Estrogen and Dopamine: Why Your Brain, Motivation, and ADHD Symptoms Can Change With Your Hormones

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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. Today we're talking about one of the most important and most misunderstood conversations in women's brain health. That is estrogen and dopamine. And no, this is not going to be just some oversimplified TikTok version of low estrogen equals low dopamine. We're going to go deeper than that and why hormonal shifts can change how your brain manages focus, motivation, reward, and emotional regulation. But we're going to make it digestible. And if you don't know who you're listening to right now, I'm Dr. Jolene Brighton.

1:23I'm your host of The Dr. Brighton Show. I'm board certified in naturopathic endocrinology, a fellow of the American Board of Naturopathic Endocrinology, a menopause society certified practitioner, a nutrition scientist, and a certified sex counselor. My work focuses on women's hormones, complex endocrinology, neurodivergence, and tissue specific hormone sensitivity. And today we're connecting the dots between estrogen and the brain. If you can take a quick second, subscribe, hang out with me weekly, hit the like button, comment, or share this, I would be super grateful. But let's not hold this up and let me be really clear that like all of our episodes, this is educational.

2:06I'm not diagnosing you. I am a doctor, but I'm not your doctor. And we are not substituting any medical care with what you're going to hear in this episode. I just simply want to give you better language to understand what may be happening in your brain and what to bring to your clinician. So the first thing we need to start reframing in medicine and neuroscience is definitely picking up on this is that estrogen is not just a reproductive hormone. Estradiol or E2, that's the most biologically active form of estrogen during our reproductive years. It's also a neuroactive hormone. That means it interacts in the brain and it's interacting in regions that involve your memory, your emotional regulation, your motivation, and your executive function, like your ability to plan, organize, and not be completely blinded by time.

2:52So one of the key systems that estrogen interacts with is the dopamine system. Now we're going to focus on estrogen and dopamine today. I need you to understand that estrogen is not the only hormone. And in fact, when we talk about perimenopause and midlife, there are so many other hormones that are involved. This is why I'm going to be speaking this winter at the CHAD Child and Adults with ADD. Well, it's ADHD now, but they named it that before. But I'll be speaking at the CHAD conference beyond just estrogen in terms of brain health neurotransmitters and the perimenopausal transition for those with ADHD.

3:30If you're going to be there, let me know in the comments because I would love to hang out in real life. Now, let's keep going on just what the heck is going on with estrogen and dopamine and what you should know. So dopamine is often described as the pleasure molecule, but that is a very small definition and it's way too simplistic because dopamine is involved in our motivation, reward prediction, learning. It's also like movement, how we regulate our attention. It can be involved in our working memory as well. and what I like to call the like go do the thing circuitry in the brain. So we've got the prefrontal cortex.

4:09That's the part of the brain that's involved with the planning, prioritizing, emotional regulation, impulse control, working memory. What did I just name? Executive functions. Dopamine has to be at a sweet spot in the brain. Too little dopamine signaling and your brain feels underpowered. It's too much or it's just too much work to do the things you need to do. If you have too much or poorly regulated signaling of dopamine, things can feel very noisy, anxious, impulsive, scattered in the brain. So when it comes to dopamine receptors, we've got the D1 and the D2-like receptors. D1, we think about increasing intracellular signaling.

4:47And the D2, we think about inhibiting intracellular signaling. And that is important because dopamine is not one signal with one effect. It depends on the receptor. It depends on the brain region. the timing of it, but also the hormonal environment. Now, a lot of people think that estrogen is just a stimulant. So I want to clear up a major misconception. Your estrogen is not Adderall, friends. Estrogen is not a stimulant. Estrogen does not simply flood your brain with dopamine. And that's a lot of what is being said on social media. What estradiol E2 specifically can do is influence how dopamine systems behave.

5:25It can affect the synthesis, the creation of dopamine, the release of dopamine, the turnover, the cleanup of dopamine, the receptor expression and its sensitivity, and the way dopamine signaling shows up in brain networks. This is why a woman can say my ADHD symptoms are worse the week before my period or I feel less motivated when my estrogen drops in perimenopause. Maybe the brain just doesn't respond to effort in the same way. But that doesn't mean that estrogen is the only factor. And I say this because we don't want to miss things like iron deficiency anemia, irons needed to make dopamine, poor sleep.

6:05That can definitely affect how the brain operates. You know, the thyroid, if you're hypothyroid, that can masquerade as ADHD. It looks like ADHD, but it's not quite. Doesn't mean you can't have both. But, you know, other things like insulin resistance. You know, in my new book, ADHD and Women, I have an ADHD hormone profile quiz that you take to try to understand what is the main hormone driving your symptoms right now. And while low estrogen is one of those, it's not the only one that can be driving ADHD symptoms. So we always want to ask how are hormonal shifts interacting with the brain system that was already there, okay?

6:41Because perimenopause doesn't cause ADHD. It unmasks it. It makes it visible. It makes it so we can't ignore it anymore. I want to talk though a little bit more about dopamine synthesis. So Dopamine is made from an amino acid, tyrosine. My friends, this is why we eat protein with our meals. Tyrosine is then converted to L-dopa by the enzyme tyrosine hydroxylase. And then L-dopa is converted into dopamine. All right, fun little nerdy pathway there. And I put an image on the YouTube video so that you can see it really easily. Now, linking estradiol into all of this, it's been shown in preclinical and mechanistic research to influence dopaminergic activity.

7:21So that includes the enzymes involved in dopamine production and dopamine signaling. But in humans, it's just not as simple as more estrogen equals more dopamine. We're also looking at a dynamic regulatory system. And so this is why just saying like, oh, all you need is estrogen, that'll fix things. It's not always necessarily true for everyone. It may help, but it's not the only piece of the puzzle. And it's why blanket statements like it's just estrogen get people in trouble because hormones don't act in isolation. Estradiol is going to interact with dopamine, serotonin. It also interacts with GABA as progesterone interacts with GABA as well.

8:00It interacts with glutamate, acetylcholine. It's part of influencing the HPA access. So the hypothalamic pituitary adrenal access, your stress system. It influences sleep architecture and mitochondrial function. That means your energy production within the brain itself. So when someone says, just balance your hormones and your dopamine will be fixed. I need you to hear like a record scratch, like, stop. That is not how neuroendocrinology works. We do need to optimize hormones, but I think the thing we have to understand is that we don't know as much about the brain as we would like to or think we do.

8:41And we don't know as much about hormones interacting with the brain to just say that all you need to do is dress hormones. It's definitely more than that. So let's zoom into the prefrontal cortex, the front of the brain. This is your executive function headquarters, chief operator, okay? It helps you decide what matters, hold information in your mind, suppress impulses. It helps you organize tasks, regulate emotion. That's a huge one for perimenopause, right? This is also the region many women describe when they say, I know what I need to do, that I can't make myself do it. And that is often seen as a character flaw.

9:19It is not. That's the executive network being strained. So dopamine signaling in the prefrontal core attacks is famously dose sensitive. There's an inverted U concept here. Too little signaling impairs working memory focus. Too much can also impair performance. That's not fair, is it? The brain's not asking for maximum dopamine. It's asking for regulated dopamine. So the D1 receptor signaling in the prefrontal cortex that we were talking about previously, that's been linked to working memory, signal to noise regulation, okay? And in simpler terms, dopamine helps the brain decide what signal is important, what do I amplify, and what do I need to ignore?

10:04These are really, really important things that I think we take for granted until we get into perimenopause and we start to struggle so much more. And this is why some women describe the estrogen-supported phase, so the follicular phase from your period to ovulation is like, I can finish a thought, I can prioritize, I can tolerate the friction in my life without like emotional outbursts. And then when estrogen drops, maybe it's right before your period or maybe your postpartum, or maybe it's that you're in the luteal phase, progesterone is so high that you're feeling like, oh, I just don't have enough estrogen, or you're in the phase of perimenopause where your estrogen is declining.

10:43Those are the phases when women start to say like, everything is so chaotic and loud in my brain. Everything feels urgent. I can't find the thread I'm supposed to locate in my brain of like being on task. And you know, as I'm saying all this, I think it's really important to just clarify that this doesn't mean that estrogen is always good. I've had episodes on histamine where we've talked about that. And it doesn't mean that low estrogen is always bad. And menstruation itself is not a cognitive disease, even though you can feel like a major deficit before your period. There is emerging research that shows that cognitive performance across the menstrual cycle, it is variable.

11:20It can be. It's not always worse when people expect it to be. So there was a 2024 study, so just a couple of years ago, that found that regularly menstruating women performed better on some reaction time and error-based cognitive tasks during their period. despite reporting that they felt worse subjectively. Now, the opposite's been found to be true in those with ADHD in that there are significant deficits that happen in the luteal phase. And for years, women have been told that there's these phases of our menstrual cycle and in the luteal phase, like you're not able to plan as well. You may have impulse control issues.

12:01And as it turns out in the research, that is true for the ADHD brain. likely true for autistic brains and other neurodivergent brains, but the non-neurodivergent brain, the neurotypical brain, it actually doesn't have as profound of changes across the menstrual cycle as we've been told. And while women may think they're having deficits, the research shows that actually they're performing well, if not better sometimes being on their period. And I say this because the concept of cyclical changes across four phases of your menstrual cycle, which by the way is not how medicine views the menstrual cycle.

12:39But I get as somebody who menstruates that like the period does feel very different and why women would want to split it up that way. But the concept that's been put out over the last decade of saying that there's all of these cognitive changes and the way we perform is so different across the menstrual cycle is not actually supported by the science for the neurotypical brain. And what we have found is that if you are struggling significantly in that way, we need to work you up because odds are there's probably a neurodivergent condition underlying all of this that your hormones are helping you compensate for.

13:10And I do want to honor as well that not every woman feels dramatic cognitive changes when they have hormones shifts. There tends to be this subset who are hormonally sensitive that fill that. And the brain, I want you to understand, is not just responding to estrogen levels. It's also about estrogen sensitivity, progesterone sensitivity, your stress levels. And one of the most important concepts in women's health is that two women can have similar serum estradiol levels. That means I measure your blood. Serum estradiol levels, the same, completely different symptom experience because of their receptor sensitivity, their metabolism, their inflammation, their stress load, their sleep, their thyroid levels, their baseline neurotransmitter tone all influences the response.

13:55So, you know, your gynecologist isn't totally wrong when they say then hormone testing can't tell us everything. This is true. This is why we always do hormone testing with your symptoms. Your story of living in your body is so important, and we marry those things together. Now, I've mentioned ADHD a few times. I also think, you know, this conversation is especially relevant to ADHD, PMDD, those that already struggle with depression, anxiety. If you have a history of traumatic brain injury, chronic stress, trauma, this conversation becomes a lot more relevant for you. So let me give you an example.

14:31If somebody already has ADHD and their prefrontal cortex executive networks, a big mouthful to just say the command center for your executive functions in your brain, if they already require more support, a drop in estradiol may feel like losing a key stabilizer. The results may be worse. You might be worse at procrastinating, more emotionally reactive, more rejection sensitivity, more task paralysis. And one big thing women will say is they have a really hard time from going from intention to do something to action of actually doing something. 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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16:03Plus, you'll get$20 off your first order today. That's M-Y-A-L-L-O-Y.com, code Dr. Brighton. This is also why a woman may say my medication works differently depending on where I am in the menstrual cycle. You know, as a licensed prescriber with an active DEA license, like I have seen this many times where women say my ADHD medication, it's great. Like during my follicular phase, it's doing nothing for me during my luteal phase. And that's when I always encourage you to talk to your prescriber. Don't just go switching medication on your own. We need to talk to our prescriber. But a big reason I bring this up is because I want you to know you're not imagining it.

16:46Science validates that experience. and it also tells us that the hormone environment changing is changing the brain's response to neurotransmitters and that's how ADHD stimulant medications work. Now we still need more human research here. We cannot pretend the science is complete. I mean especially when you look at neuroscience it hasn't invested as much in women's health as we really need it to at this point but clinically the pattern is there. We do have research to back up that the pattern is there and There is more research being done right now, which I think is really promising and really exciting.

17:19And we should continue to follow the research and we should use research to help us understand why so many women report similar experiences. Now, let's talk about perimenopause because this is where so many women get blindsided. In perimenopause, estrogen doesn't simply just decline in a straight line for most women. It's going to fluctuate. It's going to surge sometimes. It's going to drop. and for the brain, the fluctuations can be as disruptive as complete deficiency. And this is why a woman in her late 30s or 40s may say, I used to be able to manage everything. I was like on it. I was like, you know, the person that blew everybody's mind on how on top of it I was.

17:59And now I can't keep up with my own life. And my sleep is worse. And I'm more sensitive to stress. And I'm more irritable. And I'm more distractible. And I'm yelling at my family all the time. And I feel so overwhelmed. like this is something that women experience and then they get told like well your labs are normal or this is just how it is in perimenopause now what i need you to understand is perimenopause is a clinical diagnosis normal labs don't mean you're not in perimenopause normal labs also don't mean that your brain is thriving like i said we now know from the emerging research that hormonal sensitivity is just important as the levels that we have and menopause related brain fog is increasingly recognized as real.

18:41Recent reporting on menopause brain research has highlighted the association between menopause status, cognitive complaints, mood symptoms, changes in brain regions involved with your memory and your emotional regulation. So science is backing you up. But at the same time, I do have to mention that major societies do not recommend hormone therapy solely as a treatment for cognition because the evidence is so nuanced and we don't have studies right now that say using hormone therapy is preventative for things like dementia. And so we're still waiting on more research to come out. And you might be like, no, but hormones changed my brain.

19:20And it's frustrating to hear you say that like, they're not recommending this for cognitive changes. I want to have a balanced conversation with you. We have to validate your symptoms. We have to investigate the contributors. but we also have to acknowledge the research that we have now and what the major governing bodies are saying. So, you know, what the menopause society says, what the British menopause society says, we do also have to look at them collating and bringing together all the research to see, like, you know, what is actually helping women? Now, if this episode is making you think right now, like, oh my gosh, this is me.

19:55Here is what I want you to track because having data can progress the conversation with your provider in a much more efficient way. So your cycle day and your symptoms or your menopause stage and your symptoms. So I haven't had a period in 60 days and these are my symptoms. Track your sleep quality, your focus, your task initiation. How emotionally reactive are you and how's it affecting your life? What's your motivation like? Are you only motivated to do things you like or not? I'm not even motivated to do things I like. Do you have craving, reward seeking behavior. If you take ADHD medication or mood medications, what's your response?

20:31How are you feeling with those? So that you're always in conversation with your prescriber about that. If you're having other symptoms like migraine, pain, inflammation, if you are experiencing like hair loss, cold intolerance, this is something you want to bring up to your doctor. And don't just write like, I feel awful, which is fair. You want to write very specific like, cycle dude 24. task initiation is worse. Rejection sensitivity is worse. I only slept six hours. I felt like I could eat everything. My medication didn't feel effective. And then by cycle day one, my symptoms were starting to improve.

21:12Cycle day five, I'm a different person. That's super clinically useful. That's the pattern that creates better care. When things are vague, unfortunately, suffering can get dismissed. So I need you to do specific tracking because that gives you data to leverage and data your doctor will pay attention to. And, you know, for my clinicians who are listening, I think we also need to stop separating hormones from brain health. So if a woman reports new or worsening brain fog, if she has ADHD symptoms, if she has low motivation, if she's having mood changes, if there's executive dysfunction, we need to ask why.

21:48So like, could this be hypothyroidism? Could this be about her iron status? Did she have enough B12? Is she vitamin D deficient? How's her metabolic health? Are we going down the pipeline towards diabetes? Is she got PMDD, PME, premenstrual exacerbation? Does she have depression? Like we got to ask more questions and we don't want to assume everything is hormones, but we want to keep in mind that hormones do play a role in just about every system of the body. Well, just about, they do play a role in every system of the body. Now I so often get the question of, is it ADHD or is it late onset ADHD in middle-aged women?

22:25So here's the thing. There is no late onset ADHD. There's late diagnosed ADHD. There is missed, misdiagnosed, dismissed, and now they finally recognize your ADHD in middle age and you've had it all along. But being in perimenopause can be like a pseudo ADHD experience. So let's sort through this so that you understand your brain better, but also how to talk to your provider. So what we understand, JAMA had a great article that came out and it said, there is no late onset ADHD. What there is, is that women were historically missed and misdiagnosed. And so what happens with ADHD is that you've had ADHD your whole life.

23:11It is possible for you to have a brain injury, a traumatic brain injury, and develop ADHD. But we know ADHD is a neurodevelopmental condition and one of the most highly inheritable psychiatric conditions that exists. So it is genetic. You were wired for ADHD. As I say in my book, ADHD and Women, you got a different operating system and you were born with that operating system. But you learn from society's influences of the way that you should behave and then you get your hormone allies, then you need to mask. You need to show up in the way and present in the way that people expect you to. And you need to compensate.

23:48You need to people please. You need to do all these things so that you can look put together, even though inside you are struggling and you're working harder than anyone else. And I think that's an important distinction. Internally, you are working so hard to appear normal. I'm doing that in air quotes for the people who can't steamy because I don't think there really is a normal, but you've got a concept in your brain of what is normal and you're trying to emulate that. Now what happens is, is that as we enter into perimenopause, we begin to lose our hormonal allies. Progesterone was always there to stimulate GABA to be your stop break.

24:23As my good friend, Dr. Kerry Jones puts it, your mouth filter so that you don't blurt out the things that you shouldn't be saying and then go home to replay all of the TMI that you were involved in and then hate yourself for it so you can't fall asleep at night. Estrogen has been helping with brain energy. So not just your neurotransmitters, but your mitochondria, your energy production in your brain. So as you can imagine, highly masking, always surveying yourself, thinking, oh, am I going to say the right thing? What's the right thing to say here? Oh, okay. Make sure you hold onto your thought.

24:55Don't blurt it out. Don't interrupt them. Like that takes tremendous brain energy. And as we go through the neuroendocrine remodeling of perimenopause, we lose the ability to keep up with that. Okay, does that make you a bad person? No, but some people can get really irritated because they have definitely benefited from all the ways that you've masked and showed up for them, and it can feel so frustrating for you because you're literally drowning inside trying to keep up with the same level that you've always been at, but losing your hormonal allies has an impact, not just because of the neurotransmitters, but because of the neuroinflammation and the brain energy production.

25:30This is what I describe in my book as the brain hormone immune triad. Now, what if you go into perimenopause? You're like, I never had these symptoms my whole life, and now I do. That is also a very real experience. And because of the brain energy changes, the inflammation, we can look to Dr. Lisa Moscone's work. It's really been groundbreaking in this area. we can see the brain changes. And as it changes, that can affect executive functions. And some of those executive functions may be interrupting your life. But for the ADHD woman, these executive dysfunctions have interrupted her entire life for her entire lifetime.