Brain Fog, Rage, Overwhelm: The ADHD and Menopause Overlap with Dr. Sasha Hamdani

23:02Dr. Mary Claire Haver:And the best part is how effortless it feels. The pieces are lightweight and easy to wear all day long. Whether you're running errands, going out to dinner, or just getting ready at home, it's that perfect balance of simple and statement, which honestly makes getting dressed so much more fun and a lot less stressful. They also make the perfect gift, whether it's a birthday or an anniversary. You really can't go wrong with jewelry, especially when it's Jenny Bird. Get a free gift with your first Jenny Bird order when you shop at Jenny-Bird.com. Can we talk about something that catches so many women completely off guard?

23:41Dr. Mary Claire Haver:You hit your 40s and suddenly your skin feels different. It's drier, thinner, maybe even a little crepey. So you do what we've all been taught to do. You buy the expensive moisturizer, upgrade your retinol, and hope for the best. But here's the thing. It's not that you're doing skincare wrong. For many women, these changes are happening because estrogen is declining during perimenopause and menopause. and if the root cause is hormonal, it makes sense that products designed for aging skin can only do so much. I noticed this myself. My skin just wasn't responding the way it used to and it was frustrating to feel like the routine I've relied on for years had stopped working.

24:26Dr. Mary Claire Haver:That's why I was so interested to learn about M4 Skin Care from Alloy. It's the first head-to-toe skincare line powered by Prescription Estriol, a gentle, bioidentical form of estrogen that's been clinically studied to help rebuild collagen and improve elasticity. And the results are impressive. 95 % of users reported smoother skin after using the M4 body treatment. It's prescription-strength skincare delivered without a traditional pharmacy hassle, and it's HSA and FSA eligible. Try M4 Skin Care from Alloy and see results in as little as eight weeks. Head to myalloy.com and use the code MCH20 to get$20 off your first order.

25:12Dr. Mary Claire Haver:Your menopause specialized doctor will tailor your skin care to your needs. Plus, you get$0 unlimited messaging with your doctor. Head to myalloy.com and use code MCH20 to get$20 off your first order.

25:35Dr. Mary Claire Haver:So in women, what do you think are the top missed or misdiagnosed symptoms of ADHD? I think the emotional regulation is a huge part. And what does that mean? What is emotional regulation for our listeners? Yeah. So emotional regulation. My kids would want to know, Mom, what is emotional regulation? Well, let me tell you. Emotional regulation is the capacity that you can control your emotions up or down. So for people who have emotional dysregulation, difficulty controlling your emotions, emotions feel bigger. They feel faster. They dissipate slower. So you're dealing with things, a lot of times women will come into my office and that's their chief complaint.

26:17It's not ADHD. It's not I need to research about this or I need to be evaluated. It's no, my emotions feel out of control. And then you get further into it and you ask those follow-up questions and you get to a spot where you're like, oh, okay, well, this is also, you're also dealing with chronic overwhelm. That's something that gets missed all the time because it's like, well, you're a mom. Well, you're also working well you're in perimenopause right i mean that's that's the checklist that

26:45Dr. Mary Claire Haver:gets read off to women you know this is a tough time it's the sandwich generation you're you know like all women are going through this yeah i'm like where's biology here your age where's biology hi yeah it's it's it's it's a shit deal it's such an incredible double standard that we see because we just expect women to be okay with this suffering and without regard to that their bodies are changing against their will. Like this, their bodies are changing. Yeah. All right. Let's dive into ADHD because there's more than one type, right? Yeah. Okay. So what are the classes or types? So we talked a little bit about inattentive versus hyperactive.

27:26So inattentive is typically what you see in females, and that's forgetfulness. It's distractibility. It's difficulty staying organized. It's difficulty with time and procrastination and things like that. That is all one grouping. You get into hyperactive symptoms, and that's verbal, physical impulsivity. You have a hard time staying in your seat. You're fidgeting. You're blurting out answers. You're completing other people's thoughts. Another common thing that I hear from people is like, if I don't say it right now, I'm going to forget. Like, that is stuff that you typically see with hyperactive.

28:02And then combined type is a combination of both. Which is most common in women?

28:07Dr. Mary Claire Haver:You said inattentive typically. So what is masking? You mentioned masking before. Yeah. Masking is the voluntary or involuntary behaviors that you do to compensate for your symptoms. And so I'll give you some examples. If you are already prone to dropping the ball, I know that I'm going to miss stuff. Now, all of a sudden, in order to avoid doing that, you're double, triple checking your work. You're waking up in the middle of the night to check your emails to see what you missed. You are staying late to organize your papers for the next day. So it can look like, okay, now we're compensating with this perfectionism.

28:44Well, I'll give you an example of what I'm doing right now. like for the physical impulsivity my legs are swirled together so tight so i don't bounce up and down and move this microphone my ass is firmly on the seat and squished down so i don't just like bounce and fidget because i don't want to swirl the seat around does this swivel i don't want to though. Okay.

29:12Dr. Mary Claire Haver:Yeah, you are. I'm looking at your legs down there. I'm like, am I doing it? So I hear terms neurotypical and neurodivergent. Is this all in the spectrum? So neurodivergent is a term that came about in the 90s by a psychologist, and it was her way of encapsulating learning and thinking differences. So ADHD was in there, autism was in there, dyslexia is in there, and neurotypical is basically everything that's outside of that. I feel like in the recent past, it's gotten a little bit more hazy where that delineation is. And also, like, they don't carry a clinical weight, you know? I sit here and I think about it.

29:53Dr. Mary Claire Haver:And I think about my girls. You know, I think about me and the way my brain works, my husband works. And do you think that everything is normal and just the world was built for certain brains? And when you step outside of that box, suddenly it's just harder. because your brain wasn't wired for what the world has. When you look back from like an evolutionary perspective, you know, people always bring up this theory of like hunters versus gatherers. There's some people that are just really happy staying at home, gathering their stuff. And, you know, I don't know, what do gatherers do? Stay at home.

30:29And then there are people that are going out and potentially putting themselves in harm's way and being a little bit more risky and impulsive and working, their brains are working a little bit faster and they're able to adapt. We don't live in that kind of society anymore, right? We're in cubicles and we're behind laptops and we're doing that kind of thing. So, right, we're in our phones. And so our world looks very different. So, yes, there is a very real propensity towards looking at the world as this is built for a neurotypical person. But I think if I were to, there's a lot of stuff that would have to change to make it more neurodivergent inclusive.

31:10Dr. Mary Claire Haver:Okay. We're not there yet. No, we could be. So what's the genetic component of ADHD? Hi. Wow. So the heritability is 75 to 88%. I know. Okay. Strap in for this one. If you have ADHD, you're eight times more likely to have a child that has ADHD. So it is further corroborated by twin studies. If you look at those twin studies where you take individual twins and you are checking for ADHD, but you have them growing up in completely separate environments, then they come back. Both of them have ADHD because the likelihood of having identical twins with ADHD is much higher. So it's an interesting and complicated genetic thing.

31:52A lot of people have tried to dive into like, is there an exact gene that you can trace back? And it's multigenetic. It's through many different pathways and interacting. Yeah, multifactorial.

32:03Dr. Mary Claire Haver:Yeah. So if a woman listening is recognizing the symptoms in herself, but she's not been formally diagnosed, she goes with her child, you know, she's that woman who's like, hi, I think that's me too. What does she start? What could she do? Yeah. I tell people, and I know that this is a luxury because a lot of people don't have access to care, but if you fall into this category, a lot of people ask me, like, you know, I'm 55 years old. Do I need a diagnosis? Like, I've gotten this far. Why do I need it? But to me, I feel like getting an ADHD diagnosis is so incredibly validating. Yes, and it helps you understand your brain.

32:45I don't think that there's an age limit for that. So I think if you have access to that, you should seek out and find someone who can evaluate you for ADHD. And by the way, an ADHD evaluation is so much more than just looking at ADHD in a vacuum. They look at ADHD over the course of your life. But just as importantly as ruling in ADHD, they rule out other things. So focus can be fragmented from a lot of different things. And so they're going to rule out like, is this partially due to hormones? Is this a thyroid dysfunction? Is this another medical disorder? Is this something psychiatric? Is this anxiety?

33:22Is this depression? Is this bipolar? So there's so many things that a skilled provider will piece together. I think everybody deserves to have that.

33:31Dr. Mary Claire Haver:So in my world, because most doctors don't get training on menopause, the Menopause Society has a certification. You take a test, and so we're always referring people there. Is there something equivalent in your world? Okay, she has insurance, great insurance. Who does she go see? So the problem is, and it's a structural problem, and it's very similar to menopause, is that it is stemming from poor research and poor diagnostics, right? We just don't have good data. And so without that, we're going through generations and generations and generations of physicians who aren't being trained properly in terms of picking it up, in terms of how to deal with it, in terms of all of that.

34:15And so I think there's no certification, there's no like board specialty or a fellowship that you are like, okay, you are ADHD trained in this. There's nothing like this. And I think truly that if you are a practitioner that is well-versed in ADHD, it's because you went out and you sought out that information. You started researching it. You went and you did those extra things to get that information. And truly, the reason I did all those things is because I wanted to understand my brain better. Let's talk about estrogen and the brain.

34:48Dr. Mary Claire Haver:And I want to touch on melatonin, too, before I forget to ask you about it. Estrogen brain connection. So we got estrogen receptors all over the brain. I love mapping those or going to, I don't map, going to research where I can see like the receptors light up, prefrontal cortex, amygdala, processing centers, even how we utilize glucose in certain areas of the brain changes across the menopause transition. So in your experience and your research, what does estrogen do for our brains? So the most important thing that you need to know about estrogen is its connection with dopamine. Okay. So estrogen, it works hand in hand with dopamine.

35:34So when estrogen is low and when there's a drop in estrogen, there is a drop in dopamine synthesis and signaling. So there's less usable dopamine. And in addition, it also, estrogen typically helps with dopamine. It keeps dopamine in the synapse longer. so it prevents it from getting reabsorbed and broken down. So when there is that functional drop, you're getting a drop in dopamine. And when you get a drop in dopamine, you get an escalation of ADHD symptoms.

36:02Dr. Mary Claire Haver:So explain to our listeners, why is this so important? What does dopamine do? So I know it's a neurotransmitter, and we've talked about this in the podcast before, which is a chemical that sits in between the nerves of the brain and sends signals back and forth. But why is it so important for this? So it's important for this specifically because of two things, cognition and mood specifically. So with cognition, this is the thing that's helping you think clearly, think faster, think logically. These are things that prevent brain fog. When your dopamine levels are high, you are getting things done.

36:41You are being able to execute tasks and do goal-directed activity. When your estrogen level and subsequently your dopamine level is low, then not only are you dealing with the brain fog and the cognitive changes, but from a mood perspective, emotions get more unmanageable. You deal with more anxious episodes, more depressive episodes. It's all very interrelated. And then they play on each other, right? If you're anxious, it's harder to think. If you're depressed, it's harder to think. These are all kind of playing and exacerbating each other at the same time.

37:16Dr. Mary Claire Haver:So brain fog specifically, probably 85 % of my patients. And we did a survey on social. We directed them to a questionnaire. And 800 people went and graciously filled it out who were in perimenopause, self-diagnosed perimenopause. and about 85 % had brain fog issues. So is it just estrogen? Is it just dopamine? Is it more complex than that? It's probably a combination of all of those things at the same time. I mean, you are getting this acute storm of when you're having that low estrogen that's already playing, just like we talked about, where these women were able to do all these things before.

37:59Dr. Mary Claire Haver:And nothing's new in their lives, right? No. They're like, well, your life is stressful. Hey, hey, hey, my life has always been stressful. I had it managed. You know, like nothing new has happened. I didn't get divorced. No one died. I haven't lost my job. Like, there's no big life stressors. And suddenly things are overwhelming. Yeah. And unmanageable. And so that it's quite literally that drop in estrogen that is robbing you of that capacity to do all of those things. So the brain fog, difficulty concentrating and focusing, memory problems short and long term. But in my experience, you know, with patients, mostly short term, you know, they can remember like the song that played at prom in 1986, but they can't tell you where they put their keys.

38:41Well, can I tell you one caveat to that? With chronic estrogen deficiency and depletion, you can start getting long term. Wow. So it is mostly short term. And that's, you know, when you intervene on that, sometimes you can get some resolution or improvement in those symptoms. But that's something I tend to warn people about, because if you're dealing with this complicated intermixing of ADHD and hormonal symptoms at the same time, and you are, you know, you're pulling at one of those levers, which I always recommend. I'm like, try one thing first so you can get good data. if you're following up on one thing and you're still not getting adequate results and then you bring in another element like you try to treat the hormonal stuff and then you try to treat the adhd stuff what we have found is that when you get adequate management early symptoms get better if you wait too long you you get into a bit of an issue yeah yeah

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43:33Dr. Mary Claire Haver:So explain to our listeners, what is executive function? I hear that word on social media constantly, and I think I know what it means, but I'm not a psychiatrist. So what is it exactly, and how is it affected by all of this? So executive function is referring to the systems that are required for goal-directed activity. So planning, organizing, managing, kind of getting you from point A to point B. That's everything. You prioritize your events, you think about what is needed, like even with making dinner. There's so much executive function that goes into going to the grocery store, figuring out what to make, figuring out what I need from the grocery store, figuring out what's going to stay and not go bad, figuring out what order to make things.

44:21I mean, there's so many steps that are required.

44:23Dr. Mary Claire Haver:Is this reversible? I mean, in your patient population, are you able to give people that function back? Yeah. Yeah. Yeah. Just address it. So what does the research show about? And lots of questions on this from our listeners. Talk to me about HRT. And I'm not talking about birth control pills. I'm talking about menopause hormone therapy, usually in the form of estradiol in a low dose, plus or minus the progestogen, usually progesterone. What do we know about that and cognitive function, like brain fog? Yeah. For people that have that estrogen deficiency specifically, although, you know, you can, we'll talk about progesterone right after, but with the estrogen deficiency, what you see is that early supplementation with that, if they are deficient.

45:08And again, you're the expert on this. But my understanding of this is that, you know, early on in that process, as that transition is occurring, your brain actually creates more opportunity for estrogen receptors. You upregulate the receptors. Yes. And so then that you have that beautiful early window to kind of correct that problem. Whereas if you wait a lot longer, those receptors have resorbed by now. And so you're just kind of putting in estrogen. You have this window. window of opportunity yeah and so i i think that is really helpful in terms of cognitive functioning and generally when we're talking about like what i would recommend again it's so personalized and

45:46Dr. Mary Claire Haver:dependent on the person the australian studies they only use transdermal the patches there and this was for mental health and they saw better outcomes than with starting new start ssris yeah so i'm assuming it would be the same and the thing about transdermal is that you get that nice steady state rather than the peak and trough that you get with oral. And so there's room for both, right? But for brain health, it seems that transdermal, you know, because you're just got that steady feedback to the brain that the brain is like, oh, okay. And I think one important thing to distinguish in this is that when you're doing that evaluation, when you're looking at a perimenopausal woman, and if they're coming in and they're complaining of this cognitive dysfunction, you're also looking at, are you getting this from just the mental health side?

46:34Are you getting this cognitive dysfunction from ADHD? Are you getting this cognitive dysfunction just from hormones? Are you getting this cognitive dysfunction from anxiety, from depression? Because then that will indicate, do you need just hormones or do you need hormones? And if it's not corrected, then do we need to go this extra layer of trying to figure out what that next step is? And so you have to kind of doing that detailed dive into it. We'll figure out what your first step is.

47:01Dr. Mary Claire Haver:In our clinic, we generally, because we're gynecologists, we start with hormones. And we're like, however, we're going to give this a few weeks and see what gets better. Yeah. And we may need to add in other therapy and lifestyle. And we'll get to lifestyle stuff in a second. All right. Talk to me about progesterone and how it may or may not impact cognition. So progesterone is an interesting one because progesterone, I know it impacts mood. Yeah. Yeah. Every woman who's had a period or a baby. So they, you know, people say that this is your calming hormone, which is it's obviously a lot more complicated than that.

47:36What I've seen is that you can go two ways with it. Right. One way is that people are like, OK, it's like a nice it gives me a little bit better sleep. And that, you know, if you're sleeping better, everything gets a little bit better. So that is one direction you can go. And then the other direction, especially for people who are also having difficulty with the cognitive side of things, they're just like, this just makes me super tired and super foggy. And so it's - Or anxious.

48:01Dr. Mary Claire Haver:They have a paradoxical anxiety to it. They can get anxious. So about 10 % of our patients on oral micronized progesterone will have kind of the paradoxical, they don't tolerate it. It's not giving them the desired symptoms or sleep or whatever. But fortunately, we have other options that we can go to. some of the, there's a transdermal synthetic or, you know, to protect the lining of the uterus, we can always do an IUD, you know, a progestin containing IUD, which hopefully stays local and we don't get systemic effects. But yeah. What about testosterone? It's so hot right now. Everybody's talking about it.

48:33It is so hot right now. Testosterone is an interesting one because I feel - There's antigen receptors in the brain. There are. And you see a cognitive effect. It kind of reminds me of some of the effects of stimulants in that it is a little bit more on the stimulating side. It helps a little bit with energy. For people who are testosterone depleted, it's a beautiful intervention. And I've seen just in general mood people improve. I've seen in libido. Your male patients as well?

49:04Dr. Mary Claire Haver:Yeah. Yeah. Okay. Yeah. Well, sometimes they get angry. But in general, I've seen like, depending on, And, you know, it's such a fine line. Sometimes they feel like their mood gets better. And then sometimes if you kind of overdo it, they get anxious and kind of cranky. But I think that's the name of the game, right? Hormones, you're kind of hitting a moving target and you have to have this gentle touch with it. And so that's what I tell people is like we are we're trying to get as close to the target as possible and get you to a spot where we're not over correcting the issue and causing another problem.

49:40Yeah.

49:41Dr. Mary Claire Haver:That's a good way to put it. I like that. So let's go back to ADHD symptoms. And we talked about cognition. Do you find HRT might help with ADHD symptoms? If they're both happening at the same time. I would say that, like, for example, I've never had a ADHD patient that I'm not concerned about being in perimenopause that I put on HRT. I've also never had a perimenopausal patient that I have ruled out ADHD. I typically don't put them on stimulants. And I know that's kind of, some people do, because it's also used for neurovegetative symptoms. It's used for some sort of depressive disorders. Theoretically, I can see how that would be effective.

50:23This is just a hill I'm willing to die on. I like things a lot better than stimulants for ADHD management.

50:31Dr. Mary Claire Haver:Welcome back to another MidiPause. I'm Dr. Mary Claire Haver, host of Unpaused. Today, I want to talk about a menopause symptom you may not have heard of before. Musculoskeletal syndrome of menopause. But chances are, you've already felt it. It sounds clinical, but the idea is straightforward. As estrogen levels decline during menopause, the effects go far beyond hot flashes or mood changes. They also show up in your muscles, joints, tendons, ligaments, and bones. For many women, that can mean new or worsening stiffness, joint aches, reduced strength, slower recovery after exercise, or just a sense that your body is not moving quite like it used to.

51:17Dr. Mary Claire Haver:Too often, this gets brushed off as just aging. But that is an oversimplification. And it is not the whole story. More importantly, it is not something you simply have to accept without support. And then there's frozen shoulder. I want to spend a moment here because so many of you have messaged me about this. One day you wake up and you can't reach your arm behind your back. You can't fasten your bra. You can't sleep on that side. And it seems like it came out of nowhere, but it didn't. This is frozen shoulder. Research shows that women are significantly more likely than men to develop frozen shoulder.

51:56Dr. Mary Claire Haver:And the peak onset? Right in the window of perimenopause and menopause. That is not a coincidence. That is estrogen loss, triggering inflammation in the joint capsule, causing it to thicken and tighten until movement becomes nearly impossible. And the cruel part? Frozen shoulder can take two to four years to fully resolve. Years of pain, of limited mobility, of not being able to do the things you love. Here's the science in plain English. Estradiol, your primary estrogen, protects your muscles, your bones, your cartilage, and keeps inflammation in check. When it declines, a weaker form called estrone takes over, and that swap starts a cascade.

52:43Dr. Mary Claire Haver:Muscle loss, decreased flexibility, joint pain, higher fracturists, and conditions like frozen shoulder, tendinitis, and arthritis become far more common. So what do we do? We fight back. Proactively. Resistance training to protect your bones and muscles. Yoga, Pilates, or Tai Chi for flexibility and balance. calcium, vitamin D, magnesium, and omega-3s to support bone health and dial down inflammation. And for many women, hormone therapy is absolutely worth considering because protecting estrogen levels may be one of the most powerful tools we have against this entire syndrome. MidiHealth is dedicated to changing the way menopause is treated with a personalized approach to each woman's specific needs.

53:34Dr. Mary Claire Haver:Women come to MidiHealth to address the symptoms of menopause they see and feel every day. They partner with you to find a treatment, whether that's HRT or a non-hormonal solution, or simply a lifestyle change. A more personalized approach really matters. MidiHealth is helping women navigate menopause with clinicians who understand the full body impact of hormonal change. They also offer targeted tools designed specifically for women in midlife. moving beyond the generic one-size-fits-all options on the market. Because this stage of life is not about slowing down. It's about adapting with better information, better strategies, and better support.

54:14Dr. Mary Claire Haver:If your body feels different, there is a reason. And there are also ways to feel stronger, more supported, and more like yourself again. Go to joinmidi.com, join M-I-D-I dot com, and connect with one of their clinicians today.

54:38Dr. Mary Claire Haver:so how do you properly assess someone for adhd especially during perimenopause which is you know all my listeners yeah and their husbands and their loved ones and their partners and all of them no one's easy right no one is just like a cut and dry it's not cookie cutter right it is so So nuanced. It's so nuanced. And so you really have to, in the midst of all of this perimenopausal and menopausal chaos, you can't just look right in a vacuum right at this moment in time because you're not going to get a clear answer. You have to look at longitudinal symptoms. You have to look at historically how have things been.

55:13You have to look at symptoms over time. You have to look at patterns. Especially for women, you need to ask questions about masking and overcompensating because those aren't in the DSM, but that's what's going to get missed. And so you have to peel things apart. You also have to ask those exclusionary things like asking about underlying medical stuff, asking about behavioral stuff like, is this is this a sleep deficit? Is this a you know, you ask all those other things. So it's complicated. Okay, that's fair.

55:42Dr. Mary Claire Haver:So what is you know, just for our listeners who are toying with this? What is the treatment? I know. I know. So my answer to that is, number one, it's so personalized on the person. Like, I don't really have a treatment algorithm I go down every time because it really, truly does depend on that person. And it's just a very complicated thing getting to that answer. when you are dealing with ADHD, there are two big things that you can do in terms of management. You manage behaviorally or you manage with medication. We can talk about the behavioral stuff, but if you're talking about medication, there are two big classes of medication.

56:19There is stimulants and non-stimulants. Stimulants you've heard of. There are the Adderall, the Ritalin, the Vyvanse, all of those things that we've heard of. But non-stimulants are typically, they work in a slightly different mechanism. Okay, what are they? I love them. What are they? I love them. They're different types of antidepressants. They're blood pressure medications. They're just alternative medications that treat ADHD. But let me tell you why this is the hill I'm willing to die on. And this is coming from someone who has taken these medications, right? So I'm in this unique opportunity where I have been both a patient and a provider in this space.

56:57I feel like a stimulant. There was a WashU study that came out at the end of last year, end of 2025. I was talking about, and it's egregious that we didn't know this before, like how do stimulants actually work? Stimulants actually work by working on two areas of the brain. Number one is alertness, and number two is goal-directed behavior. So they get rid of sleepiness cues, and they push you towards things that you're supposed to do. Great. Non-stimulants can potentially do some of that, and some of them don't work to actually, you know, help with sleepiness and work in different mechanisms. But the big difference is that you can't stimulate a person 24 hours a day.

57:37Their heart will explode. Like, that's not going to happen. You need, you can get, even with the long-acting four to six hours of relief, non-stimulants will give you 24 hours of relief. And so to me, and I've had patients who have done both, and I have a lot of patients that want to come back to the non-stamulants because the way that I phrase it is I would rather instead, like with short acting, get two-ish, three-ish hours. I would trade having my two hours of 100 % coverage and really get 24 hours of 80 % coverage. That's where I want to be. So I just want my functional baseline to improve significantly.

58:21And that's not controlled. They're not usually. They are dual agents. Like, for example, they will give you an underlying scaffolding to help with anxiety and depression at the same time, depending on the ones. Some of them help with sleep. Some of them help with blood pressure. So depending on what you want, you can get a more comprehensive solution with those. I love them. I don't know why people don't scream about them more.

58:47Dr. Mary Claire Haver:So women, I've had patients come in who were on stimulants for ADHD and say that their medication stopped working. Yes. What do we do for them? Well, it kind of depends. About the dose. It depends. It depends. So here's the deal. That is a very real phenomenon, right? Because as that estrogen is dropping, your dopamine is dropping and the effectiveness of the medication is, number one, working harder and might not be able to get there. And so, yes, there are some cases where you do have to increase the medication. There's some cases where you have to change the formulation of the medication. Maybe it's just that you need a longer coverage.

59:26This is not working. You need this. Yeah. Maybe sometimes you need to do things where it's like you're changing how you dose the medication instead of like I was taking it once in the morning. OK, maybe you can take the same dose, but now you just need to take it like break it up into three doses so that you can kind of get those little bumps so that you're not kind of falling flat and getting into these valleys. So it really depends on what is happening. But there are cases where you do have to increase the medication for sure. Dr.

59:57Dr. Mary Claire Haver:Hamdani's new book, Tube Sensitive, is available for pre-order now and comes out August 25th, wherever you buy books. You can find her on Instagram, TikTok, and YouTube at thepsychdoctormd. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepawselife.com. My new book, The New Perimenopause, is available now everywhere and anywhere you buy books and through our website. If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode.

1:00:36Dr. Mary Claire Haver:While you're there, leave us a review and be sure to share the show with the women you love. We would be so grateful. You can also find full episodes on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with Pod People. This episode was sponsored by MidiHealth, the first virtual clinic created for women by women for the treatment of menopause. Don't let anyone tell you menopause is something you have to suffer through alone. Midi can help. Visit joinmidi.com to learn more. This is the sound of captivity. This is the sound of rescue. And this is the sound of freedom. Give Armenia's captive bears a second chance by supporting International Animal Rescue.

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