ADHD and Perimenopause: Why Perimenopause Is Worse for Women With ADHD | Dr. Jolene Brighten

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0:43Find OLLI's sleep solutions for the whole family at OLLI.com. That's O-L-L-Y dot com. More than half of women with ADHD experience severe perimenopausal symptoms, often starting in their mid-30s. Not their late 40s, not menopause, their mid-30s. Let that sink in for just a second there, because if you've ever been told you're too young for perimenopause, or this is just stress, or maybe your ADHD should be getting better as you age. This study says that assumption is wrong. A large population-based study published in European Psychiatry found that women with ADHD are not only more likely to experience severe perimenopausal symptoms, but they experienced them earlier, more intensely, and across more systems of the body than women without ADHD.

1:46And once you understand that data, it becomes very clear why so many women feel blindsided during this stage of life. Before I get into how much more severe perimenopause is for ADHD women, and yes, we're going to break down the symptoms, can you take 30 seconds to subscribe and review the podcast? because I think it's about time women with ADHD get the hormone help they deserve. And it's your support that helps me get the info out to the women who need it most. So if you've already done all of this, thank you so much. Okay, now here's the deal. This study that I just referenced, this wasn't a small or niche study.

2:24Researchers followed over 5 ,000 women between the ages of 35 and 55 using a large population-based cohort in Iceland. About 10 % of those women had ADHD, which is consistent with what we're seeing globally as adult ADHD is finally being recognized in women. So there's going to be a lot of critics who are like, that's a small amount of women. Well, ADHD doesn't make up as far as we know, like 90 % of the female population. So it tracks with what we see globally. And what they measured were ADHD symptoms and perimenopausal symptoms. And they used validated rating scales for this. And they looked at things like physical symptoms, so pain, fatigue, sleep disruption, palpitations.

3:11Nobody talks about it, but it's one of the worst things that my patients report about perimenopause. And all of this matters because like this wasn't a study where they just asked if like women were filling off. They really tried to look at what specifically they were experiencing. And they use tools that quantify symptom severity, which is really important. Now, here's the first like headline result takeaway that like, I still, as a woman with ADHD, feel astounded by. 54 % of women with ADHD had severe perimenopausal symptoms. 54 compared to 30 % of women without ADHD. That is not a subtle difference, friends.

3:55That's nearly double, double the symptom experience. And so when we look at symptom scores, okay, let me break this down. Women with ADHD averaged a total symptom score of about 18. So looking at all symptoms, they would score about 18. Women without ADHD averaged about 13. And clinically, that difference is meaningful. It's the difference between this is uncomfortable, but I'm managing, and like this is affecting my daily function, and I feel like I'm falling apart, and why am I losing my mind kind of vibes. Now, we're going to get into the specifics of the symptoms, but before we do that, I want to invite you to grab my free five-day ADHD hormone course that teaches you how to make your hormones work for you instead of against you.

4:44Sounds good, right? You can grab it at drbrighton.com slash synch. That's D-R-B-R-I-G-H-T-E-N dot com slash S-Y-N-C. Okay, you can grab that and keep listening because we need to get into the systems that are being affected. Now, one of the most important and misunderstood findings is that this wasn't just about mood. So everybody always thinks like, well, ADHD women already have anxiety and depression. So of course, they're going to have more anxiety and depression and perimenopause because women and perimenopause tend to have more anxiety and depression. That logic follows suit. But women with ADHD had significantly higher rates of severe symptoms across every single category.

5:30So yes, psychological symptoms like depression, anxiety, irritability. Yeah, if you know, you know. That got worse. We also see fatigue that amplified as well. And the study showed in the psychological category that about 59 % of women with ADHD reported these symptoms, whereas 36 % of those without ADHD said they had these symptoms. So again, a big differential there. Then there were somatic symptoms. So hot flashes, sleep disruption, something you already have with ADHD, like 70 % of people do, but also heart palpitations, joint and muscle pain. 30 % of those with ADHD reported these symptoms.

6:1314 % of those without ADHD reported these symptoms. This was the largest relative difference. This is not something to be ignored. Now, your genital symptoms, sexual dysfunction, vaginal dryness, bladder issues, these were also reported at a higher rate if you had ADHD. Well, with the women who had ADHD in this study. So 43 % versus 28 % of the non-ADHD women. So ADHD women had nearly double the rate of severe general physical symptoms like pain, headache, digestive issues, and exhaustion as well. So this tells us something critical. ADHD in perimenopause is not just a mental health story. And it is often something where ADHD is relegated to only being a mental health disorder and like this is happening in your head.

7:06But ADHD is a full body experience. And so it makes sense that the perimenopause transition is also a full body experience that's amplified in those who have ADHD. So ADHD, it's a neuroendocrine whole body story. But I want to talk about who is affected the most because I think this might shock you. And listen, I don't want to just offload info. I want to give you solutions so I want you to around to the end. So you can get some tips to manage ADHD through perimenopause as well. So this is the part of the study where every clinician should stop, stop, look, and listen. I feel like a kindergarten teacher.

7:41But this is the part that should fundamentally change how we screen women. The largest symptom burden in women with ADHD occurred between the ages of 35 and 39. Suck at every doctor out there that says you're too young for perimenopause. Meanwhile, while their patients are like spiraling into hormonal hell. That is where the symptom severity tends to peak with ADHD brains. Meanwhile, women without ADHD didn't peak until their late 40s. What? So they might have like symptoms going on, but like almost a decade earlier. Like what? So in other words, ADHD women are experiencing perimenopausal level symptoms up to a decade earlier at an age when they're routinely told things like you're too young or maybe like this is just stress this is just anxiety how about i put you on an ssri and call it a day hey your labs are normal and women with adhd are like nothing about me is normal and this aligns with genetic data showing that women with ADHD tend to reach menopause earlier.

8:51But this study shows that their suffering starts long before menopause itself. Now remember, perimenopause is the countdown to your final menstrual period. The final menstrual period, that's the day you arrive into menopause. Happy birthday. Next day, you are now postmenopausal. So women with ADHD, they have a higher prevalence of severe perimenopausal symptoms. These symptoms present at an earlier age than among women without ADHD, indicating an earlier onset age of perimenopause for those with ADHD. Say what? Yeah. And I've got theories, and I've definitely been writing about this in my book, and I will be sharing more episodes with you, why I think it is that those of us with ADHD hit perimenopause sooner.

9:40And I don't think that it's a given, but I do think we need to start asking the question of like, can we be doing better screening with women? Because another critical finding of this study was about 30 % of ADHD women in their late thirties and early forties had also severe ADHD symptoms. And that lasted even into their 50s, one in four still met the criteria for severe symptoms of ADHD. And then I think this is also especially important. Around 8 % of women without an ADHD diagnosis reported severe ADHD symptoms during this stage of life. And this raises some key questions. Is it perimenopause worsening ADHD or is it unmasking ADHD that was never recognized before?

10:29And the answer is both. It's both. And this is what I'm seeing. We're not seeing that there is a late onset ADHD. What we are seeing is that either you are ADHD and it got a hell of a lot worse and you already knew you were ADHD or you were not ever diagnosed with ADHD. But as you get into perimenopause, it becomes impossible, just impossible to mask, to keep it up because your brain energy is shifting. I've done an entire episode of like what happens to your brain as you're going through perimenopause. And so there are women who are not ADHD. They experience ADHD-like symptoms for the first time in their life during perimenopause.

11:14But what research tells us is that all goes away. That just goes away post-menopause, usually within two years of your final period. Your brain comes back, everything's working again. That doesn't happen for the ADHD brain. You are ADHD for life. What may happen is that because you're no longer cycling, it's no longer amplified in the luteal phase like I've talked about in other episodes. So if you haven't caught my other ADHD episodes, let me say this. Estrogen plays a direct role in dopamine signaling. When your estrogen is fluctuating in perimenopause and then declining attention, executive function, emotional regulation, impulsivity, working memory, they all start to take a hit.

11:56And that's especially in brains that are already dopamine sensitive. And there are a lot of people who like to also use the argument of like, this isn't hormones, this isn't ADHD, it's just trauma. Now, because this study came from a trauma-focused cohort, the researchers specifically tested whether PTSD explained the findings. And it didn't. Okay. So we're going to shut that argument down right now. Even when they separated women with and without a history of PTSD, ADHD still independently predicted more severe perimenopausal symptoms across psychological, somatic, and physical domains. So it's not just worsening ADHD, although that's there, it's also overall worsening perimenopausal symptoms.

12:45And so trauma does matter, okay? And we must acknowledge it, but it doesn't always explain away everything that is happening to a woman with her hormones, in perimenopause, or with ADHD, okay? So I want to be clear that when you're getting a diagnosis for a neurodevelopmental condition as an adult, PTSD and trauma needs to be accounted for in that, and it should be in the diagnosis, and it should be as part of your treatment plan as well. Now, one of the most important takeaways, especially for clinicians who are listening to this, is women with ADHD are entering a high-risk window, that's perimenopause, earlier with fewer supports and less clinicians recognizing them.

13:28And what this study calls for is earlier screening for perimenopausal symptoms in those with ADHD. So we need to start having this conversation earlier. This conversation should be happening in their early 30s, talking about what's coming down the road ahead, not waiting until symptoms are just like hitting her like a Mack truck, right? We need to recognize that worsening focus, mood, sleep, and physical symptoms may be hormone driven. We need to address those hormones and we need to remind our patients that it's not a personal failure because it's not. And feeling like you're struggling in perimenopause, like we're all struggling in perimenopause, right?

14:05The medical system is like not cared about any of us, right? That have gone through perimenopause and menopause. And like, I think about the generations before us and like, oh my God, I don't even know how they did it. But especially every protocol, every, you know, person out there who is talking about perimenopause, menopause, trying to get it like at the forefront of people's minds, even like trying to change like hormone protocols and clinical practice, they are not thinking, they're not even caring about the neurodivergent brain. I'm going to be honest about that. And you know what? They're not neurodivergent.

14:38So I don't really want them speaking for us anyways, but also like I wouldn't expect them to know anything about our experience because it would take not just living in our body, but listening really intently and having enough patients who are neurodivergent for you to be able to cultivate those skills. So I'm not trying to blame anyone for that, but I am saying that ADHD women are being completely left behind in this perimenopause menopause conversation, even in the hormone therapy cookie cutter approach that is being done. We're being left behind in that conversation. And this study is very disruptive because it's saying you got to wake up and you got to help these women.

15:12You got to help them sooner. I am going to talk about specific things that you can be doing, ways for you to help yourself, but integrative care that addresses the ADHD woman in perimenopause, this is what it should include. And I want you to know what you should be thinking about with your provider. So they should be talking to you about hormones. they should be talking to you about adhd treatment across your lifespan and they should be talking about your full body experience because adhd is not just a brain experience we know it's related to the gut it's related to the immune system it's related to the hormones it is related to your entire body and the authors of this paper pointed out that like we don't have data on hormone therapy for women with adhd on how like stimulants should change on non-stimulant meds for these women um how all of this should change in the conversation of perimenopause and i want to say to my clinicians who are listening, that's not a reason to do nothing.

16:05It's a reason to do better research and better clinical care. Okay. So we got a call for research. If you're a researcher, get on it, please. But we got a call for research, but we also need to listen to our patients and we need to fine tune with the individual because they deserve better clinical care. No woman has time to wait around for research to finally acknowledge that we exist and that we deserve the care.

16:30Like like we didn't even have women included in trials until like the late 90s drug trials. And like, we ain't even really included now. Okay. They're just like, psych, we're kind of including you. It's like, looks good on paper, but it's not legit. Like we as women have waited around forever for medicine and research. And I think about like Dr. Amy Shaw always says like, no one's coming to save you. No one's coming to save us. So that's why I'm here. That's why I'm doing this podcast because I'm like, we ain't going to wait around for that. We're going to feel better now. One thing I hear from women all the time is that they're struggling with symptoms like hot flashes, sleep disruptions, and brain fog, but aren't sure where to turn to for help.

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17:57Plus, you'll get$20 off your first order today. That's M-Y-A-L-L-O-Y.com, code Dr. Brighton. But if you are a woman with ADHD and you felt like, oh my God, my 30s have been so hard and it's just getting harder, you're not imagining it. And if you were just told that like, it's just stress. It's just aging. It's just anxiety. It's just like, have you tried losing weight? Like this study says that the explanation ain't going to cut it. Like this study is telling us that like, yes, you are having it a harder time and medicine should be treating you better. So before we get into solutions of what can help, I just want to say, and especially if you're a clinician listening to this, the message is super clear.

18:45Perimenopause and ADHD starts earlier. It It hits harder and affects more than just mood. And ignoring that reality is no longer scientifically defensible. Okay, so I talked about how estrogen supports dopamine signaling. It also supports mitochondrial energy production. That's how your brain actually has energy, like your whole body has energy. It's supporting blood flow to your prefrontal cortex. So estrogen is going to be really important. And we are going to talk about hormone therapy. I'm going to talk a bit more about that. But I just think the estrogen is something that has been vilified for so long that people are afraid of it.

19:25But I want to like shine some light on like, you know, estrogen, it helps the ADHD brain buffer like the capacity. It helps with executive functions. But when it goes down, as it does in perimenopause, executive function becomes dysfunction and it becomes more expensive to even try to do that because you don't have the brain energy. Emotional regulation becomes harder. the nervous system shifts towards threat mode. Oh my God, I need to do a whole podcast just about that, about what happens to us going into threat mode. We've already been surveying and doing surveillance and making sure that we're fitting in and we're camouflaging and we're masking and all of that.

20:03And then we hit perimenopause and HPA axis is off the train. So when we talk about solutions, we have to look at what estrogen was doing. We need to increase the dopamine. We need to help with neuroinflammation. We need to stabilize stress hormones. We need to support brain energy, not just like having a good mood. We got to literally support brain energy. So I want to talk about my first tip. But before I get there, I do want to say I am going to talk about supplements, hormone therapies. So please be sure to stick around. But the first one I got to say, please don't leave me. I got more for you than just this.

20:37But movement is non-negotiable for the ADHD brain. So we're going to talk about the most under-prescribed intervention for ADHD women in midlife. And you might want to run away when I say exercise, but friend, movement is medicine for the ADHD brain. I'm going to get very specific with you here. So it's not just like, move your body, friend. It's going to be like, this is exactly how to move your body, especially in perimenopause to help your brain. So this is not about weight and it's not about discipline when we talk about exercise, although like this is definitely going to help those things, but this is about movement directly increasing dopamine availability, BDNF-alpha.

21:15So that's like your neuroplasticity is so good for the brain. We love it so much. And we know from the research and from my clinical experience that movement matters more for the ADHD brain in perimenopause because that exercise is not only going to help with the neurotransmitters, but it helps with their receptors. So the brain receptors increases dopamine receptor sensitivity. So dopamine that's there actually works better. It improves your executive function and improves your working memory. It reduces neuroinflammation. We absolutely need that in perimenopause and especially ADHD. Put it together, drop that neuroinflammation, please.

21:54It also helps with your cortisol. When it's done correctly, it can help with lowering baseline cortisol. all. But here is the key distinction that I think a lot of people miss is that more is not better. The right type is better. So what tends to work best is that two to three times a week, you're doing moderate intensity strength training. That's going to help you with building mitochondria storehouses. We love that little powerhouses in our cells. So it's going to help with improving insulin sensitivity, dopamine signaling. And this is so important because as estrogen goes, we become less insulin sensitive.

22:31The ADHD brain is very, very sensitive to changes in blood sugar and insulin dysregulation. Insulin dysregulation can change how our ADHD operates. Now, the other thing you got to incorporate at least once a week is some zone two cardio. It's 20 minutes, just 20 minutes. If you can do 40, great. This is going to support blood flow to the brain without spiking your cortisol. Spiking cortisol sometimes is good, okay? But we do want to get some cardio that helps our vo2 max helps that blood flow what did they say estrogen does it helps with blood flow so if we're losing estrogen we got to do other things that help with blood flow not to mention that uh you know because we're going to talk about hormones um and i'm not going to go super deep into like all the risks and the pros and cons and all of that like because i've done that a lot of other episodes but i do want to say that exercise also significantly reduces your risk for breast cancer so that's something that you are concerned about one of the most positive things that you can do is exercise.

23:27And the next one is don't drink alcohol and your ADHD brain is going to love that. Now, the other type of exercise that ADHD brains really love are short bursts, especially of novelty based movements. So like if hiking is great and you love that and like doing a little trail running dance, you know, doing like kettlebells, Pilates, if you like that, but running sprints on a bike or actually running sprints, but doing like bursts of like five to 10 minutes of like really intense exercise. Like Norwegian 4x4 is another really good one. I will put that in the show notes so that you can check out what that is.

24:07But we do need those little like high intensity bursts. Our brain likes those. But what fires is when high intensity bursts, like HIIT training, is chronic and it's all we do every single day. If we're fasting, we're not eating and we're doing like a really intense workout. If we're training so hard that like we don't recover for three days, we're depleted, we're emotionally fragile afterwards, we're more irritable, more foggy. But literally, if you work out and you're sore like three to five days later, like you went a little too far. And that's just data. You didn't screw it up. It's not a reason to throw in the towel, quit everything.

24:43It's just data. It's information. and we don't want to be pushing through when the intensity is too high all day, every day. Now, before we talk about nutrition, I want you to know that I have a framework for you. It's at drbrighton.com slash plan, where you can grab a free recipe guide that's not heavy on cooking, a structured outline of what to eat and when. It's a done-for-you solution that checks all the boxes on your protein, your fiber, making sure you're hitting everything that you need in perimenopause to optimize your blood sugar, your brain function, and your hormones. And it's done for you.

25:20So you don't even have to think about it. So drbrighton.com slash plan. You can grab that. Now, the best way to eat is hands down an anti-inflammatory diet, sometimes referred to as a Mediterranean diet. But like, you know, we're going to break it down here. I just want you to know going into it, this is not about perfection. It's not about never having a piece of chocolate or never enjoying a cookie. It's about reducing inflammation that is blocking your neurotransmitters from functioning right in your brain. And this study that I've been talking about, it showed that ADHD women had much higher physical symptoms.

25:52So it's a much higher physical symptom burden of pain, palpitations, fatigue, sleep disruption, that can all be inflammation, nervous system dysregulation related, and nutrition can help support you. So let's go through some core principles that can help. So the first thing is protein anchors every single meal. Protein is how we make our neurotransmitters. It's how we keep our blood sugar optimal. We're going to get 25 to 30 grams per meal. Maybe you need more. That's a possibility, but this is a minimum we want to try to hit. Again, drbrighton.com slash plan. I got you covered. If you're like, oh my God, what?

26:26I got you. I make it really easy for you. If there's one time a day we're going to hit it right, it's going to be breakfast. It's got to be breakfast. You've got to get your protein in first thing in the morning. We need to focus on that blood sugar stability and it's because blood sugar crashing that's going to worsen ADHD symptoms. It's going to worsen anxiety. You're going to higher propensity towards visceral adiposity that's going to be belly fat packing around your organs. That's going to increase your risk for cardiometabolic disease. Okay, we're dodging diabetes and heart disease on this show.

26:56Okay, like I don't want none of that. And blood sugar swings are also going to impact more night wakings. You're going to struggle more with going to sleep. So when we're eating carbs, we're eating fat and protein. That's what I want you to focus on. If you grab that meal plan, it also focuses on fiber. When you get 25 to 35 grams of fiber a day, that can feel really overwhelming at first. So I really want you to grab that meal plan to make it just really easy. Now, anti-inflammatory fats are going to be essential. This is another pivotal part of this. Omega-3s, they're going to support how your brain receptors function.

27:30We're going to eat olive oil. We're going to eat fatty fish like salmon, mackerel, sardines. We're going to get walnuts. We're going to get nuts and seeds, chia seeds, soak them, grind them up, whatever you need to do to digest them better. And the fourth thing I want you to think about is reducing inflammatory load, not food joy, okay? Ultra processed food, refined sugar, these foods are not nutrient dense. And I don't want you to think about like eliminating this. This is like, you know, a strict diet. We're going to crowd it out, okay? because the goal is steady brain fuel, not metabolic stress, not taking away everything you love, okay?