Doctor (25 years experience): ADHD Women Need To Stop Doing THIS | Dr Helen Wall

1. 0:00 – 1:38

   Trailer

   1. HWDr. Helen Wall0:00

      Women with ADHD are definitely not coming in begging for an ADHD diagnosis. She wants answers. She wants validation of how she's feeling and why she's feeling that way. That's very, very different to wanting a diagnosis of ADHD.

   2. APAlex Partridge0:12

      Dr Helen Wall has over 25 years experience in improving the lives of women with ADHD.

   3. HWDr. Helen Wall0:17

      As an ADHD specialist-

   4. APAlex Partridge0:19

      She's dedicated to helping women with ADHD-

   5. HWDr. Helen Wall0:22

      Who are coping with menopause. With women with ADHD, there's a high degree of emotional regulation differences. We don't talk enough about the effect of hormones on our brains, on our chemical messengers. We talk about our periods, about fertility, reproduction. We need to get into the nitty-gritty of what this actually does to our brains.

   6. APAlex Partridge0:41

      Just how bad can it get for ADHD women as they approach menopause?

   7. HWDr. Helen Wall0:45

      I can't even get the words out to tell you how bad this can get because-

   8. APAlex Partridge0:49

      Huge announcement just before we start. Tickets to the ADHD Chatter podcast live theater show are selling fast. I'll be joined on stage by three leading psychiatrists, and we'll be unpacking all things ADHD, how to process a late diagnosis, AuDHD, and of course, the dreaded Rejection Sensitivity Dysphoria. I really hope you can join me for a night full of validation, laughs, and insights, and one that will remind you that you're not broken, just different, and that you have always been enough. It's on the 19th of May in London. You can find a link to the tickets in the description. I can't wait to meet you in person. Helen, welcome.

   9. HWDr. Helen Wall1:29

      Hello. Thank you for having me.

   10. APAlex Partridge1:31

       You've been a doctor for 20 years, and you've recently authored this amazing book, Menopause and

2. 1:38 – 3:17

   The struggles of female ADHD

   1. APAlex Partridge1:38

      ADHD. During your fascinating career, what have you learned about the trials and tribulations of ADHD, specifically in women?

   2. HWDr. Helen Wall1:48

      I think ADHD has so many positive traits to it. People with ADHD are some of the most emotionally intuitive, creative, driven people I'm, you know, I've had the pleasure of meeting. I think the difficulty, particularly for women, is how we define it in society and clinically and medically as well. It really saddens me that I still have colleagues who truly believe, and this is medical professionals, that ADHD is all about being hyperactive. You know, that, that image of a boy chucking a chair around the classroom, not able to sit down and learn. Um, you know, as they get older, having addictions, being in trouble with the police, all of these sort of stereotypes, and they're being transferred to women and girls, and therefore women and girls are being missed. So I think the biggest travesty for me in this is not that, you know, women have ADHD because actually that's not... That shouldn't be a, a barrier to, to anything. We make it a barrier because we're, we're diagnosing women late. We're missing them. We're mislabeling them, which is even worse. We're, we're diagnosing them with anxiety, stress, depression, uh, medically sort of unexplained symptoms, um, and we're not getting to the nub of the problem, and that's what we need to start doing really. And I think if we can do that, we can open up a whole world of opportunities for girls and women with ADHD.

   3. APAlex Partridge3:14

      Mm. Wow. Yeah, I couldn't agree more. And I mean, it is heartbreaking,

3. 3:17 – 14:13

   The toll of undiagnosed ADHD

   1. APAlex Partridge3:17

      right? And what, what do you think the, the, the toll is or the, the knock-on effects to a, a woman's mental health when they are labeled incorrectly for so much of their life?

   2. HWDr. Helen Wall3:27

      It's huge. It's absolutely huge, and this is what happens when I see women in perimenopause or menopause. We're not just identifying that they've got ADHD at that point in time. We're opening up a whole can of worms about what's gone before, all the missed opportunities, all the, um, misinterpretations, the mislabeling. Um, m- many women are carrying that with them when they come into my room with perimenopause and, and it becomes evident that there's something else going on here. And I think what we are not very good at in medicine is thinking, well, okay, this lady sh- this lady may have anxiety, burnout, depression. I'm not saying the two can't coexist, but I think perhaps what we're not good at in women particularly is looking at what's the thread running through this, what's driving this. And if you spend your life chronically having to mask, which a lot of these women have done, um, overcompensate, overprepare, try and, you know, copy, copy facial expressions, you know, practice, rehearse, and, and pa-- these are all things that patients have told me they've done and women have told me they've done. Um, for, you know... I had a, I had a lady, a patient, who told me that she would-- had a really great high-flying career. On the surface of it, she was just absolutely smashing life, and she was smashing life. That, they can't take that away from her. But she said that every night, like, it's a... She said, "Every night when I go home, I have to look what meetings I've got tomorrow, what I'm supposed to be doing, and I can spend three to four hours of my evening preparing for the day after." And she did that every single night. Now, that might seem like, well, that's not a cost. You know, that, that's what you have to do. But actually, the cost of that to her was huge because it meant she didn't... She hadn't had a relationship for 10 years. You know, she, she had- didn't have children, and she wanted children. She rarely went out with her friends and engaged with them because she just had to put so much effort into the thing that she was doing to focus and to get by and to, and to be, um, exactly what, you know, what everybody expected of her in this role. Um, and I think that's what we miss with women. We miss the hidden costs. So when, for example, you know, my colleagues say, "Oh, well, that lady can't have, uh, ADHD 'cause she's been to university, she's got a good job, she's never been in trouble with the police," and I've heard all of these things said, the frustrating bit is, the g- next question should be is, but what was the cost of that to that woman? You know, what was the hidden cost? And there are always hidden costs when women have been mislabeled, misdismissed, and misdiagnosed with neurodivergence until late on in life, and that's what we see unravel then when the hormones go into flux in perimenopause and, you know, we-- they just can't keep up anymore and keep that mask up.

   3. APAlex Partridge6:13

      Wow, it's powerful. I'm thinking of so many women that I've spoken to since starting this podcast who have described exactly what you've just said. And it's, it's, it's the internal frustration of how people perceive them and the words that they use is high-functioning-

   4. HWDr. Helen Wall6:31

      Yes

   5. APAlex Partridge6:31

      ... when behind the scenes they're crumbling, and they, they almost wish that it was more transparent, the, the difference between how the world perceived them sometimes, perhaps at work when they were handing in that assignment on time and-

   6. HWDr. Helen Wall6:43

      Yes

   7. APAlex Partridge6:43

      ... it was being rewarded, and yet at home it was catastrophic sometimes, rows with the partner, getting home and just bursting into tears.

   8. HWDr. Helen Wall6:51

      Yeah, complete meltdown. And this happens all the time. I see parents who will say to me, "You know, I, I think my child, my daughter, has ADHD." You know, often they've got a parent or a sibling and they, they recognize it. They know-

   9. APAlex Partridge7:02

      Mm

   10. HWDr. Helen Wall7:02

       ... they know something's not right. And unfortunately now, and I think this is the same for the whole country, but certainly where I work, we can't refer a child for an ADHD assessment. We have to signpost the parents to go back to the school and ask the school to get, um, s- uh, educational psychology, et cetera, involved. And, um, what the school will... N- I can almost guarantee 99% of the time with a girl whose parents think she has ADHD, the school will come back and say, "Oh, but they're no trouble at school. They, you know, they're perfect child. They are a pleasure to have in class." Um, and, you know, the parents say, "Well, yes," and then they get home and there's complete meltdown, complete overwhelm, and it's like having two different children. That child is likely masking at school because that's what girls are conditioned to do from an early age, to fit in with societal norms and to fit in with what, um, we expect of girls. You know, where I've got boys, I, I've got three children, I've got boys and, and two boys and a girl, and I'm guilty of this. You know, I know all this, and I'm still guilty of it. I expected my daughter, when I went to an appointment at the doctor's or whatever, to sit and color quietly and not disturb anything. Equally, when I had my son and he was climbing around the waiting room and, you know, coloring on things he shouldn't be and all the rest of it, obviously, I, uh, obviously, that wasn't great, but I thought, "Well, he's a boy. That's what boys do." And so we un- we, we sort of, we condition girls, and we do it unconsciously. I, you know, we all do it unconsciously, I think. Um, and that's how girls grow up, and then they become adolescents who then sort of start to question themselves and, "Why am I struggling? What's different?" Uh, and that has a real sort of burden on self-esteem and, you know, that's the time when you're meeting your peers and trying to find your place in, in, in society and who you are and what you are, um, and you've got all the hormones then changing as well in puberty. So yeah, it's really, it's really tricky, I think, for girls and women to be seen in this, in this area.

   11. APAlex Partridge9:10

       The thing that's driving the girl in the classroom to put on this character that doesn't cause any trouble, doesn't upset anyone, and the woman that that girl becomes, and therefore they want to put on this perfect version, they'll do... they'll stay up all night, they'll put four more hours into that piece of work. Is that the same strive for perfection that's running through both stages of their life?

   12. HWDr. Helen Wall9:39

       Yeah, I think it is, and I'm not sure whether it's a drive for perfection. Like, I don't think it's a conscious thing. I don't... This is my own opinion. Uh, I don't th- I don't necessarily think it's a conscious thing. I think it's just sort of almost like that people-pleasing fear of wanting to fit in, whether that's conscious or unconscious, and I often see that as a, as a theme with women with ADHD. They're very self-critical, lots of, um, self-blame. Uh, you know, there's at no point have I met one of these women and they've said, "Well, this is, you know, because this happened or that happened, or because I- I've got a brain that's wired differently." It's very much like, "This is my fault." It's their own moral failings, and that's really s- that really strikes me with the women that I meet, uh, who get to perimenopause with late diagnosis. Um, and I just think we as society just enable this, and we are perpetuating enabling it by not standing up and saying, "Actually, you know, girls and women do have ADHD." And the difficulty is because they mask so well, they often are hidden if you don't look for it. You have to look for it. And, um, we, you know, the diagnostic criteria are exactly the same for boys and girls to be diagnosed, but we have clinical bias, I think, and, and clinically, we are looking for hyperactivity in ADHD. Um, we're not looking f- and it's the, uh, it's the external hyperactivity, you know, the, the restlessness, the chucking things, the not being able to ... climbing on everything, not being able to sit still as a child. The... With girls and women, it's often very much internal hyperactivity. Uh, it's about, you know, that rest- internal restlessness, the noise, the, the voice that's continually running the script. You can't rest, you can't switch off, um, and that inability to focus and really sort of task, um, progress, et cetera. So yeah, I think, um, we just need to get better at recognizing, uh, first accepting that it happens in girls and women, and, and secondly, recognizing that, uh, you know, what it looks like.

   13. APAlex Partridge11:44

       And when a woman comes to see you, Helen, perhaps she tells her story of being mislabeled or misdiagnosed in the past, you must see that a lot. And how does that make you feel?

   14. HWDr. Helen Wall11:54

       Oh, I get really angry. [laughs] Really angry.

   15. APAlex Partridge11:58

       [laughs]

   16. HWDr. Helen Wall11:59

       Um, and I've not quite figured out why. I don't know why it makes me so angry. I think women are generally very underserved in, in medicine anyway, you know. I can't believe some of the things that I hear in 2026. Um, and one of the things that really riles me up is the fact that in 2026We barely talk about the fact that our female hormones impact our brains. You know, we, we... I was at medical school 25 years ago. We, we weren't taught that estrogen and progesterone impacts a woman's brain. In any woman, whether she's neurodivergent or neurotypical, that is a fact. Um, because the studies have been so late being done, and it's only really been the last few years that studies have started to look at this. Um, and, you know, I went to a conference, I do some speaking, just education speaking, and there was about 100 clinicians in that room. There were pharmacists, there were doctors, there were nurses from, from primary care, and I started by asking them, "Have any of you in this, in this room, when you did your training at medical school or nursing school, when you did your specialist training or, or ever since, post-grad or whatever, have you ever been taught about the effects of women's hormones on, on women's brains?" And it was like tumbleweed. Not one person put their hand up. Everybody looks at each other. They looked at me. They looked at my screen, which wasn't doing anything.

   17. APAlex Partridge13:22

       [laughs]

   18. HWDr. Helen Wall13:22

       They looked at the ceiling. [laughs] And they were like, "Where is she going with this?" And I just thought, "Oh, my God, we're actually screwed." Like, we... This needs to change. Like, we can't... And, and that made me so angry. Not tha- not at them, 'cause that's not their fault, but it, the system is not designed for women. Or, and it's... And the, what we do have is designed for 1950s housewives, effectively, who were staying at home and just have to sort of worry about what they're putting on for tea and what the kids are doing. We are functioning effectively as men now. We're in the same jobs, the same roles, leadership positions, running businesses, um, doing everything else at home, looking after the kids. You know, we need our brains to be functioning, um, and, and, you know, 100%. And there's so many reasons why that doesn't happen, and as medics, we just don't talk about it. That's bonkers.

4. 14:13 – 16:38

   Do ADHD women deserve an apology

   1. APAlex Partridge14:13

      Do you think ADHD women deserve an apology from the medical community?

   2. HWDr. Helen Wall14:18

      Yeah, I do. And I do say to, um, women that I see, "You know, I'm sorry. I'm sorry you've had to, to get to this point." I'll hold my hands up. I'm not by no means perfect. I've been a GP in the same practice for 17 years, and I've seen some women most of that 17 years through all different stages of their life. I've seen their children, I've seen their, their husbands, their families, and that's what I love about general practice. But one of the, one of the downsides of that is when you screw up, you know you've screwed up because you're still there. You know, you're not somebody who's seen someone in the clinic and never see them again. I get to see my mistakes, and I've seen, I've seen mistakes that I've made. You know, I've, um, I've seen women who I've treated for anxiety, depression. They've kept coming back. They're in crisis. They're struggling at work. Their relationships are failing. And I'm, as I'm talking, I'm, I'm thinking of these women. I can see their faces right now. And, um, they've... I, I've not known why. You know, I've been totally, totally oblivious to why. Why is this person not getting better? Why can they not just, you know, get on with, with this or that? Um, and at least three of the women that I'm thinking of I've seen recently in perimenopause because they've come for menopause support. And I've suddenly realized, you know, at that point, when things have got so much worse and, and their executive function has unraveled because the hormones are all in flux, I've realized, oh, my God, like, you've a- you've, you're probably ADHD. This is, this was the thread that was running right through this all along, and I didn't see it. And once you've seen it, you can't unsee it. Um, and, and I've said to... I, I've, you know, I've said to them, "I'm so sorry." Like, "I feel like I've failed you." But we just haven't been in that space. Like, I haven't been in that space in my mind. And my journey started when my daughter, uh, when it became evident that my daughter had ADHD, and she was assessed and diagnosed. And then it switches you, it switches you on to what those, what those features are and what you c- you know, you see it. You, you see it in people, whereas before I didn't see it. And I think, you know, that's the problem, that we're just not seeing it. It's there in plain sight, but we're not seeing the thread that's running through these life stories.

5. 16:38 – 19:45

   Most memorable diagnosis reactions

   1. APAlex Partridge16:39

      What reactions have you witnessed when you have revealed to your patient that perhaps it is ADHD after all?

   2. HWDr. Helen Wall16:46

      I'll be honest, most of it's relief. A huge amount of relief initially. Um, sometimes there's a bit of, you know, questioning, like denial really. I d- I... You know, 'cause obviously women have been, um... It's not just clinicians that have been told for years that ADHD only affects boys and, and men. It's women as well. So, you know, there's a lot in the press, there has been a lot in the press recently about, you know, GPs are over-diagnosing ADHD. Well, for a start, GPs don't diagnose ADHD. We have to refer them on for a, a, you know, a very, very thorough assessment, which takes years in some places to get. Um, but I would honestly say a lot of the women I see, they just don't know what's going on. Their brains are so... That, that, you know, their executive function's gone, their emotional regulation's all over the place, and they don't all come in going, "I think I've got ADHD. I want a diagnosis of ADHD," which is what you would believe if you read some of the, the media articles or listened to some of the media outlets. Um, some of it is just absolute burnout and complete exhaustion, and I don't want anyone to think that I am looking for people with ADHD and I am, you know, encouraging people to have ADHD. I think, as I said, it's just when you've seen it, it's hard to unsee it. And, um, one of the criticisms, one of the biggest criticisms that I get from colleagues is, you know, everybody with perimenopause, women with perimenopause and menopause, they're bound to have some features of ADHD. You know, they're bound to have brain fog. They're bound, bound to have trouble with focus, trouble with switching off, anxiety, et cetera, because that's what happens in perimenopause or menopause. Yes, they do. Absolutely, and I, I'm not saying that's the, that's not the case.But these women have had things right through their life, going back to childhood. They're not gonna get a diagnosis of ADHD just because they woke up one day in perimenopause and suddenly they couldn't function. This goes back and back, but what nobody has seen it because of the masking. The woman herself often hasn't seen it because she's masked. She's kind of... I think most women I've spoken to about this kind of have known there's something not quite right. They've known that things have been a challenge. Perhaps things have been a bit more difficult for them than, than their peers, but they've never been able to put their finger on it. Um, and then, you know, they get to perimenopause, and the, the sheer volume of hormonal change of- is the thing that tips the balance into this realization that something's going on here. Um, but I think, you know, women are not-- women are definitely not coming in begging for an ADHD diagnosis. I, I really d- refute that, and I would honestly say that I've never met a woman who wants an ADHD diagnosis. She wants answers. She wants validation of how she's feeling and why she's feeling that way. That's very, very different to wanting a diagnosis of ADHD.

6. 19:45 – 21:06

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   1. APAlex Partridge19:45

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7. 21:06 – 25:11

   The truth about hormones and ADHD

   1. APAlex Partridge21:06

      Do you think the hormone changes and fluctuations that women go through, do you think generally that creates a lived experience that means ADHD is harder for women than it is for men?

   2. HWDr. Helen Wall21:18

      Yeah. I think there's a few things that make it... I mean, it's not a competition, is it? You know, it's, it's hard. ADHD can be very, um... it can be great, but it can also be quite disabling for men and women, uh, you know, with, with certain challenges. I think the difficulty for women is, is the... one, the hormonal changes that we undergo, so puberty, pregnancy, postnatally, perimenopause, menopause, you know, huge shifts in our hormones can really impact how ADHD shows up. But then I think everything else for why it's difficult for women with ADHD is we can change. You know, we can't, we can't change the fact that our hormones flux all over. Yes, we can support them with, with medications w- and, and so on. Um, but we can change how society manages this and how we see it and how med- how medical, um, c- how the medical community sees it and manages it. That's what we can change. Um, and, and that... I think that's one of the biggest factors that makes it hard for women. You know, women with ADHD, if they were supported i, i- in a... you know, if they were in an evir- environment where their positive strengths were celebrated and embraced and, and, um, not challenged and shut down and they weren't effectively swimming against the tide, which everyone with ADHD kind of is, whether you're male or female, um, but probably a little bit more so 'cause of the lack of recognition for it in girls and women, um, that's what I think what makes it really hard.

   3. APAlex Partridge22:46

      Masking we've touched upon and, and, and we know that masking is, is a, is very common in men and women with ADHD. But do you think hormone changes, can it make masking trickier for women, depending o- where they are in their cycle?

   4. HWDr. Helen Wall23:01

      Yeah. I mean, it can even change from, you know, month to month, exactly that, with a, with a menstrual cycle. Um, we see the biggest changes, I think, in-- at times of significant hormonal flux, so, uh, as I've said, perimenopause, puberty, pregnancy. But even throughout a month, we know that, I think, the key to this is the chemical messengers in the brain, um, and we know that with ADHD, the brains are wired differently. The, the parts, some parts of the brain are, are different in volume, et cetera, and the, the chemical messengers signal differently. Um, so estrogen really supports dopamine signaling. We really need estrogen to be sta- enough estrogen and for it to be stable to have perfect dopamine signaling, and dopamine's responsible for our motivation, our reward, our focus. Um, so even throughout one month where estrogen is rising and falling as it does in a normal cycle for a woman, um, when the estrogen is higher, that can mean that she might feel more focused, more, um, able to get on with things because, um, of this effect on the dopamine signaling and to some extent the serotonin signaling as well, so, uh, which helps with emotional regulation. That's something we've not touched upon, but actually, you know, with women there's a high... I think there's a high degree of emotional regulation dif- differences with women with ADHD, um, and that's been shown in some of the neurobiological studies in terms of, again, the chemical messaging within the brain and the effect of hormones on that.And I don't think we give that enough credit. And, and that happens, you know, throughout a month that might happen to every woman. You know, she might feel better at the start and the, the middle of her cycle and then worse towards sort of the end. But if you've got, um, ADHD, that's likely to be, in some women, much more significant, uh, change. So I think, yeah, we don't, um, we ... This all goes back to my former point that we don't talk enough about the effect of hormones on our brains, on our chemical messengers. We talk about them, you know, about our periods, about fertility, reproduction. Um, we need to get into the nitty-gritty of what this actually does to our brains.

8. 25:11 – 34:05

   The truth about ADHD and the menopause

   1. APAlex Partridge25:11

      How big of an event is the menopause? And what do I mean by that? Is it possible that a woman could almost self-calibrate how she manages her ADHD with consideration of her own knowledge of how her mood and everything changes throughout the month and then the menopause comes, there's such a drastic change in the hormones, all of her scaffolding-

   2. HWDr. Helen Wall25:32

      Yeah

   3. APAlex Partridge25:32

      ... falls away, and then she enters a crisis and goes for an assessment. Is that-

   4. HWDr. Helen Wall25:38

      Yes

   5. APAlex Partridge25:38

      ... quite a common-

   6. HWDr. Helen Wall25:39

      Absolutely, yeah

   7. APAlex Partridge25:39

      ... routine?

   8. HWDr. Helen Wall25:40

      Yeah. And I think what we have to remember is when a woman's about to hit perimenopause or menopause, which is generally in her 40s, um, give or take, often they've got so many other things going on at that point in life as well. They've often got teenage children who are also going through hormonal changes, who are likely going through, um, assessments for neurodivergence. That's one of the key points we see women, uh, have a light bulb moment. Um, you know, there's all sorts of things going on. Often a career, might be at the peak of her career or having career changes, you know, questioning what she's doing with her life, relationship changes, et cetera. So there's a huge amount of things going on for a woman when she hits that period of her life. Um, and then, you know, throw into that ADHD and the chemical messenger changes that are happening driven by the hormones. Um, I guess in, in terms of, you know, can a woman manage that herself if she's aware of it? Absolutely. Um, but that goes back to the first point that she has to be aware of it.

   9. APAlex Partridge26:36

      Mm.

   10. HWDr. Helen Wall26:36

       And because we're not talking about this, we're not talking about the effects of hormones on our brains, neither in the medical community or really in, in general, you know, female, girl, in fact, women environments, um, then we're just not spreading that awareness, and that's what we need to do. I'm very, you know, I'm very give or take medication for ADHD. Um, I think it's a very individual decision, individual choice. It's not for everyone. Um, but in my book, I talk a lot about things that you can do if you don't want to go down the medication route. Um, and a lot of it is about, you know, first of all, it's that validation of what's going on, it's understanding, a bit of self-compassion, and then sort of looking at your, um, you know, tr- if once you understand it, it becomes much easier to manage things, doesn't it? And, uh, yeah, that's what, that's what I think-

   11. APAlex Partridge27:28

       Mm

   12. HWDr. Helen Wall27:29

       ... uh, is helpful to women if we can give them that understanding. But in order to do that, our medical colleagues need to understand it first, which is, which is tricky because GPs do a bit of everything. You know, I'm rubbish at things like neurology. You know, if you come to see me with a neurological condition, you ain't gonna get much from me. Um, so every GP's got a l- a little bit of, uh, knowledge about everything, and often they've got a bit of a special interest-

   13. APAlex Partridge27:50

       Mm

   14. HWDr. Helen Wall27:50

       ... where they're very keen, and this is my special interest where I'm very keen. So, you know, it, it's easy for me to sit here and say GPs should not dismiss women. I know that, you know, I know the factors behind why and how that happens.

   15. APAlex Partridge28:05

       Just how bad can it get for ADHD women as they approach menopause? Uh, and I suppose, do you have any anecdotes or stories, anyone you know that might illustrate that point?

   16. HWDr. Helen Wall28:16

       I mean, it can get, it ... Yeah, I mean, I can't even, I can't even get the words out to tell you how bad this can get because I've, yeah, I've seen quite a few women now who are just in bits really. Um, we already know that perimenopause, menopause has a seven times increased suicide rate, so the, the peak point of time for women to commit suicide or attempt suicide is between the ages of 45 and 55, which again, we don't nearly highlight enough. Um, and then if you throw into that ADHD and unmasking and all the issues that we've talked about that come to the fore and, and the surface at this point in life, um, I've, you know, women, I've seen women really, really at the lowest point. Uh, I can think of a lady, uh, off the top of my head who, um, was, came in, you know, she, she'd, she'd basically given up her job, so she'd gone off sick, um, completely unable to sort of focus. Brain, brain was just fe- she described her brain as being like mush. Everything she'd ever done to try and to, to get on just no longer worked for her. Um, and she'd give ... She was on the sick. She then got sacked because she was on the sick for so long, they let her go. That started to affect her relationship. Um, she started to drink alcohol because she was at home all day and she was feeling really low and she needed that sort of something to lean on and, and sh- and she went to alcohol. Um, and, you know, she turned up just saying, "You know, my menopause is so bad. Like, why am I going through menopause? So bad. So bad." And when you actually started to talk to her, this wasn't just a menopause issue. You know, she'd had points in her life where things had unraveled for her several times before, after the birth of her first child, um, and subsequently second child, although she was more prepared for that, so she sort of put things, support around her to, to expect things to unravel a bit. Um, she'd gone from job to job. She'd never sort of really been able to, to focus. Um, she'd been described at school as pleasant but inconsistent, you know, d- daydreamer, and this is what I often hear women have been called daydreaming, ditzy, can't get on, lazy, et cetera. Um-And then, you know, she'd hit menopause and this had all unraveled and, and everything was in tatters for her, absolute tatters. And when we spoke about this, I saw her a couple of times, 'cause I didn't just go, "Oh, do you know, do you think you've got ADHD?" And, and I sort of started to gather a bit of information and I started to think, you know, this is... there's a pattern. Once you've, once you've seen it, you have... you develop a pattern recognition tool as a GP. And I, and I said to her, "You know, do you think this could be something else? Do you think, like, there could be some ADHD?" Um, and she was like, "You're not the first person that's said that to me, but I thought that was just for boys." So the women themselves don't often know what's going on. You know, they, they arrive in absolute tatters and they don't un- they think they're going mad, they think it's their fault, they're blaming themselves. They're blaming themselves that everything is gone, you know, they've not got a job, their relationship is in tatters. I mean, I, I've seen her a few times since, and she's not actually, she's on- she's still on the waiting list for a diagnosis, um, which is quite common in the NHS. [laughs] But what I would say is, I often say to women, you know, "If we think this is ADHD, you can still access resources, you can still access support. There's plenty of support groups that will help you. You don't have to go in there with a formal diagnosis. You can still look at things like resources online, um, tools. There's plenty of books for tips and tools of how to sort of externalize your brain, how to, how to manage, how to see things and understand yourself a bit better." And she started slowly but surely, she, she got a bit of that help with the alcohol, and then she started trying to, to, to do that. And she did sort of, j- she said to me, "Just you saying, 'Do you think this could be ADHD?'" She said, "I didn't believe it at the time, but when I went away and read it and spoke to my family and it all made sense, just that was enough to start me on the road to feeling like I could get round this." That was it. Like, she didn't need... She said, "I don't need... I'll stay on the waiting list, but I don't need medication. I don't need somebody else to tell me this, like, that it's therapy in itself that I've got some answers and I can start to work round this." And I thought, that's quite... That's key, isn't it? It's, it's just listening and being able to validate somebody's story.

   17. APAlex Partridge32:53

       So she came to you, this, this woman, in a point of real crisis, and the final piece of the acceptance puzzle was locked behind a gate of her belief-

   18. HWDr. Helen Wall33:01

       Mm-hmm

   19. APAlex Partridge33:01

       ... that only boys could have ADHD.

   20. HWDr. Helen Wall33:03

       Yeah.

   21. APAlex Partridge33:04

       How did that make you feel, hearing that?

   22. HWDr. Helen Wall33:06

       Well, again, it goes back, doesn't it, to this whole sort of societal... You know, it's 2026, for goodness' sake. It's 2026. Like, I'm constantly, like, just nothing... I always say nothing will surprise me anymore. But then I, I get really surprised [laughs] when things like that happen.

   23. APAlex Partridge33:24

       [laughs]

   24. HWDr. Helen Wall33:24

       It's like, how can this be? Um, but it's not her fault. This is what we tell, this is what we tell people. This is what we tell, um, women and girls. This is what is trotted out time and time again. If I've got colleagues, I've got GP colleagues who've said that very thing to me. How can we expect women to know what's going on here? Um, and it needs to change, and that's part of my sort of motivation, because I don't want my daughter, who is ADHD, I, I don't want her to get to her perimenopause, menopause, which is a long way off, hopefully, and end up in that position. You know, I don't want her to, to have to fight to be believed, fight to be heard.

9. 34:05 – 37:10

   A message of hope for ADHD women

   1. APAlex Partridge34:05

      What's the silver lining, Helen, for the many ADHD women who listen and watch this podcast who relate to what you're saying? Perhaps they have gone through menopause or they're approaching it. What's the silver lining, and how can you make them, help them see it?

   2. HWDr. Helen Wall34:19

      The silver lining is that having ADHD is not a failing or, you know, you're not broken. There's so many positive things to being, having ADHD. You know, m- and obviously we, we can generalize, but the w- the women that I meet with ADHD are often some of the most emotionally intelligent, intuitive, uh, creative women. You know, if you're in a crisis with a deadline-

   3. APAlex Partridge34:47

      Yes. [laughs]

   4. HWDr. Helen Wall34:47

      ... you want that woman with ADHD in your corner, you know? Nothing's gonna get done as quick [laughs] as that woman with ADHD fighting for you.

   5. APAlex Partridge34:56

      [laughs]

   6. HWDr. Helen Wall34:57

      Um, you know, if I ever have a crisis, I should be fine now, 'cause I've got lots of women with ADHD that would come in my corner, so, you know, I'm happy. Um, but you know, th- there's so many positives to it, but I think the difficulty is, as a society, we often talk about it as, as a deficit rather than a difference, and we need to celebrate it as a difference, um, and, and stop seeing it as a negative thing. And that comes from, you know, right from the very fact that we're being criticized for over-diagnosing it. There was a study done, uh, not so long ago, I think it was 9,000 GP records were analyzed, and the number of ADHD diagnoses in men and women was only, I think it was about .322%. So we are massively under-diagnosing it, probably 'cause everybody's sat on waiting lists waiting to be seen. But we're certainly... You know, we've got evidence we're not over-diagnosing it. We're just not seeing what's there in plain sight.

   7. APAlex Partridge35:50

      The last time I checked, there was roughly about 800,000 ADHD diagnosed people, men and women, in the UK.

   8. HWDr. Helen Wall35:57

      Mm-hmm.

   9. APAlex Partridge35:58

      And if we put the prevalence of ADHD at about 4.5%, that's what the World Health Organization puts it at, there is 2.5 million people in the UK with ADHD, and yet we've only diagnosed 800,000 of them.

   10. HWDr. Helen Wall36:10

       Yes, exactly. We're, we're massively under-diagnosing it, and I stand by that. That is a hill I will die on. We are under-diagnosing ADHD a million percent.

   11. APAlex Partridge36:22

       Women have been missed and let down for far too long, but what do you think women do need to hear for them to start their journey of self-compassion now?

   12. HWDr. Helen Wall36:32

       They need to be validated. They need to be seen and heard, listened to.And I think if women are not getting that from their clinician, I want, personally want women to know that they can go back again. You know, don't ... If you really think that something's not right, advocate for yourself. And that can be really hard to do, uh, if you're a, a woman whose brain is sort of really mushed and, and you're struggling and you're anxious. Um, but please find that strength to do that because it w- it can be life-changing, and I've seen it be life-changing.

10. 37:10 – 44:04

    Audience questions

    1. APAlex Partridge37:10

       Amazing. Thank you so much, Helen. We're gonna just close with some questions from the audience, and I've got three. And the washing machine of woes-

    2. HWDr. Helen Wall37:17

       [laughs]

    3. APAlex Partridge37:17

       ... which is-

    4. HWDr. Helen Wall37:20

       I thought I'd got away from washing machines today. [laughs]

    5. APAlex Partridge37:22

       I know. It's, it's, it's, it serves two purposes. It houses the questions, and also it's a public service announcement to remind the listeners to-

    6. HWDr. Helen Wall37:28

       Yeah

    7. APAlex Partridge37:29

       ... empty their washing machine.

    8. HWDr. Helen Wall37:29

       Yeah. [laughs]

    9. APAlex Partridge37:29

       'Cause that's my, my biggest ADHD woe is my memory. I always forget to empty the machine.

    10. HWDr. Helen Wall37:33

        Yeah, and then you have to put the cycle on again-

    11. APAlex Partridge37:34

        That's it. Yeah, yeah

    12. HWDr. Helen Wall37:35

        ... 'cause it's been in that long it needs a re-wash.

    13. APAlex Partridge37:37

        Good. Are you regular to it? Oh, good. That always makes me feel less alone when the guest relates to it.

    14. HWDr. Helen Wall37:40

        [laughs]

    15. APAlex Partridge37:40

        So we'll wait a few minutes for the audience to come back from washing th- emptying their machine.

    16. HWDr. Helen Wall37:43

        Yeah. Okay.

    17. APAlex Partridge37:44

        [laughs] The first question, Helen, from the audience this week is, "My ADHD is unpredictable as it is. What does menopause have in store for me?"

    18. HWDr. Helen Wall37:55

        Well, hopefully it won't be bad. You know, I think w- I think it's important that I say that, that not all women, uh, are going to have a horrific time in perimenopause and menopause, regardless of whether you're neurodivergent or neurotypical. But I suppose if, if you have got ADHD and it already is causing you problems, then, you know, you might want to be prepared for the fact that your hormones are gonna fluctuate, and when your hormones fluctuate, that can have an impact on your chemical messengers in your brain. Um, and you may start to feel like you're not quite as in control as you were, so that the scaffolding that we've already mentioned might start to wobble a bit. Um, and I think if you are aware of that and you can know what's happening and be prepared for it, um, that can be so much easier to deal with. Uh, most of the women I see who have really gone into, you know, catastrophic decline at this point, the hardest thing for them was not understanding what was going on and thinking that they were going mad, being told that there was nothing, you know, they were ... nothing to worry about, just get on with it. You're just going through menopause. You're just stressed. Um, so I think if you go into it with your eyes wide open, that can be really therapeutic.

    19. APAlex Partridge39:08

        Before your book, podcast, general awareness has obviously gone up massively.

    20. HWDr. Helen Wall39:13

        Yeah.

    21. APAlex Partridge39:14

        Previous generations of women who, who are going through this very natural process of menopause, what did they truly believe? D- was, did, was it quite easy to just assume that you were going crazy?

    22. HWDr. Helen Wall39:26

        I think it probably was. I mean, one of the, um ... I go into some workplaces doing some, uh, training of staff. Um, and one of the key things that I often hear is from older women who've been through menopause, who say, "In my day, we just got on with it, and it was none of this. This is rubbish." So some of the most diminishing statements can be from other women, you know. This is not all about men in, in menopause and perimon- menopause. Um, but I think when you actually drill that down and speak to some of those women, what does "we just got on with it" actually mean? Um, you know, they, they didn't really just get on with it, many of them. Some will have, like they, some, some will do now. Um, you know, they were very emotionally dysregulated. They were, um, having relationship problems. They were, um, you know, crying and emotional. Um, so I think the difference is they just didn't feel they ... They didn't have the language or the knowledge or the ability to speak up and ask for support, and we do now. You know, things change, fortunately, and, and women are getting that, um, that awareness. So I think that's a good thing, and I, and we can't just ... You know, just because things have changed and they're not like they were in the past doesn't make it wrong.

    23. APAlex Partridge40:40

        Do you think the, the women who were saying that they just got on with it, do you think, do you think to be stoic is just to be high masking?

    24. HWDr. Helen Wall40:51

        Quite possibly, yeah. I mean, I think, um, as women, often, you know, they do just get on because they've often got other people to look after. Um, I think, you know, I see that time and time again with women in my surgery when that's for any- anything that they come in with, you know. They'll often say, "Well, I can't ..." You know, I've had women say, "I can't go to hospital with my crushing chest pain 'cause I've gotta pick my child up from school or my grandchild up from school," you know. Uh, I mean, that's not just isolated to women. We see it in men as well. But very much there's always a thought for somebody else.

    25. APAlex Partridge41:21

        Mm-hmm.

    26. HWDr. Helen Wall41:21

        It's never just about themselves. There's always like, "Oh, well, I've got to do this. I've got to do that. Actually, I've got to do that." W- I think women are quite bad, um, at putting themselves first, most women. Um, and yeah, I think, yeah, absolutely, for some women who were neurodivergent in perimenopause, that is extremely high masking, isn't it, to say, "Oh, we just get on with it"?

    27. APAlex Partridge41:41

        The next question from the audience, Helen, is, "My daughter is approaching puberty and she has ADHD. What can she expect?"

    28. HWDr. Helen Wall41:50

        Yeah, puberty can be a bit of a hang on to your hat moment for any parent, can't it? And, um, the thing, as I've said, with girls is emotional regulation can really go a bit AWOL i- in puberty in any girl, but I think with, with an ADHD brain, that is more likely to happen. So I think, you know, it's, it's those shifts in, in emotions that can be quite hard to, to manage. And, and often adolescence is the time when things like RSD, so, you know, Rejection Sensitive Dysphoria can kick in. Um, just your sensitivity can be seen more floridly, things like that. So I, um ... Yeah, I think puberty's tricky, and I think what helped, what helped me with my daughter, who went very much like this in, in puberty, and that's sort of what led to us getting an assessment and diagnosis, was just understanding that it wasn't directed at me. You know, it wasn't, it wasn't us. It wasn't me and her dad that were the actual attack points. It was just the brain that was just sort of firing and, and couldn't, couldn't be controlled. And I think once we got our heads around that, we stopped taking it personally and just let ... just were there to support-

    29. APAlex Partridge42:59

        Mm

    30. HWDr. Helen Wall42:59

        ... and just sort of to hold the space really in that moment.
11. 44:04 – 44:29

    A letter to my younger self

    1. HWDr. Helen Wall44:04

       "To my younger self, you weren't too much. You were enough. You don't need to shave your edges off. Be yourself." I think that's perfect, isn't it?

    2. APAlex Partridge44:15

       Very nice tone to finish. Helen, on behalf of everyone listening, struggling to grapple to understand how hormones and menopause affect their brains, thank you so much.

    3. HWDr. Helen Wall44:26

       Thank you. [outro music]

Episode duration: 44:30