What Is ADHD Masking? The Perimenopause ADHD Connection

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0:43Find Oli's sleep solutions for the whole family at Oli.com. That's O-L-L-Y dot com. This fact absolutely pisses me off and it should make you furious too. Most women with ADHD do not get diagnosed until their late 30s or early 40s. Hi, it was me in my early 40s. That means we're going decades, decades thinking we're the problem, decades not getting support. We get report cards in school that say, oh, she's smart, but dot, dot, dot, fill in the blank. We get told that like this is probably depression, just go on an SSRI. We are met with labels like, you're lazy, you're too emotional, you're just too much.

1:25You need to try routines. Get a calendar. Why don't you set a reminder? Why don't you try harder? Oh, Susan can do it. What's wrong with you? And for so many of us, we suffer mental health issues because we have internalized all those messages. And when it finally clicks for so many women is the intersection between perimenopause hormones beginning to decline and their child getting evaluated. Now, maybe you're childless, but those with children, absolutely no. That was my moment. That was the moment where I was like, oh, so I'm not normal, which by the way, there is no normal. But I got diagnosed with ADHD, later with autism, all intersecting at the same time I got an endometriosis diagnosis, which is what made me dive into the literature and say, there's something here.

2:10This is something connected. I will link to that episode where I broke down the research on ADHD and endometriosis. But this episode is about masking. And today, we're going to talk about why masking stops working, why your brain feels hijacked by your hormones, shocking health risks that no one else is talking about, and exactly what to do about these things. Now, stay until the end, because if you're an ADHD woman, I have this super exciting project I've been working on. It's going to be a 100 % free resource for you. I want to share it right now. That's the ADHD impulsivity of me. But we're going to wait until the end because the first thing that we need to talk about is the fact that we are losing years on our life.

2:56ADHD is associated with a significantly shorter life expectancy, up to about a decade in some research. A decade. Now, before anyone twists this into fear-mongering, I want to talk about why and what's going on because it's not because just having ADHD in itself is a fatal condition. It's because ADHD affects sleep. Dr. Brighton.com show notes. I have a whole episode on how 70 % of us have sleep problems and what to do about it. But it also has to do with stress physiology, metabolic health, accidents and injuries. We are more impulsive, but also we are more distracted sometimes. And There's also impulsive health behaviors like drugs and alcohol use, especially in populations who don't get adequate treatment like women.

3:48We also are hitting chronic burnout. We miss medical care and appointments. And then there's an inflammatory component as well. And when you spend decades living in a nervous system that's constantly overclocked, like you never get to clock out, you are undersupported. You are misunderstood. Medicine doesn't support you. That has consequences. And this is why women deserve earlier diagnosis and earlier support. Because ADHD for women, it's not just about focus. This is about our long-term health. Now, listen, if you're new here, this is The Dr. Brighton Show. I'm Dr. Jolene Brighton, board certified in naturopathic endocrinology, nutrition scientist, ADHD girly, and I'm really glad you're here.

4:32If you can take like a second, share this, like it, comment, subscribe. It is tremendous support for this podcast. It's a little act for you, really big deal for me and my team. But I don't want to hold you up any longer. So let's go into why the mask breaks. So here is the shocking truth that we are not told. The mask holds until hormones start to go. So for years, many women survive on things like people-pleasing. You can let me know which one is you in here. Perfectionism. That one's me. I'm the perfectionist. Also overachievement. I'm also that person. Oh, and anxiety. Anxiety-driven compensation.

5:18Mm-hmm. Yeah, I could fall into that bucket as well. But also like just sheer force of will. Like you're just white knuckling through it. And then perimenopause hits. And I want to be clear that like everyone talks about estrogen and yeah, you might even be like, yes, girl, you're the one that put estrogen on the map. Yes, I know that I talk a lot about estrogen too, but I want you to know that if anyone ever tells you that ADHD and perimenopause is only an estrogen phenomenon, they do not understand even half of what is happening because estrogen is only one part of the hormonal storm that's hijacking your brain.

5:57We also have to talk about progesterone shifts, progesterone intolerance, cortisol dysregulation that comes along with this, insulin instability, what's happening with DHEA and our testosterone as well, not to mention thyroid changes. Thyroid changes can look a lot like ADHD, so you always have to rule that out. They can totally go together. And then there's also like sleep hormones like melatonin. That matters. Histamine surges matter. Stress hormones amplifying other systems matter. This is a full endocrine event. It's not just estrogen, okay? And your brain, it's being hit from multiple directions, which is why we have to look at things from multiple directions.

6:43And listen, for an ADHD woman like me, like if you're like me, you're often carrying a higher sensitivity and sensory load plus a cognitive load. And that effect can become super dramatic. So we know that there's a high co-occurrence of ADHD and autism, but doctors still believe that women can't be autistic or the fact that like I can sit here and talk to you somehow I can't be autistic. But our mask starts to break because noise becomes unbearable. Transitions are impossible. Our executive function collapsed just like an ADHD person. Emotional regulation, that gets way harder. and the mask becomes way too expensive to wear.

7:28It's too expensive. It's too costly. You're not failing. You just can't keep surviving this way. Your hormonal changes colliding with years of compensation and you cannot keep it up because literally you will burn out. It will hurt you. Masking and camouflaging are slowly killing us. They are part of what wears us down. So what is masking and what is camouflaging? Masking is suppressing, hiding, trying to hide your traits, okay? And I want to be clear because whenever we talk about masking, a neurotypical will be like, oh, so you're faking it. Oh, so you're pretending to be someone you're not.

8:11Yeah, I'm trying to survive. That's what masking is. Masking is survival. and we as humans have to have community. Our brains, they die without community. Our bodies die without community. I know I sound dramatic, but research has shown that being isolated, it has the same negative effects as 15 cigarettes a day. You're 50%, 5-0 % more likely to die if you do not have community, you don't have a social circle. So us as neurodivergent individuals, we are going to find a way to fit in, to survive, to have that community. Also, we've been bullied. I would venture to guess every single person who is listening to this that identifies as ADHD has been bullied.

8:59So you learn the ways to fit in. So masking can look like not interrupting mid-sentence. You know, that's a really benign thing. And people would be like, oh, you just learned self-control. Well, I mean, kind of, but my impulsivity, like, it takes a lot of energy not to interrupt your long-winded story, which you could have just started with the point, but for some reason you had to spend 15 minutes giving me a backstory that had nothing to do with what we were talking about. If you know, you know. Masking is also spending an enormous amount of energy trying to look like you have it all together, trying to stay on top and compensate say, for the executive dysfunctions you are experiencing.

9:39Like it's spending a lot of energy trying to make up for the inherent deficits of your executive function. That does not mean you're deficient as a human, okay? What ADHD is, is a significant executive dysfunction that interrupts your daily life, your relationships, your school, your work. And that was first brought to me, that definition by Dr. Anne Louise Lockhart. I will link to her episode. She is a tremendous resource if you have a teenager or a kid with ADHD, by the way. Now, camouflaging is like the umbrella that masking sits under because with camouflaging, we're taking it a step further.

10:23We are copying other people's traits. We're emulating other people. We are rehearsing scripts before we go out. thinking through conversations, how we'll react to that. We are mirroring what our colleagues are doing at work so that we look like we are a good worker too. And we're like, that's an archetype of what people are looking for and says is good. I want to emulate that archetype. Now, if camouflaging was a bad thing and there was anything sinister about any of this, why do we have mirror neurons? Why do we have entire sections of our brain dedicated to mirroring people to making sure that we match their facial expression.

11:05So this can also look like trying to maintain eye contact and making sure that it appears that you are listening to a conversation in the right way. So like as an autistic person, I will have to monitor my face because I will hear what you're saying and then I'll have another thought and another thought and I'll be connecting it to other things. And then sometimes I get this face that's like scowling and I'm like, oh, they just said this and that might mean this and that connects to this. And like this happens a lot in science conversations where I'm like, hmm, putting all the puzzle pieces together.

11:41I have to make sure that I'm monitoring myself and that my facial expressions match what you expect of me. I have to match what your expectation is. Otherwise, the perception is I'm rude. I've been called the B word by people because they think that I'm being rude to them because of, you know, like different interactions, which was like, I wasn't even aware of. So this camouflaging masking is our way of constantly surveying ourselves. And often, not just should we show up so that we have community, but so that the way we show up for people makes them feel good, makes them feel like they feel good to be in a relationship, that we also are, as women especially, we want to caretake to their emotions.

12:29So now that you understand that aspect of what actually is masking, camouflaging, we talked a bit about why it breaks down. Let's go into the part that medicine keeps missing. And in fact, this is the part I got to say with my whole chest, because medicine has treated women like an afterthought for far too long. Most ADHD research and treatments, those frameworks were built around what symptoms look like in boys and men. And then women were handed those same solutions and basically told, figure out a way to make it work for you. Make it work for yourself. When you're like, this isn't working for me and I need more help.

13:07They're like, oh, you're just so broken, like something's so wrong with you. No, that doesn't fly. It's not even like, if you think about it, like it doesn't even make sense to say that we would have the same experience as men. Men's hormones, up and down one day. I like to call them like the sun. They rise and they set. They're super boring. That's why I don't like to do men's health. Women, we are complicated. Hormones, they change women's brains. They don't exist in a hormonal vacuum. So as you cycle throughout the month, day after day, your hormones are changing. I mean, month to month, decade to decade, our brains are responding to ovarian hormones, adrenal hormones, sleep hormones, blood sugar changes.

13:49Like it is a whole cascade of hormones plus like the inflammation that can come along with them. And so it's important to understand you're more like a moon cycle. You're having these phase changes. You get to perimenopause, then it starts to get like really wild. Menopause, hormones just bottom out. But all of the hormone transitions, including pregnancy and puberty, postpartum, they affect our brain. And so what often happens in these hormone transitions is it looks like you suddenly got worse. And like, you're not able to mask. So something that's like seriously wrong with you, but the reality is, is that that was underlying the entire time you lost your hormone ability to compensate.

14:30And now instead of saying, oh gosh, we should have supported you. You needed accommodations. We needed to have things in place. Like instead it becomes blame. It's like, why can't you just hold it together? Why aren't you trying harder? Why can't you just do this? And people in your life, they sure don't like that you always showed up for them. You masked and you camouflaged in a way that made them feel comfortable. And now you're not able to do that. Like, oh, how dare you? How dare you have your experience that affects me? So I want you to understand that hormonal transitions, They don't necessarily make like our ADHD worse in the sense that like now you're broken, something's wrong with you.

15:11What they do is they really take off a layer that shows you what you've been hiding and compensating underneath. And there's no shame to be had in that. Somebody else along the way should have recognized the support that you needed. 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. Menopause is inevitable, but suffering through it isn't. That's why I want to tell you about Alloy. Alloy is a digital health platform that connects you with a menopause-specialized doctor who can create a personalized treatment plan tailored to your needs, all from the comfort of your home.

15:53Join the 95 % of women who tried Alloy and saw relief in the first two weeks. Head to myalloy.com and use the code Dr. Brighton. That's myalloy.com, M-Y-A-L-L-O-Y.com and the code Dr. Brighton, D-R-B-R-I-G-H-T-E-N. Share your symptoms and you'll get a fully customized treatment plan and unlimited messaging with your doctor. Plus, you'll get$20 off your first order today. That's M-Y-A-L-L-O-Y.com, code Dr. Brighton. And you, losing your hormone allies in those transition periods, you need more accommodations. You need more support. So I want to talk to you about some solutions and how to help yourself.

16:47But if you find that you cannot mask and you're in a hormone transition, not just perimenopause, you're not alone. It is near impossible to mask. And if you followed my journey, I tend to share my journey on particular social media platforms. People on Instagram aren't so nice to me. Hopefully you guys will be nice to me here. But when I talk about my experience, there is always somebody challenging and being like, you can't be ADHD. You can't be autistic because look at all these things I've seen. And I'm like, if I had a bank account, it would be overdrawn because what you see is such a big cost to me.

17:26And you don't understand that if I want to fill that bank account back up, that's why I disappear for like two weeks at a time. And people don't see me in my life because I cannot keep up the mask. I need to recalibrate my nervous system, but also like re-energize myself. So let's talk about some solutions for you. And if you are new to this podcast, I just want you to know that we always talk about solutions because I firmly believe that awareness without support is absolutely useless. Because I'm like, what are we going to do about it? We need a plan. So number one, audit your load. The first thing you need to ask yourself is what am I carrying that's draining my executive function before my day even begins?

18:10because mental load is not invisible to the brain. It has a real biochemical demand. And so if before you even start your day, you're feeling like, oh, I'm overwhelmed, we need to audit that. So unfinished tasks, decisions that you really don't have to make, every emotional obligation that is consuming your bandwidth, audit it and ask yourself, do I really need to handle this? Is this really something I have to be a part of? I'm going to give you an example of how life can shift as well. So I am working on a book right now. It is about to come back to me with the technical copy edits. That's like the hardest part of the book because that is like 1 ,000 micro decisions that have to be made.

18:56And for an ADHD brain, that's exhausting. I'm like, I need that back in my ovulatory phase, like pre-ovulation, not like mid-luteal phase because I will fail. It's a short turnaround. usually you're going to get like weeks upon weeks with this. I'm getting days. So I have already audited, looked at things and in preparing. And I told my husband, I will not be deciding dinner. Anything that needs to be decided in our life, if it's urgent, that's on you, bro. Like I gotta, I gotta let that go. I gotta trust you. You, otherwise you're going to bring it to me after I get that done because that load on me, having a thousand micro decisions to be made, I'm going to hit decision fatigue.

19:38I'm going to be exhausted. I'm not going to have any more to give. So we are getting things lined up and in place to accommodate my needs during that. I want you to do the same thing in your life. If you know there is a major stressor, and look, these things come out of nowhere sometimes, you got my permission to start dropping things that are not necessary. Like I told my husband, like, it's going to end up being five days on this book. Don't tell me I stink if I don't shower. And like, I know someone's gonna be like, that's disgusting. Look, I'm gonna be working like 12 hour days. Okay, like, give me a break here.

20:13But also like, I'm gonna probably wear like, I'm just gonna wear whatever, whatever I pull out. My outfits are going to be ridiculous. My hair, never going to be done. Like my food, I just need things to be put in front of me. I need food and water put in front of me during a schedule, because even making the micro decisions around that are going to be too much for me. So you have to audit and just give yourself permission to really start to get rid of the things you don't need to make decisions on. You know, Dr. Leanne Borman was on the podcast and something she talked about is just even showering and the like I the routine of like I have to like shampoo my hair and then condition my hair and like how when you are going in that burnout phase, that's too much.

20:57I have pump bottles in my shower and everything has to be lined up in the order that I do it so that I, and I do like my routines, but that way it's not even a decision. It's just autopilot what I can do. And these things sound ridiculous to neurotypical people, but these are the real strategies that actually offload your brain and make it so that you can show up the way you want to show up in life. Now in perimenopause, This is really relevant to you. Estrogen drops. Insulin sensitivity becomes less sensitive. Visceral adiposity accumulates. Inflammation rises, including neuroinflammation. Insulin is one of the most under-discussed hormones in ADHD women.

21:39So when we have blood sugar crashes, we get irritable like everyone else. We also can get impulsive. We can have lack of concentration, lack of focus, lack of mental motivation. We can become more emotionally volatile. So if there was one thing, just one thing I would say to you, you get 30 to 40 grams of protein at breakfast, non-negotiable. Pair that with whatever else you like, honestly. If it's just the one thing you can do, protein at the start of the day is going to affect your entire metabolic system. Not talking about weight loss, talking about insulin regulation for the rest of the day.

22:19We have a propensity to just like do coffee and forget about food. I know because I've worked with enough ADHD women. If you are a, I got to do coffee first, collagen, my friend, please add collagen. Please try to get 20 grams of protein in that coffee. And if you just add a little bit of cream and you get a good collagen, you're not even going to taste that. The next thing you have to do in perimenopause is protect sleep like it's medicine because it absolutely is. Sleep loss worsens ADHD symptoms dramatically and it amplifies cortisol. People who are not ADHD miss sleep and they look like someone with ADHD.

22:55So what do you think it does to us? We got sleep problems. I know this is easier said than done. Drbrighton.com show notes. I got you covered in episodes. Lots of sleep strategies. But if you need to use something like melatonin, phosphatidylserine, L-theanine, progesterone, then do it. Do what you need to do to get good sleep because there is absolutely no way you can protect your perimenopause, menopause, ADHD brain if you ain't sleeping. Now we have to address hormones comprehensively. Oh my God, the number of conferences I lecture at where I talk about ADHD and hormones and everyone's like, estrogen.

23:33And I'm like, yes and. Okay, so it's not just estrogen. The question is what system is destabilizing your brain right now? And for some, that's estrogen. But for others, it can be progesterone sensitivity. So you actually have fine progesterone levels, but you're sensitive to it. It can be insulin dysregulation. It can be cortisol. It can be that they gave you estrogen because they were like, oh, estrogen, ADHD, and then boom, histamine problem. So this is why personalized support matters. You need to work with an ADHD competent hormone prescriber, ideally someone who has been doing it for a long time, not someone who just started a few years ago, but if they did start a few years ago, this is one screening question that I always ask.

24:18Do you use compounding hormones? If they say, no, I never use compounding hormones, red flag, I'm going to tell you why. But if they say, no, those are not FDA approved, burn it down, red flag, okay? Hormones at compounding pharmacies are FDA approved. That is willful disinformation to keep women basically in someone's practice and keeping them in the cookie cutter model and saying like you have to fit into this. So compounding hormones are FDA approved. The FDA does not approve medications that are made for an individual. That's what we're doing here. They approve medications that go out to everyone.

24:55So maybe that provider just doesn't understand how the FDA works. That's a possibility. but why it's a red flag if they never use compounding pharmacies is they've never worked with a neurodivergent woman i will tell you that we are more sensitive we can have progesterone sensitivity okay so 100 200 milligrams of prometrium that doesn't necessarily work for all of us sometimes we got to start on 50 milligrams sometimes we got to go a different route with things the other thing is we can have more sensitivities and issues come up so you might be more prone to have a localized allergy, but not like anaphylactic allergy, just like a sensitivity to an estrogen patch.

25:37You might be someone that they tell you, oh, do testosterone and squeeze a pack and just do a pea-sized amount. And like, that's not working for you. You might be someone who's like, yeah, I've done topical estrogen. I can't do oral estrogen because I have a clotting risk factor. I need to do injectable estrogen instead. If they're not working with compounding pharmacies, I will tell you they're not working with hormone-sensitive women. They're not working with the type of women that we are who tend to have more adverse events with prescriptions. So I think that's a really important screening question to ask someone.

26:11And also, if they're being dogmatic about it, they're letting their beliefs and their dogma ahead of the science and the patient's needs. I just also personally think it's ableist AF to be like, no, I won't use a compounding pharmacy. Like this is the way I prescribe hormones and you should just be fine. You should just take it. Why do you have such a problem with it? All my patients are fine. And it's like, well, yeah, because like our, us being ADHD, our systems are different. We know genetically our systems are different. And so no, we're not going to respond the same way that everyone else does.

26:48Now, with all that said, this is actually why I'm really excited to finally tell you what I have been building. I am launching a brand new ADHD and women YouTube channel so that I can nerd out with you and get into the specifics about hormones, ADHD, and the female experience. I am dedicating a home built specifically for women's brains. And because far too long, women have been expected to just like figure this out all alone. And I, for one and done, watching this community struggle while being handed male default advice that doesn't reflect our biology, I am making this channel and I'm super, super excited because I'm ADHD, as I said, and like autism, ADHD, hormones, brains, this is like my special interest.

27:41So I get to do something that I am so thrilled to be doing. This is a work I'm obsessed with. And this channel is going to be built around entirely what women actually need. We're going to talk about, you know, hormones, perimenopause, postpartum, puberty, what to do with your teen daughter, executive dysfunction, sensory overwhelm. We're going to talk about being pregnant. We're going going to talk about what happens in menopause. We're going to be hitting every phase of women's lives with practical science-backed support. And this is a place that is going to be all ours. And I'm excited about this.