ADHD Archives - Balance Menopause & Hormones https://www.balance-menopause.com/subject/adhd/ World's largest menopause library of evidence-based content by Dr Louise Newson, previously Menopause Doctor Fri, 28 Feb 2025 18:26:00 +0000 en-US hourly 1 https://wordpress.org/?v=6.8 ADHD and perimenopause: Sumi’s story https://www.balance-menopause.com/menopause-library/adhd-and-perimenopause-sumis-story/ Tue, 17 Dec 2024 07:00:00 +0000 https://www.balance-menopause.com/?post_type=menopauselibrary&p=8722 On this week’s episode, Dr Sumi Rampling, a GP and Menopause Specialist […]

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On this week’s episode, Dr Sumi Rampling, a GP and Menopause Specialist who works alongside Dr Louise at Newson Health, shares her personal story of attention deficit hyperactivity disorder (ADHD).

Diagnosed in early adulthood, Dr Sumi talks openly about the challenges of her ADHD diagnosis, as well as the impact that hormone changes, including perimenopause, can have on women with ADHD.

She talks about the determination her condition has given her, and also offers advice for women navigating hormone changes and ADHD.

Download balance’s ADHD and menopause booklet here.

Click here for more about Newson Health.

Transcript

Dr Louise Newson: [00:00:11] Hello. I’m Dr louise Newson. I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon- Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on the podcast, I’ve got with me someone who I do know well and I have met in real life and I’m very lucky because she works with me in our Newson Health clinic. So I’ve got Sumi with me who is a GP, she’s still an NHS GP. She works through with us in the clinic and she has a really interesting story which I feel embarrassed because I’ve only recently learnt about it when we went to visit the prison together and she told her story in front of about 200 prisoners I think wasn’t it Sumi? [00:01:30][79.4]

Sumi Rampling: [00:01:30] Yeah, about that. [00:01:31][1.3]

Dr Louise Newson: [00:01:32] So we had a wonderful day. I’ve been doing some visits to prisons and we had a day where we were speaking to the staff and then later in the day we spoke to prisoners as well. So you actually told your story twice. And each time I felt very emotional and actually everybody felt emotional. But I tell you, the people who were prisoners really got it and really felt very emotional. But it fired something up in them because a lot of what you were saying resonated with them in their past. So let’s get going then. Tell me bit before we start talking about your story, just tell me a bit about you and why you even went into general practice. Because you, you didn’t start off as a GP, did you? [00:02:14][42.0]

Dr Sumi Rampling: [00:02:15] No I did’t. So I’ve been all around the houses with medicine, so I qualified in Wales in ’99. And so back then you could be a bit more sort of, I don’t know, freelance for a bit. So I did various jobs, paediatrics, general practice, just as a standalone, a few other things, and then went off to Australia and worked there for a year. So I did A&E out there and psychiatry, which was really, really amazing, wonderful experience. And it was when I was out there, I decided to go into public health. So and I was thinking actually at that time to move away from the NHS completely. So I was applying for master’s degrees in global health. So I wanted to do more of a sort of global health focus. I went then to the States and did my masters over there, and then did, I did a little bit of nothing major, just sort of a bit of internship work with the UN for a couple of summers and did some research in Afghanistan and El Salvador and travelled around a bit and then eventually came back to the UK and did public health training within the NHS. So became a public health consultant. [00:03:30][75.6]

Dr Louise Newson: [00:03:31] So just explain what public health is, because some people might not understand what public health means. [00:03:36][5.0]

Dr Sumi Rampling: [00:03:36] So public health is the health of populations. So rather than looking at the health of the individual, you’re looking at the health of populations. So some of it is centred around health protection, infectious disease control, some of it is more focused on policy. So it’s quite broad and you don’t have to be a medic to go into public health. So you can go into it as a medic or if you’ve got different backgrounds, you can go into it as well because it’s so broad and the field benefits from so many different backgrounds. So yeah, so I did that and while I was doing it, it was when I was back in the NHS, I started to really miss seeing patients and it was something that really caught me by surprise actually, because I thought I’d given up on that. And, you know, yes, maybe go back to the NHS and do public health that way. But I wasn’t expecting to visit hospitals and miss it, you know, miss being on the wards, miss seeing patients and speaking to people. And, and I thought, how am I going to get back into this? And what I did was, my last, I think my last six months of training and public health, I met all the competencies that you need to meet or I think I had one more left. And I said, I can meet this competency by working in a sexual health clinic. Will you let me go once a week to the sexual health clinic and I’ll work as a practitioner there? And, you know, sexual health is so public health focused. And so they agreed they were really supportive and they agreed. And so I got back into clinical work that way and then worked in a very big sexual health clinic in Soho in London. And I did that for three years and they trained me up in contraception and they trained to do the HIV clinics. It was just amazing. But I wanted to be a GP and I was too frightened to go into the training because it had been so long. And eventually I plucked up the courage and did the training scheme and it took me a long time because by this point I was having my children so, it took me about seven years part time, but I got there and yeah, and then here I am now as a GP with a big interest in women’s health and in public health and all kind of work. [00:05:53][136.3]

Dr Louise Newson: [00:05:53] Yeah. And it’s so interesting and I have had, as you know, a very varied career and I do think it enriches how we manage our patients, how we see things in different ways because medicine, when I spoken about it a lot before, even on my Instagram too, has become very siloed. And people have become very specialised very quickly now in medicine, which can be good, but it also can be not so good when we’ve got a condition that’s affecting multiple organs in our body, but also it stops us thinking about the bigger picture. And I went into medicine to help individuals, but now I’ve sort of done a big circle and thinking you know what I really want to obviously help individuals, but I want to help global health improve as well. And so a lot of the work we’re all doing together is public health medicine. [00:06:41][48.1]

Dr Sumi Rampling: [00:06:42] It really is. [00:06:42][0.4]

Dr Louise Newson: [00:06:43] And it’ come around in a big circle really, hasn’t it? It’s so interesting. [00:06:46][3.1]

Dr Sumi Rampling: [00:06:47] It is. And you know, the work that we do everyday, you know, with HRT, we’re helping to prevent conditions like osteoporosis. That’s, you know, cardiovascular disease, dementia, type two diabetes. This is all public health, you know. [00:07:03][15.4]

Dr Sumi Rampling: [00:07:04] And it’s important and it’s so easy that we obviously get so frustrated because it’s such an easy, cheap and cost effective and clinically effective treatment to reduce so many diseases. But we’re going to focus on your story because as clinicians, people think that we’re just machines, that we don’t have emotions, we just keep going. And sometimes we have to be a bit mechanic because otherwise we would fall over because there are so many things that we hear and experience, but actually we still can have illnesses, conditions, and sometimes we talk about them and sometimes we don’t. It’s not the sort of thing at a job interview, you talk about your medical experience, but you’ve shared it twice in one day and you’re going to share it again because I think it will resonate with so many people say so tell me if you don’t mind a bit about how you spoke in the prison in that time? [00:07:58][53.7]

Dr Sumi Rampling: [00:07:59] So I remember I visited a prison with you previously and you came up to me and said, you know, I’m going to this other prison and would you like to join? Yeah, of course. And then, you know, and then you can tell, you know, your story about, you know, perimenopause because you’ve I think you knew that I it’s something that I’ve gone through. And and in the back of my mind, I was thinking oh boy because, you know, it’s not something I had shared with anyone. And, you know, it’s quite a big thing. So I was diagnosed with ADHD. You know, obviously I’ve had it all my life. I was diagnosed as a young adult, and I can talk to you a bit more about that in a bit. But in the prison I was speaking about my treatment for ADHD. I had treatment when I was first diagnosed with stimulant medication, which I only took for about a month. And I came off that because I felt it was absolutely amazing in that I took it and it was like this, I don’t know, this sort of there was like a misty glass that was sort of surrounding me and it was removed and it was just amazing but frightening and also a little bit sort of on off. So, you know, the medication would run out and I’d be back to how I was. And and I thought, well, this isn’t the solution. What if, you know, you know, one day I’d become pregnant, what? How you know, how does that you know, I don’t know how many, you know, studies have been done on this that what’s the, you know, how will it interfere with my long term health? And I stopped taking it after a month. And then, that was in years before. And then, as I mentioned, I went to the States. This was a few years after I qualified as a doctor and I did a master’s degree out there. And when I got to the States, I did the first few weeks of this programme. And I was doing alright. It was fine. Obviously very hard, very challenging. But I was managing and I took the medication. And in the beginning it sort of made the difference for me doing well to me, doing exceptionally well, which fine, you know, by the way, I think, you know, that’s fine. And then what happened was I was noticing and I was in my late 20s now, just before my periods, my focus and this was always the case, this wasn’t a new thing. My focus was all over the place, really. You know, can’t remember, well I can remember. what my name is, but, you know, but really not, not great. And I was finding, well OK I’ve got this medication now, let me take a bit more. So I would take a bit more in those periods and that was fine. And then I started doing not so well and I was taking more and more medication, but not just then. I was doing it all the time and I was, you know, I was overdosing on it really. It was quite dangerous what I was doing, but I wasn’t doing well. And I was just taking more and more and more to try and manage my mood, to try and manage my concentration, my focus. And I got myself into a bit of a situation in that I was now reliant on this medication. I couldn’t get out of bed without it. Literally, it was by my bedside. I couldn’t get out of bed without this medication. [00:11:05][185.9]

Dr Louise Newson: [00:11:06] And this is medication for ADHD, which is often based on amphetamines isn’t it? [00:11:09][3.9]

Dr Sumi Rampling: [00:11:10] Yeah. And I couldn’t function. I literally couldn’t function without it. And. It got to the point where I spoke to someone in the faculty because they had noticed that, you know, I’d been doing really well, and then I was doing really badly and this was going on and this was possibly, this was sort of towards the end where I wasn’t even sure if I was going to graduate, actually. And I said, this is the situation. I’ve got ADHD and I’ve got anxiety as well. And, you know, I think my mood is affected. And they said, well, why didn’t you tell us this before? That you have this ADHD. And I thought it being, you know, it’s a prestigious institution there’s not going to want to know me if I’ve got this condition, they’re going to ask me to leave. But it was the opposite. They said, we come across people with these conditions. And had you told us earlier, we would have been able to help. And, you know, if you need your own room to do your exam so you don’t get distractions, we’ll give you a room. They were, you know, what do you need to get through this and we’ll help you. And they were absolutely amazing. And, you know, and I got through it and I sought help. And I went to see a practitioner, a doctor, who helped me come off the medication completely. And my mood was really, really low. So she started me on some antidepressants as well, which I then stayed on pretty much. And for years I did sort of at times I would come off them. I didn’t stay on them when I was pregnant, but you know, I was on them for the long term after that. And then it was only when, this is years later now. So I had since got married, I’ve had problems with fertility, needed numerous rounds of IVF, needed a special protocol for it to work, and very thankful for that. But it was only years later when, after my son was born and I was studying, I was training to be a GP at this time. Only then that it clocked that this was perimenopause and I was perimenopausal and I spoke to my GP at the time and I was still fairly, you know, as probably how old would I have been? Maybe 41 or something like that. And I explained to her and she said, Well, why don’t you go on the oral contraceptive pill, combined pill. So I did and it helped a little bit and I was on my antidepressants and it will help a little bit. But it just wasn’t doing the job. It wasn’t, you know, I wasn’t quite there. And then I did the training course, the menopause training course. Your one actually, but I did that training course and that’s when I the penny dropped in that I need testosterone. And so by this point I convinced my GP to start me on transdermal, body identical HRT. So I started that and I was doing a lot better again. But then I added in the testosterone and honestly it was such a game changer in terms of my ability to focus, concentrate, you know, just operate. [00:14:10][180.2]

Dr Louise Newson: [00:14:11] And how long did that take Sumi from starting testosterone to feeling that your brain was clearer and easier to manage? [00:14:18][6.9]

Dr Sumi Rampling: [00:14:19] It wasn’t immediate. Yeah. So there were some sort of effects that happened quite quickly, in terms of my energy got better within a couple of weeks, but it probably took a few months before I started to feel like this is how I’m meant, this is me that, you know, it took me a few months before I felt that way. I was still on the antidepressants I was on by this point. I was on maximum dose, second line antidepressants. So it was this hardcore stuff and I’m off them completely now. So it’s taken me a year to because I went initially when I was on the testosterone, I didn’t even think about coming off the antidepressants. I thought, Let’s just keep things stable. But then over the course of about a year, I’ve gradually reduced my dose down, and now I’m not on it at all. And that’s not to say that testosterone is a replacement for antidepressants because sometimes people need both. [00:15:07][47.8]

Dr Louise Newson: [00:15:07] Yeah. And I think that’s really important because so many people think it’s hormones or nothing. And in medicine, we can have more than one diagnosis. You know, if I’ve cut my finger and I have a migraine, hopefully you would give me a plaster and you would look at my other pain and the discomfort for the migraine. So and it’s the same with hormones. And it’s very interesting, isn’t it, because we see a lot of women and speak to a lot of women who have been diagnosed with ADHD and we only need to look, you just Google ADHD, it’s massive. And actually, I think many of us have it, I’m sure I’ve got ADHD. A lot of people can’t achieve loads of things unless they’ve got some ADHD. So it is a power, it is a good thing as well to have it. In some ways, yeah. But some people obviously, and I do sometimes find when I’m very tired, I have so many thoughts I can’t do anything. Even just emptying the dishwasher is like no no no I can’t. And so it’s a balance. But my worry is that it’s being medicalised sometimes with the wrong things, like people who have a low mood and it’s due to their hormones. We shouldn’t be automatically giving them antidepressants, although some people will be clinically depressed and need antidepressants and hormones, but with ADHD it’s obviously a spectrum. But there are a lot of women who find that as they become older, as their periods change, their ADHD symptoms worsen or they have PMS or PMDD and they worsen before their periods when we know hormone levels decline and all our hormones, oestrogen, progesterone, testosterone, our neurosteroids, they’re produced in our brain. But testosterone has a very sort of calming influence, as does progesterone really, works as a neurotransmitter, affects other levels of neurotransmitters, including cortisol as well. But it’s been hidden and not thought about for so long. And now the narrative is just about libido. But certainly, if I could choose one of the three hormones for women who benefit the most, who have ADHD, it’s definitely testosterone, just in my clinical experience. And it’s very interesting that you say that. And I increasingly see women in the clinic, and I’m sure you do too, who are young and are more testosterone deficient than oestrogen deficient. And no research has been done in it. But I feel there’s a lot of women who, their testosterone drops before their oestrogen and progesterone. And it’s probably not the testosterone produced by the ovaries, but testosterone produced in the brain. And I feel that so many people, myself included, who wish they’d started taking testosterone many years before. I don’t know. What do you feel Sumi? [00:17:48][160.9]

Dr Sumi Rampling: [00:17:49] Yes. And I think, you know, the question I’ve asked myself about this, because testosterone is so clearly beneficial. And, you know, an essential for women, is why it’s been overlooked? And, you know, I’m not sure I can answer it. And I wonder, if you could look back in history, it was used in the 1930s for women, wasn’t it? It’s not something that’s new. And I wonder, I mean, maybe I’m right, maybe I’m wrong, but, you know, in the 1950s or whatever it was, that Premarin was introduced and there was this huge focus wasn’t there on oestrogen. And oestrogen is so important. But I wonder if somehow that took away from testosterone. [00:18:26][37.6]

Dr Louise Newson: [00:18:27] Yes, you’re definitely right. But I’ve been reading a history books, and what was very interesting is when they found all three hormones, they need to manufacture them in a way that they could be mass produced. And they had to do that with pharmaceutical companies to make money. So researchers quickly started being funded by pharmaceutical companies. Now they made the synthetic oestrogen in two ways: with pregnant horses, urine, but they also made an oral ethinylestradiol, which was chemically altered, but they would try to quickly make a synthetic progesterone, but they couldn’t. But by mistake they made a synthetic testosterone because as you know biochemically they’re very similar in structure. Yeah. But then what happened was it was a chemically altered testosterone. [00:19:12][45.2]

Dr Sumi Rampling: [00:19:14] Yeah. [00:19:14][0.0]

Dr Sumi Rampling: [00:19:14] Which they then quickly realised was very hard to be absorbed in the body orally. So they then found injections and now we have more than 300 synthetic testosterone substances. A lot of them are anabolic steroids which will have an effect on the muscles, also on the red blood cells. So they were using them to enhance performance. And so the whole narrative was about making money. So that’s when people are scared of testosterone, they’re scared of synthetic testosterone. So it means testosterone’s not got to look in because it went straight to men who started using it and abusing it, which is really interesting. But there are some reports in the war time because a lot of endocrine research hormone research obviously started in the 30s. They were did some amazing research when you read the papers. But then the war came and obviously everything changed. But they were giving testosterone to some of the men who were fighting. And they, there’s a report saying that it could help with gangrene, It could help with frostbite. No surprise, because we know it’s really good for our cardiovascular system. So they were reporting and documenting these other effects. But that’s all been forgotten because it’s about building up your muscle in your gym. And testosterone is the male testosterone. And even the way it was labelled when it was discovered that they could make it, it was about bulls, testes. That’s where they got it from. That’s where they got the testosterone from to study. So it was mislabelling of a gender inclusive hormone, if you see what I mean. And then, they stopped thinking about women because they were so keen on making synthetic oestrogen to mass produce. And then in the 60s it was all about contraception. So if you think about hormones for our brains, it’s been pushed to the bottom because all the research on these hormones was all on the womb. So even contraception. [00:21:21][126.9]

Dr Sumi Rampling: [00:21:22] Yes because that’s all we are, isn’t it, we’re just, all we are is our uteruses! [00:21:25][2.8]

Dr Louise Newson: [00:21:25] Indeed, that’s all we are, is about stopping getting pregnant! So even with the hormones, when they push synthetic hormones as contraceptives, they hadn’t even tested them as contraception. They just tested the womb and saw that people weren’t bleeding as much. And after a year, they decided to change the licensing for contraception. But no one ever did any studies looking at the effects of synthetic hormones on the brain and the body. Which is just missing so much. [00:21:53][28.1]

Dr Sumi Rampling: [00:21:54] Yeah. And you know, the side effects that people are concerned about with testosterone treatment is, you know, it’s those synthetic regimes. It’s not sort of the pure testosterone in its proper form that cause those side effects. But there we are. And here we are today, I think, to deal with the situation and change it. [00:22:12][18.4]

Dr Louise Newson: [00:22:13] Yes. And I think people are realising more and more. And like I said to you earlier, I was training a whole group psychiatrists yesterday who specialise in ADHD. And some of them actually do prescribe HRT, which is amazing. And actually, one of them I spoke to last night said she prescribed testosterone and said oh good, she said…to men not to women, but she notices that men with ADHD improve with testosterone. [00:22:37][23.9]

Dr Sumi Rampling: [00:22:38] Yeah, I’m not surprised. Yeah. The studies on this, I mean, looking at women actually, when looking at testosterone replacement and cognition and there’s clear improvements in cognition when testosterone is replaced. And when we we say that testosterone is, we shouldn’t use it in women because it’s not very well studied. But actually, there are so many studies on it that, you know, just need to be made aware of. And cognition is one of them. [00:23:02][24.6]

Dr Louise Newson: [00:23:04] So meanwhile, we’re collecting our data. We’ve got a lot of observational data because we see so many women, but we’re also connecting with many other psychiatrists in the UK and abroad. So I’m hoping going forward, this conversation will change. You know, you’ve got children, I’ve got children. We want them to not have the struggle that you had. And I’m very grateful that you said that story, because it’s very difficult, I think. Well, it’s difficult anyway, where you’re struggling mentally with symptoms because it’s not so easy to talk about and then to have medication that you’re self-medicating. Again, it’s showed that you were struggling but couldn’t talk about it. And there’s something more about a medic who can’t get help. And I’ve spoken about this before that I can’t get my HRT or my testosterone from my NHS GP. So as medics who have got a lot of training, if we can’t get help, what does that say for others? And I know when you were talking about this in the prison, a lot of the prisoners have abused various drugs, but they probably have had similar thoughts and feelings to you, but were medicating with amphetamine-like substances, with cocaine, with heroin. But they were still doing it because they were getting those thoughts. And that’s where looking at the audience, their emotions were were so surprised. You as a healthcare professional had been experiencing what them in their very deprived backgrounds, had experienced and it was a really incredible experience, but really sad for everybody because it shows that so many women are not being listened to or not being given the treatment that they need. [00:24:46][102.5]

Dr Sumi Rampling: [00:24:47] I know. I know. Yeah, and it was hard to talk about it, but I’m so glad I did. That was the first time I spoke about, you know, the abuse of the medication. I hadn’t spoken about it to anybody before that prison visit, but I recognised the importance of it. And I wonder, you know, with amphetamines and, you know, abuse of drugs and, you know, whether there may be a link between that and an early menopause because, you know, I had an early menopause. Okay, I’m one, n=1 e, that doesn’t mean anything. But I, you know, I have looked into it a little bit and I wonder if there may be a little bit of a connection there in the you know, if you’ve had a hard life, if you haven’t been able to look after your body or haven’t looked after your body for whatever reason, whether that may then have an impact. [00:25:30][43.0]

Dr Louise Newson: [00:25:31] Yeah and I’m sure it does. It’s always difficult to compare because we don’t know what our age of menopause would be if we hadn’t had that experience or those drugs. But we do know that women who abuse drugs, especially street drugs, are more likely to have menopause at a younger age. Women who have been subject to domestic violence more likely to have menopause, essentially age. And it makes sense physiologically because our body is very good at protecting us from getting pregnant if we’re not in optimal health. So if we’re using drugs, using our body in not a great way, then often we switch off and it might be temporary, but even if it’s only for a few months, that’s few months without hormones, without hormones in our brain, which can make symptoms worse. So allowing women to understand that is the most important thing. And then it will follow, hopefully, that they will seek the hormones that they need. So lots to think about. And I think this conversation about ADHD, hormones, especially testosterone, has got to continue. We hope we can do more research in this area. But before we finish, Sumi, I’ve always asked for three take home tips, so three things that if you are listening and you either have got ADHD or you know someone who potentially has. How would you think differently about hormones with ADHD if you’re one of those people? [00:26:51][79.8]

Dr Sumi Rampling: [00:26:52] Okay. So I think, first of all, just being aware that hormones, you know, are part of the picture. Empowering yourself with that knowledge. So, you know, I go back to when when I was a, even when I was a teenager, I had days where I had absolute clarity. And now, looking back, it’s probably because those are the days when I have that little testosterone and oestrogen, sort of, you have that in your cycle, don’t you? That sort of raise. Just being aware that hormones play a role. I’m not saying that, oh you need to take HRT, but I am saying that it’s important to look into it to be aware that hormones play a role. And if you’re struggling and you’re in perimenopause and things have gotten worse, look into it because you know it can be really helpful. And in terms of side effects, risks, with the newer types, it’s a different picture we’re seeing now, to, you know, how it was or how it was perceived to be in the past. So, number one, just have that awareness and, you know, don’t be afraid to speak about it with a clinician if you feel like this is something that’s going on. So that’s number one. Two more things about how hormones impact on on ADHD. I think I’d probably go beyond that because it’s, I think it’s not just about hormones. It’s about looking after yourself in other ways. So things like exercise, diet. So important. And it’s difficult when you’ve got ADHD because focusing on having a healthy diet, you need to be focused and you need to sort of be a bit ordered in your life to be able to do that. And someone who’s got ADHD is designed to be a bit chaotic, so it’s difficult to focus on diet and exercise, but it’s so important and you know, and these all interplay, diet and exercise is going to impact on your hormones as well. So that’s probably part of the reason why it’s so helpful. I don’t have a third reason to discuss hormones, but I will say, if you’re suffering with ADHD, you’re not suffering PTSD, if you’re experiencing ADHD or you know someone who does, focus on the positives of it, because as you mentioned before, it can be such an empowering condition to have. I remember when I was a teenager and I was, I chose in my A-levels I was going to do science and maths because I wanted to study medicine. I was uncertain because I didn’t have confidence. But I was told every day by my maths teacher, you can’t study maths, you can’t study maths. Even though I got, you know, a good grade at GCSE, you can’t do it. And I didn’t listen to her and I ignored her every single day. And what happened? I did well, I went to medical school, I became a doctor, and now I’m here and I’m using what I learnt to look at studies and to look at the data, you know, and to empower women and to sort of put right the sort of the false situation we’ve been put in and had I listened, I wouldn’t be here today. So don’t see it as a negative. See it as a positive because people with ADHD have determination. It’s something that we just need to have in order to survive in this world. And we’ve got it. And, you know, we should use it and just be proud of ourselves for it. [00:30:06][194.1]

Dr Louise Newson: [00:30:06] That’s so important. When anybody is given a diagnostic label, it has to be seen as a superpower in some way with the right support, help, advice and treatment. So thank you so much. I’ve really enjoyed talking to you. And thank you for sharing your story again for me. [00:30:23][16.5]

Dr Sumi Rampling: [00:30:23] My absolute pleasure. Thank you. [00:30:25][1.7]

Dr Louise Newson: [00:30:30] You can find out more about Newson Health group by visiting www.newsonhealth.co.uk And you can download the free balance app on the App Store or Google Play. [00:30:30][0.0]

ENDS

The post ADHD and perimenopause: Sumi’s story appeared first on Balance Menopause & Hormones.

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Women, ADHD and hormones https://www.balance-menopause.com/menopause-library/women-adhd-and-hormones/ Tue, 30 Jan 2024 07:00:00 +0000 https://www.balance-menopause.com/?post_type=menopauselibrary&p=6983 Advisory: this podcast includes themes of mental health and suicide. Do you […]

The post Women, ADHD and hormones appeared first on Balance Menopause & Hormones.

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Advisory: this podcast includes themes of mental health and suicide.

Do you find yourself easily distracted, with your attention rapidly shifting between different things?

If so, you could be one of the legion of women who are under-diagnosed for attention deficit hyperactivity disorder (ADHD).

Here, Australia-based psychiatrist and ADHD expert Dr David Chapman joins Dr Louise to discuss what ADHD is, how it affects women and the impact that female hormones – which have a powerful role in the brain – can have on symptoms.

He talks about how ADHD symptoms can worsen for women just before their periods and around their perimenopause, and sets out the common treatment options, including increasingly the role of HRT and the Pill, and how lifestyle changes such as mindfulness can help women affected by ADHD.

Dr Louise and Dr David also discuss how symptoms may only need treating if they are having an impact on a women’s life.

Download balance’s ADHD and menopause booklet here.

Click here for more about Newson Health.

Contact the Samaritans for 24-hour, confidential support by calling 116 123 or email

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Dr louise Newson. I’m a GP and menopause specialist and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance App. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving – and always inspirational – personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on the podcast, I’ve got someone with me who I actually heard lecture when I was in Australia a few weeks ago but didn’t manage to reach him because he was very busy answering questions from different people in the audience. And then I reached out to him for another reason and then realised that I’d listened to the most amazing lecture. So David Chapman is in Darwin, in Australia, and a long way away from me here in the UK, and he’s a psychiatrist with a special interest in ADHD and women’s mental health. But it’s not his first career choice, which we’ll hear more about in a bit. So I’m really delighted that he’s agreed to come and talk about his career, but also importantly about ADHD and the role of female hormones as well in our brains. So thanks, David, for agreeing under duress to come and join me today. [00:01:48][97.5]

Dr David Chapman: [00:01:49] Okay. Thank you, Louise, and thank you very much for the opportunity. It’s all a bit terrifying. Yeah. So I’m Dave, I’m an adult psychiatrist up in the top end of Australia. I started out working life as a teacher, secondary school teacher, and moved out of the classroom to be a consultant in head office and chief moderator in one of the year 12 our equivalent of the British A-Level exams and then had a midlife crisis and decided to go off and study medicine. [00:02:26][36.8]

Dr Louise Newson: [00:02:27] Wow. [00:02:27][0.0]

Dr David Chapman: [00:02:27] Which I did and really enjoyed. [00:02:29][1.8]

Dr Louise Newson: [00:02:30] Quite a pivot, isn’t it? [00:02:31][1.0]

Dr David Chapman: [00:02:31] It’s fantastic. And I don’t know anywhere else in the world that would give somebody that opportunity. However, I got the opportunity. The last part of my course as a medical degree was up in Darwin and somehow I never quite left. And then equally, as somehow I’m not quite sure, ended up in psychiatry and loved it and have been there ever since. But I’ve escaped the public system after many years and now do a couple of days a week private practice where I focus very much on ADHD and, perhaps not so much, women’s mental health. But ironically, most of the referrals for ADHD are in fact women ranging from 15 years old up to probably 60 years old. So that brings in the whole range of women’s mental health, but really brings in the whole range of the effects of hormones in this area of medicine. [00:03:41][70.4]

Dr Louise Newson: [00:03:42] Yeah. Which is so interesting and actually really relevant as well. So when you decided to go into medicine, were you thinking about psychiatry then or what was it that you decided to go into medicine for? [00:03:52][10.2]

Dr David Chapman: [00:03:53] So no, no, I actually I come from a very principled left wing background fighting for the common man. So I thought I would go and study law and enrolled in law. But fortunately, a very close friend who was a physiotherapist wanted a career change as well. She looked at law. She had discovered this thing called graduate medicine. I looked at graduate medicine and thought, Well, that’s what I missed, why I had the midlife crisis. I wasn’t working with people anymore. And having been a teacher for quite a few years, that’s what I like. I like working with people and I realised that maybe I should apply for medicine. So I did. She went into law, graduated pretty much the same time I graduated medicine, and I obviously carried on doing pretty much what I’d been doing for most of my life, which is talking to people, finding out what’s going on in their head and trying to help them in some ways. But the help is obviously very different in psychiatry and teaching, but the end result often is quite similar. [00:05:16][83.7]

Dr Louise Newson: [00:05:17] Yeah, it’s so interesting. I used to teach actually in Birmingham at the graduate entry course, there’s a GEC course it was called and we did a lot of problem-based learning and I really enjoyed it. I found it very, very stimulating because a lot of these students were older, they had life experiences, which I didn’t have as many of when I was 18 and joined medical school. But also they had this curiosity. I couldn’t just tell them something. It would be like talking to a two year old. But why? Why? Why has that happened? What’s the relevance and why? And actually, we did a lot of combining sort of physiology, anatomy, pathology, pharmacology, ethics as well. So it wasn’t nearly as disjointed. So my medical career was very traditional, so I would learn the physiology and then we weren’t allowed to do pathology until the third year. So we had two years of basic science and then added in disease. And then we started to see patients. And I actually took a year out and did a pathology degree because it gave me more a sort of chance really to use my brain and delve into a bit more of the basic science that I dabbled with, really. But what a shame that we weren’t introduced to patients at the beginning because so much of our focus is just on a disease and a label for patients. And I did psychiatry in north Manchester in a very deprived area, and the psychiatry training was absolutely phenomenal, actually. And looking back, I realise now how great it was, but it was very much seen as a specialty on its own. They had their own building away from the hospital. They weren’t really, you know, someone came in who’d taken an overdose. As soon as the medical bit was sorted off they’d go to psychiatry and we’d never see them again. And this joined up thinking, I think in medicine is really important, but it’s still quite fragmented, isn’t it, Dave? [00:07:02][105.0]

Dr David Chapman: [00:07:02] I think you’ve touched on a topic very dear to my heart, is the fragmentation of mental health services and the fact that unfortunately in Australia public mental health services by and large are focused on, you know, a very narrow domain of mental health, you know, schizophrenia, bipolar disorder, drug induced psychosis, acute suicidality. And they turn away an enormous range of people, including people with ADHD, other than in the child and adolescent sector, but certainly in the adult sector. And so there’s this great mass called the missing middle of people who come outside the domain of most GPs, not all, but who are not in the domain of the public sector. And so they come to private psychiatrists. Unfortunately, not all of them can afford private psychiatrists and our Medicare-refund process, which is the way that most consultations are funded, the government reimburses the patient a certain amount of money. [But] simply do not reflect the time that psychiatrists spend either talking to the person and then writing it up afterwards, thinking about it or reading about it, if it’s a novel presentation, and so many people miss out. ADHD is a prime example of people who may wait years to find a psychiatrist who will assess them. We just recently had a Senate inquiry into ADHD and we’re hoping that that will alter the landscape dramatically. But don’t hold your breath. [00:09:04][121.7]

Dr Louise Newson: [00:09:05] Well, people need to be listened to, don’t they? And I think that’s one of the first things that I learned in medicine from some really good physicians, actually, is listen to the patient. It is in the history and for too long, actually, we try and either shoehorn symptoms into a diagnosis to tick that box or we ignore symptoms all too often, especially with women. But it can be with men as well that we’re told it’s in our heads and there’s this somatisation. And I spoke to someone yesterday, actually, she’s in Holland, and patients who are abroad for their consultations, where I can’t consult, I can only just talk to them. Whereas if they’re in the UK, obviously I can do a proper consultation. But this lady had reached out to me and her story was very distressing. So I said, I’ll just speak to her. And she had had many years of psychiatric illnesses and she thought she had ADHD. But she’d, like many people, hadn’t managed to get a proper diagnosis. But she’d also had polycystic ovary disease. She’d had endometriosis, she’d had PMS, PMDD, she’d had postnatal depression, and she’d had some irritable bowel type symptoms and she’d had some palpitations. She was in her late or she still is in her late forties. So she had seen a neurologist, she’d seen a cardiologist, she’d seen a gastroenterologist, and she had been admitted to psychiatric hospitals and she kept saying, It’s my hormones, I think it’s my hormones. And then they said, You are just obsessed with your female hormones. This is part of your psychiatric condition. You have this obsession with hormones. Yet no one would give her any hormones to try. Hormones are just biologically active, you know, hormones they’re not even medication. I was arguing with my husband yesterday whether HRT is a medication or a treatment or a supplement. And we were getting a bit heated and we were in a coffee shop, so we had to be a bit quiet. But it’s very interesting how you define these conditions and treatments. And so I felt incredibly sad for this lady who was then going off to see another gynecologist this week and is going to actually ask for some basic hormones and see if that improves her symptoms. And I’m sure it will. But how awful to get to that stage. But we hear it all the time. So ADHD is four letters. Can you just explain very basically to those people who probably haven’t heard or may have heard of it, but don’t really know because there’s lots of talk about it now. But could you explain what it is? [00:11:24][139.3]

Dr David Chapman: [00:11:25] Okay. That’s, it’s not at all what people think of it. The classic image of ADHD is the naughty boy misbehaving in the classroom. And that’s about as far from the reality as you can get. So it is like all conditions that we experience medically, whether that’s mental or physical, it’s something that has a very dramatic, a marked genetic underpinning. So ADHD is one of the most heritable of all conditions. I keep using the word condition rather than a disorder because that’s a judgment and it may not be a disorder. It might be a wonderful advantage to have ADHD. So it’s something that is you have a vulnerability because you have a particular group of genes. The latest research suggests there’s three of them that are pretty likely and maybe a dozen that are probably involved, and maybe as many as 24 have a bit of an influence. And those genes overlap with many other conditions like schizophrenia, bipolar, autistic spectrum conditions. But like all vulnerabilities, usually you need some sort of trigger. And so something in the environment of somebody with those genes triggers the development of the condition. And it could be almost anything. It could be mum has an inflammatory disease in pregnancy or as a baby you have an inflammatory condition, something as simple as that. We don’t know entirely what all the triggers are, but there are triggers and that leads to the development of the condition. Where that then goes to is that the development of the emotion, anxiety, threat, motion control system in the central brain, the limbic system, its development is affected and in many respects it will become oversensitive or hypersensitive. And the development of the frontal lobe in here, which controls that system, which inhibits it, so that if somebody comes up behind you and goes boo, many people just relax and don’t really respond too much. Somebody with ADHD is very likely to react very dramatically because they can’t inhibit that startle response. So it’s very much related to the brain’s ability to inhibit or to control their attention, their movement, their impulsivity, their emotions. And it’s a spectrum. It ranges from people who just their attention is easily switched from one thing to the other. You can call that distractibility if you like, but it’s a very rapid change in response to some sort of stimulus in the outside world, and they will look at that. And if it’s not really important, doesn’t really matter. Their attention will shift somewhere else. You can call that getting bored if you like. And so boredom and inattention or distractibility are the traditional symptoms of ADHD. But if, on the other hand, it’s something really important, you know, it’s a sabre tooth tiger coming to eat you, then they pay very, very close attention to it, almost to the exclusion of everything else and are really hyper focused on it and achieve great things. [00:15:25][239.9]

Dr Louise Newson: [00:15:26] That’s so interesting. You saying achieve great things. And, you know, when you said before that it could be an advantage. And I worry in some ways, I worry about all sorts of things, but sometimes we’ve got this overdiagnosis. People like to, well not all people, but there’s a sort of advantage sometimes of having a label because it can be used as sometimes not always a bit of an excuse, but also it means that there’s need to have treatment. And that’s when I worry. Like when you say, is it disorder or not? And that’s the whole thing about do we need treatment or not? And I’m sure, I’ve never had a diagnosis and I don’t want you to diagnose me. I probably do have some ADHD because I’m constantly multitasking in my brain and I’ve managed to achieve a huge amount in a short period of time because I’m constantly pivoting and thinking about lots of things at once and I can prioritise tasks. But actually, if you said to me, I’m going to give you this medication that will slow your brain down so you can only focus on one thing. Probably a lot of my team would really like it because I wouldn’t be firing emails late at night saying, I’ve got this idea and that idea, or I’ve done this and done that, but I would absolutely hate it. Context is really important for that individual, isn’t it? [00:16:36][69.8]

Dr David Chapman: [00:16:37] Mm hmm. And this is where the whole issue arises with why do we treat it? And I’m mindful of a jackaroo. So a jackaroo in Australia is usually a guy, sometimes a woman, who either rides a horse or a motorbike or both and rides around two or 300,000 hectares or acres of land chasing cattle, mending fences on a station somewhere in the centre of Australia. And he came along because somebody had told him to come and see me. And as he sat and bounced in his chair because he couldn’t sit still, we talked and talked and I said, in the end, you’ve got ADHD and you’ve got the hyperactive form where you’re driven to move. You find it very hard sitting still. I said, Would you like me to treat you? And he said, Well, what will the treatment do? And I said Well, it’ll slow you down a bit. You won’t bounce around so much and you might be able to focus and think a bit clearer and organise your day a bit better. And he thought about it for a moment. He said, Well, what I do is the same every day. I ride around the periphery of this huge part of the world, probably bigger than most counties in England. And I fix the fence and I fill the water. And I do this. Do I need medication? To which the answer is no. [00:18:06][89.5]

Dr Louise Newson: [00:18:07] Yeah. [00:18:07][0.0]

Dr David Chapman: [00:18:07] So he was not impaired by his very severe condition, but the carpenter who is extremely good at his work, hands on making things, is promoted to foreman and has to spend half the day in the office looking at a computer, scheduling people, planning things, organising stuff, and gets kicked out of the job because he makes a mess of it over and over again. And if I treat him so that he can sit down, he can focus on the computer, he can organise things and complete the task. He’s no longer impaired. So context is all. Which is why people are coming out of the woodwork. They’re suddenly discovering the reason they can’t cope in a relationship or work or whatever is because they have ADHD. Treat them and it makes life less stressful. They’re less impaired. They can do more. They still have ADHD, but it doesn’t matter anymore. [00:19:17][69.8]

Dr Louise Newson: [00:19:18] So talk about treatments then, because it’s not just a single treatment, is it, the same for every person? [00:19:24][5.8]

Dr David Chapman: [00:19:24] No. So it’s not a hierarchy of treatments, but it’s a range of treatments. And perhaps for many people it’s enough to see somebody who’s called an ADHD coach who literally coaches you in how to manage your symptoms. They teach you a bit of mindfulness, which is a learned skill. They will teach you how to organise your life, how to ensure that you don’t just make a list, but how do you manage that list and adhere to that list and ensure things are done? I mean, that’s simplifying what they do, they can provide day to day support, if necessary, to help you develop the routines that you require or the understandings of how to set up a problem, solve it, carry the task through to the end. And for many people, that’s enough. Even if it’s not enough, it will help, it’s very much like depression, medication and psychological intervention is far more powerful than either on their own. So that’s okay. Then. Some of, just the conventional antidepressants that we use regularly can be very helpful for somebody with ADHD because they lower anxiety. They might act on the pathways in the brain to improve the pathways and help with the control of the brain, the inhibition, if you like. And so some people use those and it’s sufficient. And there’s one particular one called Strattera, atomoxetine is its chemical name. It’s an antidepressant. It’s not particularly fabulous as an antidepressant, but it’s very, very, very good at helping some people with their ADHD. Then there’s a whole group of medications called alpha-2 agonists, which is getting technical. But the one that most people may have heard of is one called clonidine, which is given to children very frequently with ADHD because it sends them to sleep. It’s also very good for lowering your blood pressure if you’ve got high blood pressure. And then there’s a long-acting version called guanfacine, and that’s very, very widely used in Europe for ADHD because again, it helps the frontal lobe and the pathways to integrate and for the brain to be better controlled, its emotions, its movements, its planning in response to external stimuli, the oversensitivity to sound and light that a lot of people with ADHD have. And that, of course, also obviously lowers your blood pressure because it’s an alpha-2 agonist. And then what are generally regarded as the gold standards in ADHD medication, the stimulants, there’s quite a range of those. But the two that most people have heard of, dexamfetamine and methyphenidate or Ritalin, and they all come in long-acting forms and generally speaking they are very dramatic in their effect. People come back after a couple of weeks of gradually increasing the dose until they get a just right effect and they say, Oh, it’s a game changer. I had a young, just 18-year-old young woman come to see me recently, and we’ve gradually increased her medication. And she came in last week and said, well, she said, I’ve cleaned my room and done five loads of washing. And Mum emailed just today in fact, and said, she’s so much better, she’s much more organised. She still has a lot of other issues to work through. But we’ve started, we’ve laid a foundation of at least control in some parts of her life and given her the control over some parts of her life. And we now need to just look at some of the other issues that she faces. But they’re the primary groups. There’s a number of other stimulant things, modafinil used for narcolepsy, hypersomnia. But they all work in similar ways, not identical. So often, if one works or doesn’t work, the other one will. And if none of them work, maybe we’ve got the diagnosis wrong. Or we need a combination. We need to have something that will help with the emotional dysregulation, plus something to help with difficulties in attention or organising or planning or finishing tasks or even starting tasks. You know, procrastination is very common. [00:24:38][313.9]

Dr Louise Newson: [00:24:39] And that’s where it’s looking at the bigger picture as well, isn’t it? You know, it’s so crucial. [00:24:44][5.0]

Dr David Chapman: [00:24:45] That’s right. And of course, I’m very mindful of young girls who’ve hidden their ADHD in childhood, hit puberty, and their brain starts to change the chemicals. There’s not enough of the chemicals to fill the brain changes. And so they become much more floridly emotional, much more floridly inattentive, much more floridly disorganised, unable to stop their impulses. And then perhaps, it’s not necessarily the same group, but a lot of women will then go on to experience a dramatic worsening of their symptoms premenstruallly, in that week before the menstrual cycle as the oestrogen drops. [00:25:38][53.0]

Dr Louise Newson: [00:25:39] So it’s very interesting the role of hormones and ADHD, because we see a lot of women in our clinic who have either been recently diagnosed with ADHD or their symptoms have worsened. And actually we know it’s related to their hormones because the right dose and type of HRT, often with testosterone actually, can be quite transformational and sometimes that can be with other treatment for their ADHD, or sometimes they do that first and then see. So what’s your thoughts about female hormones and ADHD, Dave? [00:26:04][25.4]

Dr David Chapman: [00:26:05] Well, it’s interesting. It’s quite clear that in the normal menstrual cycle in some women, but not all, the symptoms of ADHD worsen in the pre-menstrual period. And of course it’s been generally said, oh, it’s because the oestrogen drops. But as you point out, it may well be because of other issues, progesterone or the testosterone, which is a bit of a revolutionary idea. We also know that the effectiveness of ADHD medications often diminish in that pre-menstrual period. And so for some women where it’s really critical, they have to take a little top up in just a few days before the period. And then when the women enter perimenopause, if they’ve got well established ADHD and it’s well recognised and treated, that dramatic up and down in hormone levels really shows up the effects of a drop in hormones on ADHD symptoms and the effectiveness of medication. And of course, it raises the issue, what do you treat? Do you ramp up the ADHD medication or do you in fact provide HRT to smooth out the fluctuations in hormones to allow the ADHD to be treated in its usual fashion for that particular woman? And so, you know, increasingly I think the answer is we need to use hormones more regularly than we might otherwise do so. And even in a normal cycling woman, if a contraceptive pill, Zoely or whatever, would help smooth out the fluctuations to smooth out the incredible, particularly the emotional dysregulation that with ADHD they’ve already got, to the extent that it may also now present as premenstrual dysphoric disorder [PMDD], which is far more serious than just PMS. A little bit of irritability becomes the demonic person who cannot control themselves, but would really love to control themselves. It’s not they don’t want to, it’s just they can’t. So I think, you know, in the 21st century, we’ve got to spend far more time thinking about the brain, mind, body connections and not just dismiss hormones as being, Oh, you’re just a hormonal. It’s all right. You’ll get over it. Which is, I think, the worst thing to say to anybody. [00:28:59][174.1]

Dr Louise Newson: [00:28:59] Absolutely. Especially when they have hormonal changes. And what I’m very interested in also is we sort of monitor women about their hormones and ask them about their periods. And actually, it’s not just about periods, as you know. And we don’t know how we can measure the level of these hormones, oestrogen, progesterone and testosterone in our brains. Blood tests will show what’s in the blood, but they won’t show what’s in the brain. And we know that our brain produces all three of these important hormones as well. So it’s not just about our ovaries. There is so much that we need to know. But I think what you are highlighting especially is that we need to be talking and understanding patients and realising and remembering and acknowledging that they’re all very individual. So none of this is a one size treats all or one diagnosis for everybody either. So I’m very grateful for your time and I hope that we can do a bit more together and learn from patients and stories as well. So before I finish, Dave, I’m going to put you on the spot because I always ask for three take home tips. Sorry I didn’t warn you about that. So three things. If people want to learn more about ADHD and possibly the role of hormones as well in our brains, what three things do you think would be easy and realistic for them to do just in the first instance? [00:30:11][71.8]

Dr David Chapman: [00:30:13] I think it’s very worthwhile taking one of the online screening tools for ADHD. At least it will give you an indication and look very carefully at – are the symptoms that you have impairing? If they’re not impairing, it doesn’t matter. So don’t worry about it. But if your life is in perpetual chaos and you show some symptoms, then check it out with a screen. But then go and get expert assessment because it’s very easy to be misdiagnosed with either ADHD and you’ve got something far more difficult or challenging going on, or you be diagnosed with something that is not ADHD, but in fact you’ve got ADHD. So that would be one take home message. Another take home message for women would be mindful of an older lady who’s had the most unusual and erratic history of periods who had IVF only a few years ago that failed, which is a red flag for possibly primary ovarian insufficiency, but then around the age of 30 suddenly started putting on weight without any obvious reason and has ADHD as well. And that was getting progressively worse. And so maybe she is in premature menopause and the ADHD is showing up dramatically because it’s unmasking. So if you have a very unusual history of symptoms relating to your hormones, go and get checked out. And I guess the third thing is be mindful that the treatment of ADHD isn’t always just fairly, not dangerous chemicals, but ones that are frowned upon by many people. And there are many other things that you can do and just learn in some very simple skills of mindfulness. Learning to relax through yoga, for example, perhaps having a better diet, in other words, addressing the whole physical aspects might just help. It’s not going to fix it, but it might help. [00:32:52][159.3]

Dr Louise Newson: [00:32:52] And I think that’s so important, this multipronged approach to treatment, which is certainly what we do with women with hormonal issues. It’s not just taking hormones and not thinking about your lifestyle, your nutrition, your wellbeing, everything else. It’s got to all be together. And it’s really important thinking about any mental health condition, actually. So I’m very grateful for your time. I’m sure there’ll be lots of questions and discussion after this podcast, so I might have to invite you back another time sometime if you agree. [00:33:19][27.0]

Dr David Chapman: [00:33:19] Oh, I would love to come back. [00:33:19][0.0]

Dr Louise Newson: [00:33:21] Wonderful. Thank you. And thank you again for sharing so much of your knowledge. [00:33:25][4.2]

Dr David Chapman: [00:33:26] And thank you. [00:33:26][0.7]

Dr Louise Newson: [00:33:31] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk. And you can download the free balance app on the App Store or Google Play. [00:33:31][0.0]

ENDS

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My story: hormones affect everything! https://www.balance-menopause.com/menopause-library/my-story-hormones-affect-everything/ Wed, 25 Oct 2023 00:00:00 +0000 https://www.balance-menopause.com/?post_type=menopauselibrary&p=6614 Read about how Adele discovered her hormones were impacting her health

The post My story: hormones affect everything! appeared first on Balance Menopause & Hormones.

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When Adele discovered how much her hormones were impacting her health and her attention deficit hyperactivity disorder (ADHD), she not only transformed her own life but set up a clinic to help other women too.

‘I always thought I had a healthy lifestyle – I was doing keto, intermittent fasting, exercise, all the things that are touted as being good for you. But when I was 37, my period vanished.

‘At the time I had a full-on job as a senior manager in a local authority with high levels of stress and responsibility. I’d be at my desk at 7.30 in the morning and not have time to get up and go to the toilet – it was go, go, go. I also had a toddler and a baby so it was a fast-paced life, but I felt that I had things in place to protect my health so my body could navigate it. I had insomnia but, looking back, I don’t think I was even aware of it – it just seemed normal. I felt that I could handle the pace and I loved my life.

‘So when my period stopped, at first I thought, well, that’s one less thing to worry about. But inside I knew this wasn’t right, something wasn’t working. I was also aware that I had ADHD. Because of my work in children’s services, I had a robust understanding of ADHD. I used to joke flippantly how I was ADHD and laugh it off but I didn’t think I needed a diagnosis. I thought, I’ve done really well in my life so what’s the point?

RELATED: When ADHD collides with perimenopause

Learning more about hormones

‘But I did decide to take a leap of faith and leave my job to set up a holistic clinic for women. I had specialised in female offending and had a desire to work in the female arena, but I was also interested in working in health. I practiced reflexology and Reiki but when the pandemic hit, I trained with an incredible woman in the States called Nicole Jardim, who mentored me to understand more about women’s hormones. I learnt how I had put my body under incredible stress through activities I thought were healthy – because so much health advice is based on what works for male physiology.

‘As soon as I started nourishing my body with the right foods, moving my body in the right way, and using menstrual cycle awareness to restore myself, my period came back. I felt passionate about sharing my knowledge so I also set up an online clinic to support women with hormone imbalances.

RELATED: understanding hormone levels in the blood

Getting a diagnosis of ADHD

‘Several years ago, at the age of 41, I decided to get a diagnosis of ADHD. My work had taught me that hormones affect everything, plus when I started to see traits in my children, I wanted to roll model the diagnosis process for them. Receiving the diagnosis was the most validating experience of my life. It allowed me to have compassion for myself. I suddenly understood the amount of energy that I had subconsciously put into all of these strategies to be “normal”. For instance, I have lists and reminders everywhere otherwise things will drop out of my brain. And I’ll do things like when I get in the car, I’ll think: Did I turn the oven off? Did I turn the hair straighteners off? And it’s not OCD behaviour. It’s because genuinely on various occasions I’ve been distracted doing other things and I have forgotten to turn the hob or straighteners off, so I have strategies to cover myself.

‘I brought my knowledge of ADHD into my work and combined it with my understanding of women’s hormones to create a space for ADHD women to understand how their hormones affect their traits. I run an in-person clinic with a GP so it’s an integrative approach. On a personal level, my job enabled me to have an awareness of my perimenopause. I was suffering from sleep disruption, getting anxious and feeling overwhelmed about things and even the fun stuff felt like a chore. I call it inner scratchiness – no matter what it was that I was doing, it just felt like another thing for my to-do list.

‘These are all things that can come up with ADHD too so it’s about deciphering what’s an ADHD trait and what’s a hormonal imbalance. I knew that I was experiencing progesterone deficiency and I needed to have a progesterone-only HRT prescription within the understanding of my ADHD. I was fortunate to know an incredible GP in women’s health, who’s trained functionally too, and I worked with her to get the right prescription. She invested a lot of time in understanding ADHD and she looked at the work Dr Louise Newson has done around ADHD and menopause. I’ve responded really well to the progesterone.

Helping others

RELATED: ADHD and the perimenopause and menopause

‘For any woman facing the dual challenge of ADHD and perimenopause, I’d advise them to track their traits against their hormonal fluctuations. I am not medicated for ADHD and I’ve believe one of the reasons that I’m able to operate like I do is because I understand the impact my hormones have on my traits. I know when I’m optimal, when I need to step back. So understand your unique rhythm, your unique ebb and flow, through tracking. Once you have that evidence, if you need to see a healthcare professional you can say, this is what’s going on for me. And if you are medicated, you can choose to have it tailored around your hormonal fluctuations.

‘Often when women with ADHD enter perimenopause, the lid comes off all the strategies that usually help. Many women don’t realise the protective benefits hormones have on our cognitive function and our executive function so when they go awry, it can feel like you’re going crazy.

‘So I truly believe that HRT should be a fundamental part of the discussion, at least in the treatment of perimenopausal women’s ADHD.’

Learn more about Adele, her clinic and online clinic at Harmonise You

Would you like to share your experience of perimenopause or menopause? Write to us at shareyourstory@balance-app.com

The post My story: hormones affect everything! appeared first on Balance Menopause & Hormones.

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When ADHD collides with perimenopause with Margaret Reed Roberts https://www.balance-menopause.com/menopause-library/164-adhd-and-perimenopause-with-margaret-reed-roberts/ Tue, 09 Aug 2022 08:32:44 +0000 https://www.balance-menopause.com/?post_type=menopauselibrary&p=4398 Margaret Reed Roberts is an experienced social worker and educator who noticed […]

The post When ADHD collides with perimenopause with Margaret Reed Roberts appeared first on Balance Menopause & Hormones.

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Margaret Reed Roberts is an experienced social worker and educator who noticed a change in how she felt in her late 40s. Along with more obvious symptoms of perimenopause, such as hot flushes and migraines, there came a deterioration in her cognition – she struggled to initiate, plan and complete daily tasks and the mental load became unmanageable. A friend suggested there may be more than perimenopause going on and questioned if Margaret was neurodivergent. Enter ADHD and perimenopause.

In this honest and insightful conversation, Margaret shares of the ‘relief and grief’ of being diagnosed with ADHD as an adult and the impact she now understands ADHD has on her daily activity, home life and relationships.

Margaret’s three tips for those who have ADHD or think they might have it:

(provided after the conversation)

  1. Be informed. Knowledge is a game changer. You feel more confident when you understand and are better able to advocate for yourself. Challenge others where necessary, using your acquired knowledge and pass that information on.
  2. Don’t be alone; join support groups, talk to empathetic friends and family.
  3. Tell your story. You and your story are valuable, not everyone will listen or care, but the more we talk, the more we break taboos and stigma.

Follow Margaret on Facebook

Twitter: @geordiereed

Episode Transcript:

Dr Louise Newson [00:00:09] Hello. I’m Dr Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of The Menopause Charity and the menopause support app called balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based information and advice about both the perimenopause and the menopause.

Dr Louise Newson [00:00:46] Today on the podcast, I’m really excited to introduce to you someone called Margaret, who has been working hard, like many women do behind the scenes actually, to help. And we’ve just written a booklet together with other team members about ADHD and the perimenopause and menopause, which is something that hasn’t actually been spoken about before. And the number of women we see in the clinic means we’re learning so much through our patients and we see a lot of women who have ADHD or just some traits actually that get a lot worse during the perimenopause and menopause. A lot of people find that their attention isn’t as good or they ruminate a lot. They have some quite obsessive behaviour as well, which can often worsen with low hormone levels. So we’ve produced this booklet that’s come out and Margaret has been working with my team and she’s here today to talk a bit more about this. So welcome, Margaret. Thanks for coming today.

Margaret Reed Roberts [00:01:40] Thank you. It’s great to be here. It’s a real privilege.

Dr Louise Newson [00:01:43] So, do you mind just sharing a bit? Well, firstly, let’s talk – I’ve just mentioned four letters and some people won’t even know what they stand for. So medics are very good at that. We use lots of terminology that people don’t understand. So do you mind talking what ADHD is and also about your journey as well, if that’s okay?

Margaret Reed Roberts [00:02:01] So ADHD stands for Attention Deficit Hyperactivity Disorder. It’s quite a mouthful. It is loaded with negative words. It doesn’t suit a lot of people – ADHD. A number of us try to come up with our own version of what it means for each of us the A, the D, the H and the D in terms of positives and strengths as a way of sort of reframing the negative labels. So it’s a neurodivergent condition. It’s not even a condition in a way. It’s a neurodivergent type of brain. It’s a neuro type. It’s a brain design. Your brain structure is different, and it’s not only to do with some of the neurotransmitter chemicals, a lot of people think it’s to do with dopamine only, but it’s actually so much more than that.

Dr Louise Newson [00:02:54] And that is the same with a lot of conditions, isn’t it? There is a whole spectrum as well, and I think some people think you either have it or you don’t. And it’s very black and white. And actually it isn’t really, is it? There can be different degrees and you know, it actually can be a positive thing for some people as well because we all use our brain in different ways and it’s working out how to turn it into something that could be beneficial. And I think there’s so much labelling and like you say, a stigma with a label because often it’s, well we see it all the time in the menopause don’t we because of misunderstanding. And I think with ADHD, lots of people think that’s children, that’s naughty children. You know, I’ve had people with ADHD in my clinical room and they’re opening the cupboard.  They can’t sit still. They’ll be fiddling with all my equipment and it’s so easy to just say, ‘Oh, that’s a really badly behaved child’. No, it’s not. It’s an inquisitive child who wants to learn more. And, you know, isn’t that great that they’ve got such a wonderful brain that constantly needs stimulation.

Margaret Reed Roberts [00:03:54] That’s right.

Dr Louise Newson [00:03:54] It’s very interesting, isn’t it? So, yeah. Carry on.

Margaret Reed Roberts [00:03:56] So just some of the things you’ve said there are actually really helpful. And I would quite like to unpack a couple of things that you said in a way. You’ve talked about, didn’t you a spectrum. Now, actually, many, many people think of the spectrum as being linear, which is super unhelpful and not accurate at all. And people who are neurodivergent actually well, I see the spectrum is when you’re trying to go on your colour printer and you get that beautiful colour spectrum, so many different shades and you’re trying to find the exact shade. That is what the spectrum is. I do think in terms of what we understand about neurodivergent brains is you either do have a neurodivergent brain or you don’t, but actually I think a high functioning, low functioning. And that applies to mostly we’ve talked about that in terms of being autistic, but there’s actually some overlap. It’s different, but it’s similar. And that’s not always easy to put your finger on. I’m not autistic. My eldest son is autistic and my youngest son has recently had a diagnosis, but only after I had my diagnosis. Normally it’s the other way around.

Dr Louise Newson [00:05:19] Yeah, because it can run in families can’t it?

Margaret Reed Roberts [00:05:22] Yeah, it’s about 74 to 76% genetic.

Dr Louise Newson [00:05:26] Right. Which is a lot isn’t it?

Margaret Reed Roberts [00:05:28] So, yeah. Chances are if you are ADHD and you have children and you look back in your family line, you will see it. I also see it in my previous family line.

Dr Louise Newson [00:05:40] And is there an association with ADHD and autism as well?

Margaret Reed Roberts [00:05:43] Yes. So for autistics, there’s about 50% co-occurring, but the other way around. If you’re predominantly ADHD, the autism is much less. So it’s absolutely, I mean, your divergence is fascinating. Our brains are amazing aren’t they. They are really interesting. But the label, the ADHD label, I know people say, ‘Why did you want to label yourself?’ And actually, I don’t want some label as such. But understanding ourselves or our child or other family members is so important. Understanding what we need, how we work, how we function. So that diagnosis has not been a label to me. It has been a roadmap back to myself. That’s sort of the best way I can describe it, because I lost all sense of myself. I didn’t recognise myself anymore really. And then actually owning some of that and recognising, okay, these are the reasons why I’ve been struggling and that’s actually – in some ways it’s freeing. I found a combination of relief and grief with that understanding of myself at 48. Like you look back on your life and there’s a lot of different things. I think so many missed opportunities, that aspect of possibly feeling let down. Very much misunderstood. ADHD is so individual as well. I’m not obsessive, but I know there’s obsession and addiction with some people. That doesn’t impact me in that way. ADHD is you can be the sort of impulsive, hyperactive or the inattentive or the combination. And mine is a combination. But I’m predominantly what you call inattentive, but inattentive isn’t what we think either. It’s really complicated and we really need clinicians to understand because there’s so much to it. So you really, really need to be specialist in that element of psychiatry.

Dr Louise Newson [00:07:56] Yeah, absolutely. And I think that’s so important with anything is about individualisation, actually. And for too long in medicine we’ve been giving people labels and diagnoses and trying to fit people into a box. And that’s how we make diagnosis, of course.

Margaret Reed Roberts [00:08:10] Yes, you need some of that.

Dr Louise Newson [00:08:11] It’s really important. We have this big net that we cast and we’re trying to filter and filter all the time. But then when it gets down to it, everybody with diabetes is different, everybody with migraine is different. So then it’s the same with any psychiatric illness and any disorder. Even if it’s not a disease, there is a whole array and actually even for that, individual, symptoms and manifestations can vary not just day to day, but hour to hour as well. And it all depends on their external environment as well as internally. What you’re eating, how you exercise, what your relationship is with friends and family and all sorts of things.

Margaret Reed Roberts [00:08:49] That’s right. Yep we’re not we’re not in isolation. It’s all how everything fits together in our life. I mean, certainly for me, it is a neurodivergent condition. It’s not a mental health condition. It’s not a psychiatric condition. I struggle in some ways that psychiatry is focussed on this, because I actually think we need neuroscientists.

Dr Louise Newson [00:09:09] Yes, absolutely do.

Margaret Reed Roberts [00:09:10] I know there are some psychiatrists who are, sort of does the overlap. But sometimes it feels a bit funny because I’m like, I’m not mentally unwell. It can impact me, society can make me feel…

Dr Louise Newson [00:09:25] …If they’re not diagnosed properly and don’t have the right tools and the right understanding.

Margaret Reed Roberts [00:09:30] That’s right. Lots of misdiagnosis. And then the impacts can cause living unsupported, possibly unmedicated or not understanding what is going on with yourself. But it’s not just in the brain, actually. It manifests itself in your body as well in strange ways that people you know, a lot of things can be internal for women. It looks different for women as it does in men. And the combination of ADHD and menopause, it’s a complete double whammy, isn’t it? When we talk about gender bias and stigma, I just think, ‘Oh yeah.’ ADHD and menopause combined is just very, very hard for most women. And the new research is showing huge numbers of women. That is the most impactful time of their life.

Dr Louise Newson [00:10:19] Which is no surprise is it, because it is a like you say, it affects the brain and we know our female hormones affect our brain. And what’s very interesting is in the perimenopause, we’ve got great changes of hormone levels. And so I think a lot of these disorders are actually worse during the perimenopause than in the menopause when hormones are uniformly low.

Margaret Reed Roberts [00:10:39] Okay, I’m going to hold onto that.

Dr Louise Newson [00:10:40] Yeah. So when you have these big changes of estrogen, progesterone and testosterone it really can affect the way we think. And we know that some other conditions, so you know, anxiety, depression, even suicidal thoughts could be a lot worse in the perimenopause and, you know, our brains like stability. You know, any of us who have not slept well know how it affects our brain function. If we haven’t eaten for long periods of time, it can affect. So our brains like routine, they like structure. So anything that’s changing or challenging to our brains is going to affect any other condition as well. And so it’s very interesting that you said that you were diagnosed when you were 48, is that right?

Margaret Reed Roberts [00:11:21] Yeah.

Dr Louise Newson [00:11:22] Yeah. So how did that come about then? Because obviously you’ve been living with maybe thinking that your brain is working differently to others for a long time. But did you try and get help before or did you just think that was you?

Margaret Reed Roberts [00:11:35] So I think having a diagnosis now has allowed me to reflect perhaps, a little bit reimagine. That’s quite painful to reimagine what it would have been like actually, to have known, to have that kind of… I think for me information is empowering. I think it allows me you perhaps be a little bit more accepting of yourself. I think a lot of people with ADHD feel, well certainly in the past and still do, feel quite useless sometimes. There’s a lot of negative impact on us alongside some great strengths. So at 48, I was, I think probably my menopause signs started about 47. I noticed various physical symptoms of perimenopause, and then definitely the cognition started getting worse and then initiating things. So it’s really hard to start things sometimes, and it’s really hard to finish things. Often we’ll have lots of projects that are unfinished because we get an idea and we’ll go with it. Our brains actually like spontaneity quite often. So that’s another difference and whilst I don’t have specific necessarily routines, which is quite interesting. I just go with what I want to do and how I feel. I do obviously have a family to consider, so I guess we have to get up and have to get out to school. Those are all things that you do, but I don’t necessarily do everything in the same order for myself. You know, I might brush my teeth later, might brush them earlier. Lots of people have a regular routine. That’s not me. When I might start cooking dinner, which is quite a thing now. So I noticed that I’d lost interest in cooking. The planning got even harder of anything, you know, like going shopping and being overwhelmed by all the choice, making decisions about things. And it’s all the micro detail that often it’s women that are juggling, I think. The mental load was just totally unmanageable for me, and I’ve only, you know, tried to juggle some balls and I do drop some sometimes, but this just got worse and worse and worse. And then, I think I was much more irritable, much more triggered easily. Obviously with neurodivergent children, there’s a lot going on in our home environment as well. I just started… I don’t understand what’s going on and I’m forgetting words, struggling to find my words. I’m usually somebody who’s fairly articulate. Took me longer to say what I wanted to. Took me longer to process information. I just have a hundred thoughts going on in my head at once and ADHD stops me from prioritising those. And it’s a very much an interest based brain design, not a priorities and must dos. So we’ll do something that takes our interest and put off the stuff because actually it’s very, very effortful. It’s not that we’re not trying hard. It’s hugely effortful and actually quite exhausting and overwhelming.

Dr Louise Newson [00:15:00] I was going to say must be very tiring as well.

Margaret Reed Roberts [00:15:03] It’s completely exhausting. So people have and that’s a key sign. Multiple burnouts for people, you know, mini burnouts, fatigue. And there’s a big overlap there, isn’t there, with perimenopause, but you can imagine the magnification of that with perimenopause and then all this undiagnosed brain busyness and it’s different. I’ve experienced depression, I have experienced anxiety. And I imagine that is to do with undiagnosed ADHD for 48 years, as well as some difficult personal circumstances beyond that. So those are the things I thought, okay. So I also had really severe migraines that were triggered by perimenopause, and I was just ending up being in bed so much because I was so ill. I couldn’t get over one before the next one happened. And then, so I realised something seriously wrong here. I’d started HRT, the physical things had got better. The cognitive things were getting worse. You know, you talk to my neurologist, I’m a dementia worker, I’m a social worker by background, and I was a dementia worker at the time. So I started questioning, ‘Do I have dementia?’ And I was getting quite scared about what is going on. This is really frightening for me now, but very much it’s internal and people don’t see it.

Dr Louise Newson [00:16:26] Yes. But I think as women, we do hide our emotions a lot. And, you know, I think there’s a lot of misperceptions out there. I think people look at me with the work I do and think that I’m very strong and that they can batter me down and criticise my work. But actually internally I’m really upset and I’m very vulnerable and I have a lot of time where I doubt my abilities and you know, feel very, very tired and very emotional. But I wouldn’t show that in public.

Margaret Reed Roberts [00:16:53] And you’re very public, aren’t you.

Dr Louise Newson [00:16:54] Yeah, well…

Margaret Reed Roberts [00:16:57] And it means something to you, what you’re doing, you’re totally committed.

Dr Louise Newson [00:17:00] Yeah. And that’s what upsets me ever more actually. You know when I’m criticised I think actually they don’t realise I’m not doing this for me, I’m doing it to help all women. Now that’s the same, you know, like you say, if you take your children to school, you don’t want people to know that you’re upset having an awful time. You just try. And I think as women and I am selling women here, but as women, we pride ourselves in being able to multitask and to be able to do everything. Everyone looks at us actually all the time, and that can be very, very exhausting. And then if we have perimenopausal or menopausal symptoms, which often include anxiety, self-doubt, feelings of reduced self-worth, unable to think coherently and properly, but not being able to compartmentalise things in the same way. And actually we can sensationalise emotions quite a lot as well, which is very, very common. So a small criticism, which normally I would have brushed off, you know, when I was perimenopausal I would just burst into tears. And I know now, certainly with some of the bullying and toxicity that’s going on behind the scenes, if I wasn’t taking HRT, I absolutely would give up my job. I probably would walk away from my family as well because the pressure is so intense. But I know I’ve got stability with my hormones, so that is making a big difference. But also stability of my hormones allows me to do a regular yoga practice, to sleep well, to eat well, to look holistically at my life as well, and to sort out my head as clearly as I can. But without having my hormones balanced, it can be very, very difficult. And I think to do more research, which is woefully neglected in women’s health, in ADHD, in perimenopause and menopause. You know, you said about addiction. We see a lot of women whose addictive personalities come through again during the perimenopause and menopause. I’ve seen a lot of women whose drug use has changed and gone back to how they were as a teenager or alcohol as well. They start off drinking just to numb their symptoms. But actually this addictive behaviour carries on. It might be eating chocolate, you know, it might be other sort of behaviours and they come back during the perimenopause and menopause and and I think also when people feel bad about themselves anyway, they think, ‘Well, what the hell, I don’t care if I’m going to injure myself by taking drugs or by drinking more alcohol.’ And then gambling is a lot more common during the perimenopause and menopause.

Margaret Reed Roberts [00:19:22] Without ADHD. So all those things are more with our ADHD. And then ADHD will magnify those much more because the brain is seeking that dopamine. I’m not a very high risk person. Though actually I’m quite an open and honest person and a lot of ADHD people are. So our emotions impact our emotional regulation. So we are, you know, we’re deeply sensitive people, but I, I don’t see what’s wrong with that. There’s nothing wrong with that because we change things. You know, we change our conversations. We change the world with those. We’re the canaries in the coal mine really. We pick up on things that other people don’t pick up on. We might not verbalise that, but actually we do say what we think quite often.

Dr Louise Newson [00:20:11] Which is actually no bad thing at all.

Margaret Reed Roberts [00:20:12] No, completely. Sometimes it’s a bit much for people. Some of it will be with very flowery language, I swear slightly more to myself and occasionally out loud to friends. I don’t swear very much, but I noticed that had changed slightly. But I think for us. So you talked about the rejection, didn’t you, through the really tough things that you have in doing this job. And actually it’s a vocation. What you’re doing is a vocation and an unrecognised part of ADHD is a thing called rejection sensitivity dysphoria. Where criticism and actually we can be our own worst critics and bullies in our minds because we do see how many things we drop and feel like we’re failing. But actually rejection sensitivity dysphoria is something that is very, very overwhelming. And it’s a whole body experience, and often it feels like you’ve been punched in the stomach. It feels so physical. And then there’s that sudden rush of overwhelm, which can make you actually in that moment. But it can last. It can go on. Then it tips over into feeling suicidal. But I know that actually this is going to pass. And I’ve never you know, most people wouldn’t act on it. But I think we also need to be aware. We need to be looking at suicide, right? With menopause.

Dr Louise Newson [00:21:34] Absolutely.

Margaret Reed Roberts [00:21:34] Because it feels so hopeless for people. And it’s not.

Dr Louise Newson [00:21:38] Yeah, but they can’t see the way out. They can’t see that they will improve. And as I’m sure you know, we’re doing research into suicide prevention. Funding a PhD student. And this is all really, really important. And I think the other thing that is important, we talked about as individuals getting a diagnosis, which has been really important for you, but it’s also about awareness for other people as well. Because I said, you know, some of my friends who’ve got ADHD or they’re autistic, actually, when I know what’s going on, I can not get upset myself about the way that they are, if you see what I mean. And you know, once you understand people and I’ve got a great privilege of obviously being a doctor, I see and speak to so many different people. And when you understand what’s going on, well you can never fully understand but understand what’s going on in their brains and the way they work. Then actually your relationship as a friend or a colleague or a mentor can be quite different with different people. And your expectations might be different because that you’re saying your routine is different. So it might be that, you know, you behave differently on different days, which is absolutely fine.

Margaret Reed Roberts [00:22:46] But we all do in some ways.

Dr Louise Newson [00:22:49] Course we do. Yes. Well, that’s right but there are people like you say, you’re very open in your challenge and you’ll talk to me, which is really important. Whereas some people who are… They’ve got Aspergers, don’t read emotions and they’re very, very rigid in the way they think. And so I could be very upset thinking, ‘Oh, they haven’t picked up how sad I am.’ But they can’t read it. And so if you understand what’s going on in somebody’s brain, then actually you can be a better friend as well because you know, which are the bits that really are affecting that person and which aren’t and how you can talk to them. And all this is building up to really be so important that we know. And I think the problem is also ADHD is often being thought of as diagnosing children and therefore it’s a children’s disorder.

Margaret Reed Roberts [00:23:35] Yes.

Dr Louise Newson [00:23:36] And it’s not, is it?

Margaret Reed Roberts [00:23:37] It’s not. It’s a neurodivergent condition. So, you know, mostly for most people ADHD is to do with the brain they were born with. Now, who knew that neurodivergent children grew up into neurodivergent adults? I mean, that’s amazing. Yeah rocket science. So it is that. And I’m noticing, you know, we’ve come quite a long way in terms of recognising autistic needs. But actually when we talk about neurodivergence, it’s not just about being autistic, it’s about some other things. Now, I know a lot of actually ADHD women that I link in with on some really great Facebook groups I found so, so helpful. And that’s made a big difference to me. We’ve even had a book group and tried to help each other. Sometimes it’s a bit chaotic. People forget. People go off at tangents and that’s the thing with friendships and relationships. You get an idea, you’re frightened that you’re going to forget it, so it comes out and often I think women say things and then their brain catches up.

Dr Louise Newson [00:24:46] Yes, we’re very good at that.

Margaret Reed Roberts [00:24:47] Yeah. And that’s even more so for us. So I think ADHD women often struggle. But I’m an extrovert. I’m a people person, I’m a social worker. I’ve got lots of those things. But I think a lot of ADHD women are quite introvert and then have hid themselves away and masked that.

Dr Louise Newson [00:25:04] Yeah, and that’s worse because it means that they’re usually suffering more and they’re unable to vocalise and verbalise and share. So and that’s where social media has its faults, but it can be very good because you don’t have to verbalise it very close, you can absorb. But knowing you’re not alone is really important. With anything, I think it’s really important knowing that there are other people who may be better, may be worse, may be similar to you and unable to realise that you’re not alone is so important.

Margaret Reed Roberts [00:25:31] Yeah, it’s individual, but there are shared experiences.

Dr Louise Newson [00:25:34] Yeah. Absolutely.

Margaret Reed Roberts [00:25:35] And if you’ve met one person, so as a dementia worker we say if you’ve met one person with dementia, you’ve met one person with dementia and it’s the same if you’ve met one neurodivergent person, you’ve met one neurodivergent person.

Dr Louise Newson [00:25:47] Absolutely.

Margaret Reed Roberts [00:25:48] We’re all made amazingly and uniquely.

Dr Louise Newson [00:25:51] Yes, which is good. You certainly wouldn’t want two of me around. Absolutely. No it’s great. And I’m really grateful for you spending your time today because it is always difficult talking about yourself.

Margaret Reed Roberts [00:26:04] It is, you feel vulnerable. But ctually, I see the bigger picture.

Dr Louise Newson [00:26:07] Yes. And I know this conversation, there’ll be a lot of people that will be nodding and will be thinking, and it’s just planting that seed, there’s a really important start to a conversation, actually. So I’m very grateful for your time Margaret. But just before we end, I wouldn’t mind just asking for three tips, really. And I’d like to just ask you three reasons why you think people should read the booklet that we’ve been working on together. What are the three good things about the booklet?

Margaret Reed Roberts [00:26:34] Three good reasons for the booklet. Well, yeah, that’s fine. I think, one, because ADHD is very misunderstood, very misunderstood within females. Secondly, because there is a significant impact on 95% of women who are ADHD when they hit perimenopause. That’s serious. We need to look at that clinically. Don’t we? We really need to bed that in in psychiatry, GPs and when we’re treating and supporting perimenopause, we really need to look at that. That will change things. We have to take that on. So that’s the second one. Third one, I mean the booklet, if you want to be our allies, we need allies because we do get misunderstood. I think a lot of people do feel different. I haven’t felt different, but I felt really misunderstood. And there’s a lot of pain in that, and a lot of loss.

Dr Louise Newson [00:27:35] Yes. The most important thing with all of this is about awareness, understanding and also to start this conversation so we can start to build on some research as well. As many of you have heard me before, know that I’m very dedicated to research and we do give a not insignificant amount of money for research from the clinic, but we want to do more so building teams. So if any of you are interested in research in this area, then please contact and we really need to build on that. It’s really great that we’re starting, but there’s a lot more we need to do. So thank you ever so much for your time today, Margaret and I really, really appreciate it and I look forward to hearing feedback about the booklet as well. So thanks very much for your time.

Margaret Reed Roberts [00:28:18] Thanks, Louise. Bye bye.

Dr Louise Newson [00:28:22] For more information about the perimenopause and menopause, please visit my website balance-menopause.com. Or you can download the free balance app which is available to download from the App Store or from Google Play.

END.

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Menopause and ADHD https://www.balance-menopause.com/menopause-library/menopause-and-adhd/ Tue, 09 Aug 2022 08:27:24 +0000 https://www.balance-menopause.com/?post_type=menopauselibrary&p=4397 For many women with ADHD, entering the perimenopause can cause a worsening […]

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For many women with ADHD, entering the perimenopause can cause a worsening of their ADHD and many others do not realise they are neurodivergent until hormone changes at perimenopause bring many issues to the fore that they may have struggled with for years. Margaret was one of these women and she tells her story here.

“When I was 47, something started to change. Sore breasts began making sleep uncomfortable. Most days I felt unwell, and fatigue became more apparent. I was drained, irritable and frequently low despite being on an antidepressant for 3 years. I was also having to cope with a challenging home environment due to my children’s needs and struggles (due to diagnosed and undiagnosed neurodivergence).

“Everything hurt including my sense of self. Then came hot flushes that engulfed me with nausea and dizziness. I tried red clover, phytoestrogens and sage leaf tablets, with varying degrees of success. Increasingly, I felt trapped in a complex web of symptoms, I struggled to regulate my attention and my emotions and I felt stuck in something that I couldn’t find my way out of. I used mindfulness, CBT approaches, essential oils and supplements. To add insult to injury, then the devastating migraines began.

“I’ve always been informed about my health since my life was impacted by endometriosis and adenomyosis at age 13. I was aware you sometimes follow your mother in terms of the age of onset for perimenopause and I realised that this was what was probably happening to me. My mum had a breakdown with her perimenopause though, and at the time this was not recognised as the cause. It is now clear to me she is also neurodivergent, but this has not been recognised either and this period was devastating – for her, for my father and my 13-year-old self.

“Looking back at myself and my experiences – and for any hints of what had been hiding in plain sight – I had always felt tired but had curious bursts of energy and extroverted enthusiasm, lots of ideas and was very sociable. But life felt like a gargantuan juggling act. Periods of fatigue and mini burnouts where low mood would occur was a repeating cycle in my teens. I attributed a lot of the fatigue to my endometriosis which ekes life out of you through pain and other symptoms.

“Since childhood I have had on loop in my head the question, “what is wrong with me?”, as  I found it hard to retain and recall factual information making learning and exams very challenging. Because of this, I didn’t have the opportunity to show my abilities in school. There’s been a lot of lost potential. Thankfully I found my niche and motivator in Social Work and have since gained 2 Master’s degrees.

“Now in my perimenopause, I kept forcing myself to wade through treacle, striving to get to a better place. I struggled with multiple daily tasks, lacked motivation; I would forget things and be in a spin with any planning required. Eventually I’d get things done but experienced little satisfaction from it. I couldn’t understand myself anymore and started internalising these struggles as failures and character flaws.

“My GP and I discussed the possibility of perimenopause, and she agreed my symptoms did indicate this was what was going on and that HRT would be the next step. I was relieved there was a way forward. I was prescribed two pumps of estrogen gel (I’d had a Mirena coil for some years to help my endometriosis). Within a few weeks I experienced some positive impact from the estrogen: no more sore breasts, aching bones and feeling unwell. 

“However, I still had 50 things going on in my head simultaneously all vying for attention, which I could not switch off or prioritise. I would forget the detail of conversation. Instructions for complex games or construction toys I found harder to follow. I got more frustrated with myself and tasks I had to do. I lost interest in shopping and cooking.

“I felt I was deteriorating cognitively, to the point where I tested myself for early onset dementia (I had a part time job for a charity working with people with dementia at the time). I no longer recognised myself. I reassured myself I wasn’t disorientated but ‘time blindness’ however, would get the better of me. This meant I thought I could fit more into a certain amount of time than I could, and would find it difficult to plan far enough ahead.

“My migraines accelerated with the triad of lockdown, home schooling, and working. I rarely recovered fully from the last one before the next one began. When things took a turn for the worse, following a nasty drugs interaction called serotonin syndrome, I realised I had to resign. I felt I had lost so much as a result of the perimenopause.

“Feeling utterly useless about my cognitive capacity, a friend suggested I may be neurodivergent and ADHD. At this point I realised with hindsight from childhood and adulthood that yes, maybe I am ADHD. I couldn’t wait to try to find more answers to my struggles and engrossed myself in research – my hyperfocus has some benefits at times. With a sense of urgency and impulsiveness, I booked an assessment with a private psychiatrist online – I hadn’t realised there’s a legal Right To Choose process in England via the NHS – and received a formal diagnosis of ADHD.

“I discovered through my own reading that my estrogen changes had been impacting my undiagnosed ADHD through the neurotransmitters of dopamine, (a core component of ADHD and executive functioning), serotonin (linked to mood) and acetylcholine (linked to memory). My two male psychiatrists did not discuss or link the impact of perimenopause with my ADHD. I have since been raising this issue with my consultant to improve awareness. He tells me the majority of his patients are experiencing perimenopause.

“Despite what you may have thought and read, recent international consensus is that ADHD does not affect males more than females, it’s just that ADHD is harder to identify in girls and women because it is often more internal and hidden and the diagnostic criteria are more orientated to a male presentation. Gender norms and stereotypes also significantly disadvantage women with ADHD in terms of receiving recognition and diagnosis. There seems to be more understanding of men not being able to juggle the mental load and multitasking needed for work, family and home life that modern life requires.

“New research from ADDitude online magazine, which I participated in, showed that 94% of women with ADHD said they experienced more severe ADHD symptoms in perimenopause, stating

“For more than half of the women, ADHD symptoms grew so severe…that they called peri/menopause the period in which ADHD had the greatest overall impact on their lives”.

“For a lot of women with ADHD, perimenopause is a brutal and life changing experience.”

“I know some women have had success with HRT bringing control to their ADHD symptoms. I have had some success with it, in combination with my ADHD medication. I am currently on my 4th type of ADHD meds and my 3rd type of HRT due to shortages. I still feel that I have not returned fully to myself and wonder what combination I could try next to gain some further help with my executive function (planning, organisation, working memory, attention and other thinking skills). There is so little information out there. Might testosterone be needed? Perhaps that is my next step in keeping on moving forward.

“ADHD’ers are tenacious and resilient. I can’t imagine how I would be if it weren’t for my HRT. I might never come off it. I am so grateful. It’s just occurred to me that without the changes that happened at perimenopause, I might not have realised I was neurodivergent ADHD, so that is a blessing. I now have a road map for myself and I get to use my experience for good to help others.”

For more information on ADHD, read our booklet

You can hear more from Margaret on this podcast

Follow Margaret on Twitter @geordiereed

Find Margaret on Facebook at Margaret Reed Roberts Writer

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