenopause and menopause. And a lot of people like hyperfixate. They like, I say, they get quite obsessive. They can ruminate. They can worry. They can think a lot more. Any ritualistic behavior can get worse as well. Um, and that can be very difficult if people are neurodivergent. It really can. Um, and the reason I'm so confident that a lot of it's related to hormones is because I see people improve. You know, I don't do anything else to them other than rebalance their hormones and they're like, "Wow, I feel like my brain's been freed." Because it is quite claustrophobic when you have certain symptoms. Um, and a lot of people, as you know, are neurodivergent, which again can be a real great skill, can't it? But if it, if it takes a hold in your life, then it's can be catastrophic. And the number of people that are paralyzed because their brain's not working properly without people thinking about hormones is so important. And I, so I think the big telltale sign is if symptoms are fluctuating, then it's almost like think about hormones first. And if you're confident it's not related to hormones, that's fine, rather than waiting for it to be thought about at the last. Because once you start to see it and understand it, it's just there and it's so obvious. But the problem is, it's not always thought about and people don't understand the the role of hormones and the big effect that they can have on the brain. Or they think, "Oh no, I've had hormones and I felt worse, so therefore I won't have them again." But when they talk about the hormones they've had, they're often contraceptive hormones. So a lot of people who are neurodivergent or with ADHD will say, "No, I do you know what? I had the implant and I felt awful. I had to literally rip it out of my arm. I felt so terrible." But they are having a synthetic hormone. It's basically giving them a chemical menopause. It's very different to having natural hormones. So again, it's really important that people understand that not all hormones are the same. Because some people will be listening to this and going, "Well, that's rubbish because I tell you what, I felt awful when I was on contraception." Well, yeah, but they're more likely to benefit from natural hormones. And there's some people that are very sensitive to hormones. And, um, and we're seeing an increasing number of women who are more testosterone deficient than estrogen and progesterone deficient. So they're having regular periods but they're finding it very difficult to process, very difficult to think, their memory is not great, their energy is not very good, their stamina is not very good. They feel more tired, but their brain just doesn't multitask the same way. And often that's related to testosterone.

[Music]

Is there a, a, a light at the end of the tunnel for neurodivergent women going through menopause? What, what's, what's the sort of the beacon of hope that, that you would like to tell to that group?

I think the most important thing is thinking about when we think about menopause, so many people think it's just a transition. It's just something we go through, but it lasts forever because our hormones, once they're low, are low forever. So they'll be low in our brain forever. So having the right dose and type of hormone, once they've got that, they can continue it forever. And that is a massive beacon of hope because there's nothing worse than being felt great on something then being told, "Oh no, actually, you can't carry on." Hormones are very safe. They're very effective. They are, they just naturally replace what we've, what's missing in our bodies. And so many people then, once they're on hormones, find that they can think better. They can function better. They can exercise. They can do all the things that they know they should be doing but they're not doing as well. Um, and the other thing I think is really important because it sounds like I'm just pushing hormones, but, um, is that, you know, we can try them and see if they work. They can be taken very safely with other medication and if they don't work, we can stop them as well. So people don't have to be on them forever if it's not right for them. Um, but it just seems so ridiculous almost that so many people are either scared away from hormones or they're not being given them when so much is related to the hormonal effect, especially on the brain.

Just finally, or penultimately, I should say, I want to draw attention back to your ADHD item that's been patiently waiting underneath that cloth. Yeah. I ask all my guests to tell me an item that most represents ADHD for them. I'm going to reveal yours underneath this cloth now. Uh huh. Right. That is, well, it looks like a diary. Yeah. Don't open it. Oh, you can. Can I open it? Yeah, of course. Yeah. Yeah. If you're happy. So, so it's a diary, but it's, it's got each day has a whole page dedicated to it. And my writing is quite messy, but I will write a list of things that I need to do. So, it's not a diary. I used to write as a teenager all the things that happened to me, all my emotions. It's not that at all. It's literally list of things that I need to do. And in fact, when you asked me for the item, I was like, "Oh, dear. Yes, I do have ADHD. I've never had it diagnosed, but I'm sure I do." And some of it is because I'm so busy, but like, you know, my computer's always got loads of tabs open. I've always got loads of WhatsApps popping up. I'm always thinking, "Oh my goodness, I've got to do XY Z." There's something very therapeutic about writing it down because it's empty. A lot of my way I can do so much is just try and empty my brain because once it's empty, I can think and probably fill it up again. But as soon as I've written something down, then I don't think about it because I know it's there. And it's something very tactile about having paper and a and a pen. I, I know I could use notes on my phone, but it's just not, I've tried it so many times, it's not the same. But the best thing about it is that I can tick off when I've done things as well. And if I haven't done it on the day, I transfer it to the next day and the next day. And so eventually it makes me do things. Um, so that is and it, and again, it is a very like, it's a, it's a really nice, it's like my real treat. It's my Christmas present every year, but I like touching it. I like feeling it. It's a bit of, it's a bit of a comfort blanket as well. Sounds a bit silly, doesn't it? But, you know.

No, it's, it's similar. I've tried the notebook strategy. Um, quite lots of notebooks. You sort of in the, in the shop and you truly think that one's going to be the one that solves all your problems. But I write stuff down and then I, it gets closed. I forget it exists. But my solution is to have these, these big whiteboards. Yeah. In my flat. I write one in every room of my flat and when an idea, similar but slightly different. I mean, I have lots of notebooks, um, and actually, yeah, and my daughter has whiteboards up and we often salivate over different, you know, notebooks, but it has to be something that you've got there because otherwise you're just thinking, actually, that note that I wrote, it's not with me now and I'm traveling or whatever. So, I think it's, it's, yeah, it's, it's, it's difficult. Everyone's got to find what works for them, isn't it? Um, the other thing that I do a lot of is I do a lot of yoga and that definitely helps clear my mind. You know, I, I, I do Ashtanga yoga every Wednesday. So, I was doing it this morning with the instructor and I do 10 minutes at the end of Savasana where you're just literally meditating and that is just so brilliant to clear my mind. So, I think as well as taking hormones, having something where you can clear your mind and focus on the present, I think is so important whether you've got ADHD or not. And I think it, we're such a busy world, aren't we? We're constantly got this to do and that to do and this person to see and that email to respond to and something on social media that's really important to look at, whatever. So, one of the things I've learned more and more with age and experience, I suppose, is focus on the present. And I think that is so crucially important, um, because otherwise things can get overwhelming very, very quickly, can't they?

Yes, massively. And try to remind yourself to bring things that are important into your present. Yes. What I mean by that is if, if I need to, I've got a meeting tomorrow at 12:00 or I need to text a friend, like I'll put something on my fridge saying, "Text Dave tomorrow." Because otherwise that isn't in my present and I'll forget about it. I walk past the fridge, I'll see the sticky note and I, you know, it's a simple, simple thing, but very much out of sight, out of mind is a real, real thing for me. And if I don't do those little things, then I'll just get a text saying, "Where are you?" Yeah. Absolutely. It's so, it is so important. And everyone's different and having the tools is, is so crucial. And I see that a lot with my, especially my oldest daughter who's got a lot on, but then she's, she's typical. She's always late. She's always leaving and I'm just like, "Oh, why, why don't you become?" And some of it she's young, but some of it is just the way that her brain is, is working differently. Um, so I think we all need tools, don't we? We all need ways of trying to just help.

Louise, I want to do the ADHD agyant section, which is called the washing machine of woes, because my ADHD item is a washing machine. Okay. Because I'll explain. I explain this every episode, but I, I never get bored of saying it. I always forget my laundry when I do my washing. I put the cycle on. Yes. And then it just goes into a different dimension that has no connection to my memory. And then I remember obviously the next day and it's, it's damp and I have to restart the cycle. And I do ask everyone, do you have that problem?

This is so funny and I'm laughing because as I got the train down here, I dropped off at a flat where my daughter's living and she warned me because she's just, she has migraine as well. She said the flat's a real mess. So I, I didn't have time to, to really look. But when I went to the bathroom, I thought, I bet her washing is full. And I've emptied it and I've got no idea how long those sheets were in there for. But anyway, I've put another load of washing on for her. Yeah. No, I don't because I like to complete things and so I'm actually quite obsessed about if I complete it, I'm not thinking about it. So, I'm quite good with the washing machine actually. That's fascinating. Yeah. I, I have got a bit better cuz I'm using the Temo app, which is the sponsor of the show. It's like a productivity app that gives me a little reminder. Oh, okay. It's empty the machine, Alex. Um, so a little bit better since that. But this week, Louise, someone has written in or the washing machine and they have asked, "My daughter, who has ADHD, is going through adolescence and the mood swings that come with it. What can I expect from the next few years, and how can I better understand her hormonal changes and her ADHD?"

Great question. Having three daughters, the youngest one's still very much a teenager. I sympathize, but this is what I was saying before. We can't be normalizing it because it's really difficult for those children. And we've known for decades, even in 1961, there was an article in the British Medical Journal showing that girls who have PMS or PMDD, fluctuations of their hormones achieve worse if they have exams just before their periods. And so we need to be helping girls understand what's going on with their hormones, but also thinking about how we can help them sometimes as well. It's harder when they're under 16 or under 18 because of just medically treating them because they've got lots going on in their bodies. But we see a lot of people who are 18, 19 and giving just some, usually just some progesterone. You know, that big graph that I said that drop off, giving a little bit can be transformational for these people and it's just so awful that there's so little research, um, in how the hormones can have such an effect because adolescence is a bit like a flavor, a bit of a taster for perimenopause, you know, these hormonal shift changes. Um, so talking about it, getting understanding is really important, but actually thinking about how hormones might just smooth out a little bit as well, um, is something to, to consider. The other thing is, I know it sounds really obvious, just thinking about nutrition because all these inflammatory diets, processed food will have a massive effect. The sugar cravings, you know, will have a big effect on our hormones as well. And it sounds really boring, doesn't it? To eat a really healthy diet to, um, you know, even snacking regularly can help with progesterone levels as well, but snacking on healthy things, not on unhealthy things. And it's so easy to eat badly, to drink the wrong things, um, but looking at nutrition, looking at any exercise as well, which I know is quite hard for teenagers to do, um, anything that's going to help that, think about that cortisol and that balance, anything that's going to be calming, going outside, going for a walk. Um, I know certainly with a lot of people, especially with my children as well, it's so much better talking to someone that you're driving or you're walking because you're not looking at them. Um, and it's quite hard getting children to, to go out for a walk, but in the car is sometimes easier because actually can be quite isolating and scary for those teenagers as well. I've said how hard it can be for perimenopausal and menopausal women, but young girls, you know, they learn everything from TikTok and social media, don't they? And everyone looks perfect on social media, of course, or they'll catastrophize and make it sound awful. So, actually talking about it is really, really important. But if you think you need to get help, then making sure you see someone who understands how hormones can change and what could be done as well.

Hm. So interesting that you mentioned that there was an actual study that showed girls performed lesser in exams just after their period before. So that's when that drop of progesterone, that drop of estradiol, the brain is just not working. You haven't got the same connectivity of the brain. You haven't got all those synapses firing in the right way. Got probably less blood supply to the brain. Memory is not as good. Sleep might not be as good. Um, yeah, I mean, isn't it madness? That was 1961 that study came out and that alone almost summarizes our entire conversation, how much the hormones affect cognitive ability.

Totally does. Yeah. Yeah. Yeah. And so it's just, it's just such a shame that women are often, you know, not working to their best ability. And even on, you know, personal experience, if I wasn't taking hormones, I would not be working as a doctor. Like, I, I can't begin to explain how hard it is when your brain doesn't function. Um, and you don't know what's going on, you know, and you don't know what you're missing until you have it back. That's the other thing as well.

Truly fascinating, Dr. Louise. Thank you so much.

Thank you for inviting me.

Just finally, yeah, I'm going to deliver to you a letter that was written by the previous guest. All right. Okay. The previous guest wrote three rules to live by. They put it in this envelope and they posted it in that post office. I'm going to deliver it to you. If you could kindly read out the three rules.

So, right, three rules to live by. One, people are going to judge you no matter what. So, you may as well do what you want. It's your life. I like that. Everything is figure outable. Oh, I don't think everything is, but most things maybe. The only perfect thing in the world is you because you're the only you that exists. Be nice to yourself.

A, that's interesting. You know, I kind of agree with the second point. I'm trying to. What would you think is an example of something that isn't figure outable?

Working out why some people behave as badly as they do. Like the extreme, like, uh, criminals. Well, no. I think there's probably reasons why criminals. I've done quite a lot of work in prisons and you could work out often why. No, I think bullying. I, I get bullied quite a lot for what I do. Like in the media, it's fine. People can read about it and I can't understand people's motives sometimes. I can't understand why people are mean. Actually, I've sort of grown up wanting to be kind. And I don't think it's a bad thing being kind. Doesn't mean you have to like everyone, but you can still be kind and polite and courteous. And so, I can't figure out why people don't want to be kind or why they have this feeling that they can be mean. Because meanness is like such a horrible thing.

Who's mean? What, what are they saying?

Well, there's, there's a lot of meanness when it comes to women's health and hormones. And often it's come from misunderstanding. And I think also it comes from fear. Fear of women being in control and women being in control of their bodies. And people don't like change as well. So if you're changing a narrative, that can be quite difficult.

Meanness coming from men?

No, it's mainly from women actually. Isn't that interesting? Yeah. Yeah. So, I think that's hard to figure out like what people's agenda is when they're being nasty. And that's the same like I was bullied at school for being clever. You know, when I see my children, if they've ever been bullied, you think, "Oh, actually, what are these people? Why are they doing this?" You can just ignore it if you don't like something, but don't be mean.

Envy maybe disguised your success. And thank you so much.

Thank you. It's been great.

Thank you.