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ADHD Chatter PodcastADHD Chatter Podcast

How Hormones and Menopause Impact ADHD Women | Dr. Louise Newson

Dr. Louise Newson is a physician, menopause specialist and member of the UK Government’s Menopause Taskforce.

Dr. Louise NewsonguestAlex Partridgehost
Apr 7, 20251h 4mWatch on YouTube

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Transcript

  1. 0:00 – 2:39

    Trailer

    1. LN

      We see so many women who are neurodivergent and get worse during perimenopause and menopause, and a lot of people, like, hyper fixate, they get quite obsessive. They can ruminate, they can worry, they can think a lot more. And the reason I'm so confident that a lot of it's related to hormones is 'cause I see people improve. You know, they-- I don't do anything else to them other than rebalance their hormones, and they're like, "Wow, I feel like my brain's been freed." Dr. Louise Newson is an award-winning physician

    2. AP

      Sunday Times best-selling author and leading menopause specialist Today, she speaks about her one mission Spreading awareness of women's ADHD Hormones and the negative impact they can have on menopause and perimenopause

    3. LN

      Menopause, many people think it's just a few flushes and sweats. Actually, the main symptoms affecting people during menopause, but also perimenopause when levels are really fluctuating and changing, are symptoms affecting the brain. So a lot of people find they have brain fog, they have poor memory, reduced concentration, irritability, might have poor sleep. They get these symptoms and then their period comes and they feel fine again. And then the second half of their cycle, they find it harder to concentrate, harder to do things. And if they've got ADHD, they often find that their symptoms worsen. We find that when women have the right dose of hormones, especially testosterone actually, then a lot of their ADHD symptoms really improve.

    4. AP

      A woman gets a diagnosis of ADHD and they're reading they need to exercise more-

    5. LN

      Mm

    6. AP

      ... to combat the executive function challenges. You're saying they sh- should consider other options first, and what might those be?

    7. LN

      Often if I think symptoms are related to hormones, then I'll always-

    8. AP

      Loyal listeners and viewers, I can't thank you enough for tuning in. If you've ever felt broken or different, I hope this helps in your search for answers and community. And do you know what would really help me in return? By clicking the follow or subscribe button wherever you're listening. It might not seem like much, but at ADHD Chatter, it means a huge deal. And with this, I can book more incredible guests and keep the self-discovery fire alive for all of us, myself included. Just one click of a button goes really far. And remember, you have always been enough. This episode is dedicated to any late diagnosed neurodivergent women who were made to feel crazy by a medical doctor, but always knew that their hormones were responsible all along. [upbeat music] Dr. Louise Newson, what an absolute honor to have you grace the ADHD Chatter studio.

    9. LN

      Ah, well, I'm delighted to be here. Feels great. Feels very comfortable.

    10. AP

      [laughs] I say, how comfy are they?

    11. LN

      Yeah.

    12. AP

      Really comfy.

    13. LN

      Really nice.

    14. AP

      Try and not-- yeah, the, the risk of falling asleep is-

    15. LN

      Yeah

    16. AP

      ... is there, but no, thank you so much. I want to start with a bit of a, a blunt question, I suppose, and that's

  2. 2:39 – 6:21

    What will the audience learn in this episode

    1. AP

      why should somebody watching or listening stick around for the next fifty minutes or so? What can you teach them, and how is that gonna help them?

    2. LN

      I want them to think differently about hormones and how they affect the brain. 'Cause a lot of people don't even know what hormones are, or what-- if they do, they think about periods, and I'm not really wanting to talk about periods other than how s- hormones change with the cycle. But I want to be thinking about how hormones work in the brain and how they can affect our brain function in ways that people probably haven't thought about before.

    3. AP

      Okay. What is an example of a way that they could affect the brain that the, the sort of layman might not have thought about before?

    4. LN

      So the hormones really that I'm talking about are estrogen-

    5. AP

      Mm

    6. LN

      ... but a good form of estrogen called estradiol, progesterone, and testosterone, and they are made in the female brain and the male brain. So they are actually made in the brain. Whereas if you-- most people, even lots of doctors will say, "Well, they're just made in the ovaries," but they're not. So they're neurosteroids. They affect the way the brain work, and that's really important because they work with other chemicals in the brain, other hormones in the brain, other neurotransmitters. And once you understand the science of how hormones work when we don't have them, i.e., we're menopausal-

    7. AP

      Mm

    8. LN

      ... or they're fluctuating, i.e., we're perimenopausal, or they're dropping very quickly just before periods, then you can easily join the dots and think, "Ah, that makes sense."

    9. AP

      Right. Okay. And you're obviously a, a menopause specialist. What-

    10. LN

      Yeah

    11. AP

      ... so, uh, what does a specialist such as yourself know more about someone who is just aware of menopause? Like, what, what makes you a specialist?

    12. LN

      Well, mainly because I see so many people. I've got a huge amount of clinical experience and knowledge, and I've sort of dedicated my career really thinking about menopause, but it's extended more actually to thinking more about hormones. But I've got quite an unusual career in that a lot of menopause specialists are gynecologists. I have nothing against gynecologists, but I'm not a gynecologist. I'm a general physician, but I've also got a pathology degree as well, so I'm very interested in the study of disease. Um, and if you know why the body works, it helps you understand what diseases occur and why they occur, so at a sort of cellular, molecular level. Um, and then I've done a lot of hospital medicine in lots of specialties, and then I was a GP for twenty-five years, but also a medical writer. So I've written a lot of evidence-based medicine. I've written four books on evidence-based medicine, so I'm quite geeky and scientific as well.

    13. AP

      [laughs]

    14. LN

      But I'm also, well, I'd like to think a good doctor in that, you know, my patients are central to everything that I do. Very different. When I qualified in '94, it was very much you gave that green piece of paper, you know, the prescription that they used to give.

    15. AP

      Mm-hmm.

    16. LN

      You'd literally give it to a patient, ask no questions, off they go. They would take the medication or not, I suppose. But it w- there's nothing in context of how does the patient feel? What are they experiencing? Why might they be feeling like this? And so now it's so different, thankfully. So I'm very patient centered in the way that I practice medicine, but with evidence base as well.

    17. AP

      Right. Okay. Quite clearly a specialist. [laughs]

    18. LN

      Yeah.

    19. AP

      So the, obviously I was fascinated to, to chat to you about the, the, the link here between menopause hormones-

    20. LN

      Mm

    21. AP

      ... and ADHD.

    22. LN

      Mm.

  3. 6:21 – 13:30

    How hormones influence ADHD traits

    1. AP

      Um, just from a human level, having a hormone cycle-

    2. LN

      Mm

    3. AP

      ... how does that impact how one's ADHD might show up?

    4. LN

      Yeah. Hugely, actually. And it's interesting, 'cause if I'd had this conversation with you 10 years ago, I probably would've gone, "Oh, I don't know that it does have an effect," but it, it definitely does, thinking about how the hormones work. And when our hormones fluctuate or change, it affects so many cell processes. But when I see people in the clinic, they maybe have been diagnosed with ADHD, or they think they've got ADHD, but often it's got a lot worse. And menopause, many people think it's just a few flushes and sweats, something that people just get through, whereas actually the main symptoms affecting people during menopause, but also perimenopause when levels are really fluctuating and changing, are symptoms affecting the brain. So a lot of people find they have brain fog, they have poor memory, reduced concentration, irritability, they might have poor sleep. Um, they often have low mood, anxiety. So all of those things are indicating that the brain isn't working properly-

    5. AP

      Mm

    6. LN

      ... if you see what I mean. And then a lot of people say that they get these symptoms, and then their period comes and they feel fine again. And then the second half of their cycle, they find it harder to concentrate, harder to do things. Um, and if they've got ADHD, they often find that their symptoms worsen, and then they improve, and there's a sort of cyclical nature. And during perimenopause, hormones are all over the place, so it can really make an effect. Um, and I prescribe hormones to rebalance the hormones because it's, we know that when people have the right dose and type of hormones, it does two things. It improves symptoms, but it improves future health. And increasingly in the clinic, we find that when women have the right dose of hormones, especially testosterone actually, um, then a lot of their ADHD symptoms really improve. They find it a lot easier to process. They're a lot clearer in their mind. They can think better. Um, and you know, in medicine, a lot of it is pattern recognition. You know, you see-

    7. AP

      Mm

    8. LN

      ... and, and then you think actually, "Wow, why is that working? How is that happening?" And then you look at how these hormones work in the brain, and you think, "Well, it's, it's, you know... It all makes sense."

    9. AP

      Mm.

    10. LN

      But it's just been ignored really because a lot of psychiatrists, as you know, deal with ADHD. Gynecologists tend to deal with menopause-

    11. AP

      Mm

    12. LN

      ... or period problems, so there's like no connection. And then, you know, I see so many women who have been given amphetamine-type drugs, but their symptoms have started in their 40s when they've been getting other symptoms. And yeah, it's just like, I just think, "Why are we not looking at the bigger picture and saying, 'What, what's going on?'"

    13. AP

      Mm.

    14. LN

      "What are the changes going on in the brain?" And treat those first, really.

    15. AP

      So d- do you think it is a bit of a travesty that the, the, the conversation of hormones isn't even mentioned when a woman is going for an ADHD assessment?

    16. LN

      Yeah, it's an absolute disaster. I was doing some training of some psychiatrists. Um, I won't mention which clinic, but it's a clinic that the NHS have commissioned, um, because obviously ADHD services are so stretched in the NHS. So I was training, it was about 150 psychiatrists on the call, and I love teaching psychiatrists 'cause they really get it and they understand it. And at the end, so many of them are saying, "Yeah, that's like women I see all the time." It's, "Yeah. Wow, wow, wow." I'm like, "Well, why don't you prescribe some hormones?" "Oh, no, we're only commissioned to prescribe these drugs." Like, I mean, I'm sure you know more than me, but that is the pathway. That is what NHS-

    17. AP

      Mm

    18. LN

      ... are funding them to do. And I'm like, "I can't believe that." It's just im- it really plays with my mind because in my mind, I'm a holistic doctor. You know, if someone comes with a headache, it could be loads of different reasons. I'm not gonna just give them one treatment. Like, that's not how we're trained.

    19. AP

      Mm.

    20. LN

      So I was really shocked even to hear that. And then they said, "Oh, yes, but we could say go back to the GP and maybe see the GP for an assessment of their hormones." Well, firstly, people can't make an appointment 'cause it's, you know, it's really hard. And secondly, you might not see a GP who understands, and thirdly, these are medical doctors. They should be trained in how hormones affect the brain as well. So I-- and we see it a lot. There's a lot of women who, you know, it depends on who you get referred to, but so many are under psychiatrists, and they're not being asked about their hormones, and I just think it's completely wrong because in medicine, you wanna treat the underlying cause-

    21. AP

      Mm

    22. LN

      ... if you can.

    23. AP

      So following on from that, if someone, a woman gets a diagnosis of ADHD, or they suspect that they-

    24. LN

      Mm

    25. AP

      ... are ADHD, and they're, and they're reading they need to take X, Y, or Z medication-

    26. LN

      Mm

    27. AP

      ... they need to exercise more-

    28. LN

      Mm

    29. AP

      ... to combat the executive function challenges, you're saying they sh- should consider other options first, and what might those be?

    30. LN

      Yeah, so often if I think symptoms are related to hormones, then I'll always give the hormones back to physiological response, but looking at nutrition, exercise, everything else as well. But I don't know how many menopausal women you've spoken to, but often if you say to them, "Just go and do a bit more exercise. Just go and sleep a bit better. Just go and eat better," they'll probably bite your head off-

  4. 13:30 – 20:41

    How "in the dark" are women still about their own hormones

    1. AP

      Just sort of continuing on with that theme, how in the dark have women been kept still in relation to how much their ... Despite all of the-

    2. LN

      Yeah

    3. AP

      ... I imagine loads of scientific research-

    4. LN

      Yeah

    5. AP

      ... that's come out, still, how much have they been kept in the dark about how much hormones affect their mood?

    6. LN

      Yeah, absolutely. But I think actually doctors have been kept more in the dark than women. You know, I mean, women have been just denied so much good medicine for such a long time. Um, and the problem is there's lots of other drugs that can do all sorts of things to, to people, including women. But basic physiology has been there for decades. You know, when, when hormones were discovered i- in the turn of the, the 1900s, so 1930s, um, there was such a move to try and market them and think about bleeding and periods that any good research was just forgotten. And then women, as you probably know, weren't included in any studies-

    7. AP

      Mm

    8. LN

      ... of any drugs because we're too complicated because we've got our hormones. But actually isn't that so important that we study them? So that's been very frustrating. Um, and then women have known, like for a long time, even when the contraceptive pill came out in the '60s, a lot of women were saying, "I don't feel right. I can't think clearly. I feel very low in my mood. I feel more anxious." And doctors would say, "No, no, no, you're not going to get pregnant. You must take this."

    9. AP

      Mm.

    10. LN

      And then they looked and changed the dose and various things. But it's still happening now, um, that women are being given medication without knowing-

    11. AP

      Mm

    12. LN

      ... not knowing how the hormones work. But also just, I think because when people talk about estrogen and progesterone, it's about periods, so then you're constantly just thinking about the womb. Whereas thinking about these hormones that work in every single cell of our body, they affect the way that our cells function, is really important. And I think women understand more because 95% of women have PMS, premenstrual syndrome, and it's been normalized for so long where you just, "Oh, don't go near her, she's hormonal." Like, "Oh, she'll be a bit irritable. She might be a bit forgetful just before her periods." Well, actually, well, let's think about what's happening. And if those hormones are dropping, why aren't we giving them back? You wouldn't say to a man, "Oh, once a month-

    13. AP

      Mm

    14. LN

      ... for a few days you're just gonna feel a bit bad." Like it's just unacceptable. But so much has been normalized, I think, and trivialized, and it doesn't really help that the hormones are sometimes referred to as sex hormones, and they're not about sex. They're not even about gender because men have them too.

    15. AP

      Mm.

    16. LN

      But it's because there's been this misunderstanding. But the role of on the brain is so crucial to understand. Um, and you know, psychiatrists, psychologists, anybody who deals with the brain should be knowing about the role of hormones in the brain.

    17. AP

      Mm. I think, well, firstly, it's so interesting. I think one of the biggest injustices that I've come across since starting this podcast is that, that the first study on how ADHD medication affected or how hormones affected the response to ADHD medication in women-

    18. LN

      Mm

    19. AP

      ... was done last year.

    20. LN

      Yeah.

    21. AP

      Only last year in 2024.

    22. LN

      It's awful, isn't it?

    23. AP

      That's ... So women were taking ADHD medication-

    24. LN

      Yeah

    25. AP

      ... on the advice of their doctor and not recognizing why one week it, it was kind of working-

    26. LN

      Yeah

    27. AP

      ... one week it was making them feel terrible-

    28. LN

      Yeah

    29. AP

      ... because it wasn't studied.

    30. LN

      No. I know.

  5. 20:41 – 21:50

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    1. AP

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  6. 21:50 – 27:03

    At what stage of the monthly hormone cycle is ADHD most manageable

    1. AP

      Back to the episode.

    2. LN

      Mm.

    3. AP

      Taking this into account, all, all of, all of what we've just spoken, is there a particular time of the month when someone's ADHD might be most manageable, and how does that correlate to the hormone cycle?

    4. LN

      Yeah. Um, so if you think you might have done it in biology many years ago, but the sort of average cycle, and not that any woman's average, is 28 days, and in the first half of the cycle you get an increase of estradiol and progesterone, and then in the middle there's like a peak where, where women ovulate, produce an egg, and there's a peak of estradiol, progesterone and testosterone actually. And then the second half of the cycle, progesterone goes very, very high, estradiol goes a little bit high, and then they both fall off a cliff, and then that triggers a period. So often with the brain, as you know, the brain likes homeostasis, everything the same, everything calm. So any change, so lot-- some women find as they ovulate in the middle of the month, they might find that their symptoms change, but it, it classically is just before their period when they've got that big decline because the hormones work to, um, improve the way the cells work in the brain. The, the energy production, you know, they, we've got receptors on mitochondria that produce energy in every single cell. Um, and also just the way that the hormones, um, work in the brain with all the other, you know, like I've said, the other neurotransmitters like-

    5. AP

      Mm

    6. LN

      ... serotonin, dopamine, glutamate, um, melatonin, all of those are really important obviously for our mood, our memory, our sleep, our cognition. So this fluctuation can really trigger symptoms. So often it's before a period, but it can vary so much between women, but they often do notice there's a cyclical variation.

    7. AP

      Being a late diagnosed woman, I mean, it's confusing enough trying to grapple-

    8. LN

      Mm

    9. AP

      ... with this, this understanding of-

    10. LN

      Mm

    11. AP

      ... of how you operate and coming-

    12. LN

      Mm

    13. AP

      ... to terms that you've gone for so many years not understanding-

    14. LN

      Yeah

    15. AP

      ... why.

    16. LN

      Yeah.

    17. AP

      And how important do you think it is for, for a late diagnosed woman who has had so many years of feeling misunderstood, both by others and herself-

    18. LN

      Yeah

    19. AP

      ... to go on this journey to understand the impact that hormones are having-

    20. LN

      Yeah

    21. AP

      ... on her behavior?

    22. LN

      It's crucially important. It's so important and it's so neglected because like I say, a lot of people just dismiss hormonal changes when people are young or it's normalized. And then as we age, um, our, our ovaries don't work as well because we're only born with a finite number of eggs. So our hormone levels start to really fluctuate in perimenopause. So peri just means around the time of menopause, and menopause means when periods stop. But that can last for 10 years or so, and I see quite a lot of women who still have regular periods, but they're suddenly getting these symptoms, especially affecting their brain. And unless you've got that knowledge, or unless someone sits down and explains to you what's going on, or you track and monitor your symptoms, it's very easy to blame other things or think there's something else going on. Um, and you know, like I said, a lot of people I see have waited often many years to get a diagnosis.

    23. AP

      Mm.

    24. LN

      They've got a diagnosis, but it's so obvious it's related to their hormones.

    25. AP

      Mm.

    26. LN

      But it's very hard ... You know, I had s- symptoms eight, nine years ago, and, uh, it's a bit embarrassing being a menopausal specialist, but they lasted six to n- seven months until my middle daughter made my diagnosis for me-

    27. AP

      [laughs]

    28. LN

      ... which was very kind of her. But when you're with yourself 24/7, you just accept any change and you don't always notice any change, or you put it down to something else. And so often with women, it's like, oh, well, sh- it must be really hard for her because she's got three children and she works full time and she's, you know, got parents or whatever. And it's like, hang on, there must be something else that's going on, and i- i- if you haven't got that knowledge, then it's very hard to know, and if you're locked into a medical system that's telling you X, Y, Z, not telling you about how hormones work in the brain, then you're not, it's not going to be on your radar-

    29. AP

      Mm

    30. LN

      ... at all. And then the other travesty, I think, is that so many women who are younger are given contraception and then their brain function actually worsens. And I see it a lot with my children, their friends are given contraception and then they're given antidepressants and then they're not being able to think properly and I'm just thinking, oh my goodness, if I could, and I do see quite a few of them as patients, give them natural hormones, it can make a massive difference. And that's ... Well, I think it's all very well me, age 54, having hormonal changes, but actually if you're in your 20s and 30s, that's, your whole career could be different.

  7. 27:03 – 28:41

    How female contraception is affecting ADHD traits

    1. AP

      What ... You mentioned c- women, young women are given contraception and it affects their-

    2. LN

      Yeah

    3. AP

      ... con- what contraception are you m- talking about?

    4. LN

      Any type of contraception. So the tablet contraception, so the combined oral contraceptive pill, the progesterone-only pill, the implants, they will all, they're all synthetic, so they've been chemically altered-

    5. AP

      Mm

    6. LN

      ... which basically means if something's been chemically altered, it's not going to have the same beneficial effect on the cell because all our cells have receptors. It's a bit like a key and a lock. So they've got the lock waiting for the key, the hormone, to fit in, unlock, and then you've got these lovely biological reactions going on. You can imagine if it's been c- if it's been altered a bit, it might go into the lock. You know if you've had a dodgy key cut-

    7. AP

      Mm. [laughs]

    8. LN

      ... it fits in and then it doesn't quite unlock, and that's what happens with, um, these synthetic hormones. So they block the natural hormones having an effect, but they also don't have the lovely biological reactions going on. And there's some studies, not many, because no one's really done good studies of women, of course, that women who have contraceptive pill will have lower levels of serotonin in their brain because estradiol will inc- improve serotonin. So if you block estradiol, you're going to reduce serotonin levels and dopamine and other neurotransmitters as well, which is really important.

    9. AP

      Mm.

    10. LN

      But a lot of younger people, they're just blamed, "Oh, it's because, you know, they're students," or it's, "Oh, because, you know, they're, they're young and they've just got immature brains" or whatever.

    11. AP

      Mm.

    12. LN

      Um, but again, thinking about what we're doing to the brain, which is such an important organ, is so crucial.

  8. 28:41 – 30:48

    The correlation between menopause and ADHD diagnoses’s in women

    1. AP

      Have you noticed a correlation between a, a woman who ex- starts experiencing menopause symptoms and a- as a consequence of that, they, they, they really start to struggle?

    2. LN

      Mm.

    3. AP

      And, and I suppose you could ... The feedback I've heard is life gets too much.

    4. LN

      Yeah. Definitely.

    5. AP

      And the, the menopause has been the trigger.

    6. LN

      Yeah.

    7. AP

      And then that is what led to an ADHD-

    8. LN

      Yeah

    9. AP

      ... assessment.

    10. LN

      Yeah.

    11. AP

      Have you noticed the correlation there?

    12. LN

      Absolutely. The effect of changing hormones on the brain is huge, and often things just get very overwhelming. People often catastrophize. People often find that they're very, very anxious, and they worry about things that they wouldn't have worried about before. Their short-term memory is not as good. Their, uh, recall is not as good. A lot of people worry that they've got dementia. They know that something's not right, but they don't know what to do, and they can't fix it. Um, anybody that's listening that's had brain fog, it's just the hardest thing ever because you know you should be able to function and you can't.

    13. AP

      Mm.

    14. LN

      It's really, really disconcerting and it's very, very isolating, and a lot of people are too scared to talk about their symptoms, or they go and get help and they're misdiagnosed with depression, and then they're being medicalized with the wrong medication. That's can often make things worse as well. So people really scramble and, you know, we also know, like as I've said to you, you can have low dopamine with the low hormones, and then people aren't having that reward, so then they're thinking about drugs or, um, alcohol or any addictive behavior to try and get that dopamine, and that's not gonna necessarily help, but y- they don't know that it's not helping because they're so desperate to get help.

    15. AP

      Mm.

    16. LN

      Um, you know, we did a addiction survey last year and it's qu- it's shocking actually the number of people that are turning to Well, alcohol to try and numb their symptoms, but also drugs as well. And, um, you know, that, that is really scary and it just highlights that as a medical profession we're letting these people down-

    17. AP

      Mm-hmm

    18. LN

      ... 'cause they don't know where else to go and get help

    19. AP

      Gosh, have,

  9. 30:48 – 40:55

    Advice for ADHD women approaching menopause

    1. AP

      have, have you got any advice? If someone's listening and they're, and they th- they're thinking, "This is coming."

    2. LN

      Mm.

    3. AP

      "I haven't got to menopause yet."

    4. LN

      Yeah.

    5. AP

      "At the moment I feel I've got my ADHD under control-

    6. LN

      Yeah

    7. AP

      ... but this is scary-"

    8. LN

      Yeah

    9. AP

      "... what you're saying. I know it's coming."

    10. LN

      Yeah.

    11. AP

      You got any advice for someone? How do they sort of weather that storm of emotions?

    12. LN

      Yeah. So the first thing is everyone's different. So like I'm painting a really negative picture. Some people are fine or they think they're fine. Most women do have some sort of symptoms, but not everyone has huge symptoms. But the most important thing is to have that knowledge. So obviously I've, uh, created Balance app, which is a free app so people can actually record their symptoms, and that's can be really useful actually just to have a log of symptoms. Because sometimes you, you, you don't know unless you do it every three months or so, and then you can see is there a change? Is there a pattern? Is something else going on? If people have periods, they can monitor it with their symptoms, uh, uh, and, and periods as well, so that can be really helpful. But it's also getting others to know what's going on as well because it's ... And it's not just at home, because most of us just spend more time with work colleagues than we do at home. But just to let people, like, recognize some of the symptoms that might be occurring as well. And then it's also thinking about, "Well, if I do have symptoms, what am I going to do and when am I going to get help?" Because a lot of people think with menopause two things. They often think they have to have flushes and sweats, which most of us don't have, so you don't have to. Or they have to wait until they're really experiencing a lot of symptoms that are very badly affecting the quality of their life. And you know, no one gets a badge of honor for suffering with symptoms, so we know that the earlier people can have treatment the better. Um, so it's really about being proactive rather than just reactive, um, I think is so important. And if someone's decided that they do want hormones, then making sure that they see someone who understands the right dose and type. Because about 50% of people who come to our clinic are already taking hormones. They're not coming 'cause they wanna just see us, they're coming because they know they're still having some symptoms.

    13. AP

      Mm.

    14. LN

      And like I say, the addition of testosterone can be s- make such a difference that often people think testosterone is just for libido for women, and if your libido's okay, then you don't need it or, um ... But actually the way that testosterone works on the brain, but also progesterone is a very calming neuro hormone as well. Um, and a lot of people might have had a hysterectomy, their womb removed, or they might have a Mirena coil and be told they don't need progesterone, you know? Whereas actually a lot of people when they take natural progesterone, they sleep better, their way they think is a lot calmer, they're a lot less anxious, and I'm sure that has a s- quite positive effect on women with ADHD as well.

    15. AP

      Mm. Is it possible therefore that someone who's going through the menopause and therefore they, life gets really hard-

    16. LN

      Mm

    17. AP

      ... as a consequence of that, and then they get an ADHD diagnosis in response to that hardship? Do you see a correlation in, in those chain of events?

    18. LN

      Yeah. There's a lot of people that are, I think, misdiagnosed. And, like, in medicine, you just want to ... They take a really good history, work out what's going on, but treat the underlying cause and then see what's left. So I would- wouldn't rush and diagnose ADHD in somebody who was having hormonal changes. And I'm not saying all hormonal changes will cause ADHD, but they'll often cause symptoms suggestive of ADHD or worsen it. And so it's a lot more natural to have the replacement hormones that are fluctuating and causing this, these changes in the brain rather than giving another drug, if you see what I mean.

    19. AP

      Mm.

    20. LN

      And it's so many women, it, it, they just don't join the dots. Because often, like if you look at the definition of menopause, it's a year since the last period. Like it's, it's a rubbish diagnosis. Like why does someone decide it has to be a year after someone's last period? It's just stupid actually. Um, but actually when we think about what it is, it means the hormone levels are low and they stay low. But like I've said, this perimenopause, this time before when hormones are really fluctuating, this chaos in our brain can often trigger a myriad of symptoms that will often be dis- you know, misdiagnosed as ADHD.

    21. AP

      Mm.

    22. LN

      And that's, I think, so awful 'cause women are suffering, and without thinking about what are the hormonal shifts? Is there anything I can do to, to replace those hormones? And that's what's so important, I think, for women to get that knowledge so that if they're being made or, or given a diagnosis or referred to someone, you can say, "Well, actually could I think about having hormones first? Could I consider having those hormones?" And it's often multi-pronged, like nothing or very little in medicine is just one cause and effect other than, you know, if I cut my hand, I put a plaster on, it's one cut, fine. But when it's the hormones, they have an effect on everything else as well. They have an effect on other hormones in the body, but also the way that we function. So many people who are perimenopausal are not sleeping well, they're feeling more tired, they've got low energy, they've got muscle and joint pains, so they don't want to exercise. So it's not just the hormones, their lifestyle's changed as well. And so looking at all of those things together and then seeing what's left is so much more important than rushing to make a diagnosis.

    23. AP

      Mm.

    24. LN

      And it's very interesting actually, I'm on a WhatsApp group with some ADHD specialists, um, across the world. So there's a great specialist in Darwin, Australia. There's a gynecologist, would you believe, who specializes in ADHD in Sweden. And then loads of GPs. And it's so interesting, the chat, because they- We all are seeing similar patients. We're all seeing similar effects. Even the gynecologist in Sweden, she's saying the biggest effect is with testosterone when it's added to HRT, but I can't talk about it because the gynecologists don't want to believe it. And the, um, [smacks lips] psychiatrist in Darwin is being really converted. It's great. I love converting other doctors.

    25. AP

      [laughs]

    26. LN

      And he's just going, "Yeah, this all makes sense. Why didn't I think about this before?" And it's just great. In medicine, you learn so much from experience, and then actually in the chat a couple of days ago, people were putting loads of papers in about the role of hormones in the brain, roles of estradiol and progesterone, testosterone, how they work in the brain, and everyone's just going, "Wow, wow, wow, this is great."

    27. AP

      Mm.

    28. LN

      And I think it's so important that as a doctor you're really open-minded. And I ... It's also, I think, the way that we talk to patients because so often people think, well, they've got a disease, they've got a label, therefore that's it, I'm not interested as a doctor 'cause I've done my diagnosing bit. Whereas actually for that individual, it's not so much what they're labeled as, it's how are you gonna treat, how's it gonna affect my life? What's, what are the things? And I think what I ... I'm sure you agree, but ADHD is, can be a superpower if it's done in the, if it's channeled in the right way, if people have the right information. And what worries me is that obviously there's this plethora of clinics now. There's a huge number of waiting, people waiting, and they almost think that to have the diagnosis is gonna transform their lives. And I worry about that actually because I worry about medicalizing people the wrong way. I worry about medics, doctors giving people false expectations actually. And actually, a lot of, so much, or so much of it is about knowledge and looking at intrinsic and e- extrinsic factors that make a difference, um, rather than just waiting, waiting for-

    29. AP

      Mm

    30. LN

      ... a label. Like, what do you do with a label? Like it's, it might be helpful to tell people that you've got a condition like ADHD, but actually how ... Like, two people with ADHD are not the same. So it's not like just putting people into a slot and making you feel better. It's, it's far more than that. Um, and that's why I think thinking about what's going on in the brain, what are the factors that are changing, what's gone on, what's going on in this person's life, and how much is treatable with hormones. And, and, and it's not just women actually, 'cause men have low testosterone, and that's often not addressed, or it might be addressed in the wrong way. So I think it's so important that doctors wake up to the fact that hormones have a role in the brain.

  10. 40:55 – 44:14

    The link between Emotional Dysregulation and Menopause

    1. AP

      do you think that emotional dysr- dysregulation, which is rife in the-

    2. LN

      Yeah

    3. AP

      ... ADHD community-

    4. LN

      Yeah

    5. AP

      ... but that can be connected to menopause?

    6. LN

      Absolutely. If you think very basically, our hormones all derive from cholesterol. So cholesterol is not all bad. It can form our cell membranes, but it's, it's really important. So cholesterol forms progesterone. Progesterone then forms testosterone, which then forms estradiol. But going further up, progesterone also forms cortisol, and cortisol are stress hormones. So it's a bit like a seesaw really. Uh, if you've got more stress and more stress hormones, you're likely to have less progesterone, and that's why often progesterone having the right balance and d- dose is quite calming as well. And what worries me sometimes is that a lot of, um, emphasis is put on what's gone on in the past, like previous events, trauma, and it's ... And it of, of course these things have an effect on the brain, but they're exemplified and worsened if we don't have the right hormonal balance. If you've got too much adrenaline, noradrenaline, cortisol going on, it, it's gonna make that brain more hyper-aware, hypervigilant, but also that worry, that reactivation of maybe some negative things that are going on.

    7. AP

      Mm.

    8. LN

      Um, and then it's just almost people are, I don't know, not really labeled, but I think so many people will say, "Oh, well, it's, it's related to previous trauma. We understand why that's happening." But actually lots of people have trauma. Not everybody has symptoms that's going to then cause a problem in the future. But thinking about that balance of hormones is so crucial, and thinking about how the hormones affect- Like I say, cortisol-

    9. AP

      Mm

    10. LN

      ... and cortisone. You know, it's just this direct pathway. But also, like I said before about how they affect different neurotransmitters in the brain, so like noradrenaline, adrenaline, dopamine, serotonin, all of those have a really important crucial effect. And I think so often in, in the brain people think about one area or one chemical without thinking about how they all interfere with each other.

    11. AP

      Mm.

    12. LN

      So I think, you know, doing a, doing a proper assessment is crucially important, but I do feel sometimes that is a bit too much, not blame, but emphasis maybe put onto previous events that could have triggered something else and I don't even, I don't know sometimes that's helpful because then people aren't being treated in the right way.

    13. AP

      Mm.

    14. LN

      It's sort of, it's almost like associated with something that's happened in the past, and of course that's going to affect their brain, that's going to affect their processing. But actually, with the right treatment it doesn't all have to be related to previous events.

    15. AP

      Mm.

    16. LN

      Does that make sense?

    17. AP

      Yeah, it does. Yeah. I suppose where do you draw the line?

    18. LN

      Yeah.

    19. AP

      When do you need hormone therapy or when do you just need therapy?

    20. LN

      Yeah, yeah. Yeah.

    21. AP

      I guess one is-

    22. LN

      Yeah

    23. AP

      ... trying to-

    24. LN

      Yeah

    25. AP

      ... dig deep into something-

    26. LN

      Yeah

    27. AP

      ... that might have happened in your early years, and one-

    28. LN

      Yeah

    29. AP

      ... is an actual response to a physiological issue now.

    30. LN

      Yeah.

  11. 44:14 – 45:34

    Hallowell Brain Health Advert

    1. AP

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  12. 45:34 – 50:26

    The link between AuDHD and hormones

    1. AP

      In terms of, there's a big topic at the moment in this community that is of high interest, and that's AuDHD, which is the dual diagnosis of ADHD and, and-

    2. LN

      Yeah

    3. AP

      ... autism.

    4. LN

      Yeah.

    5. AP

      Like how does menopause come into-

    6. LN

      Yeah

    7. AP

      ... how does it difference? How, how is it different in the way that it clashes with the traits of ADHD compared to how it might clash with-

    8. LN

      Oh, it's all there

    9. AP

      ... AuDHD?

    10. LN

      It's all there.

    11. AP

      [laughs]

    12. LN

      Like hormones get everywhere.

    13. AP

      [laughs]

    14. LN

      And it is all, we see so many women who are neurodivergent and get worse during perimenopause and menopause, and a lot of people like hyper fixate. They, like say they get quite obsessive. They can ruminate. They can worry. They can think a lot more. Any ritualistic behavior can get worse as well. Um, and that can be very difficult if people are neurodivergent. It really can. Um, and the reason I'm so confident that a lot of it's related to hormones is 'cause I see people improve. You know, they ... I don't do anything else to them other than rebalance their hormones, and they're like, "Wow, I feel like my brain's been freed." 'Cause it is quite claustrophobic when you have certain symptoms. Um, and a lot of people, as you know, are neurodivergent, which again, can be a real great skill, can't it? But if it, if it takes a hold in your life, then it's can be catastrophic. And the number of people that are paralyzed because their brain's not working properly without people thinking about hormones is so important. And I, so I think the big telltale sign is if symptoms are fluctuating, then it's almost like think about hormones first, and if you're confident it's not related to hormones, that's fine. Rather than waiting for it to be thought about at the last. 'Cause once you start to see it and understand it, it's just there and it's so obvious.

    15. AP

      Mm.

    16. LN

      But the problem is it's not always thought about, and people don't understand the, the role of hormones and the big effect that they can have on the brain. Or they think, "Oh no, I've had hormones and I felt worse, so therefore I won't have them again." But when they talk about the hormones they've had, they're often contraceptive hormones. So a lot of people who are neurodivergent or with ADHD will say, "No, I, I, do you know what? I had the implant and I felt awful. I had to literally rip it out my arm, I felt so terrible." But they are having a synthetic hormone and it's basically giving them a chemical menopause. It's very different to having natural hormones.

    17. AP

      Mm.

    18. LN

      So again, it's really important that people understand that not all hormones are the same. Some people will be listening to this and go, "Well, that's rubbish because I tell you what, I felt awful when I was on contraception." Well, yeah, but they're more likely to benefit from natural hormones, and there's some people that are very sensitive to hormones.

    19. AP

      Mm.

    20. LN

      And, um, and it, we're seeing increasingly a number of women who are more testosterone deficient than estrogen and progesterone deficient, so they're having regular periods, but they're finding it very difficult to process, very difficult to think, to ... Their memory's not great. Their energy's not very good. Their stamina's not very good. They feel more tired, but their brain just doesn't multitask the same way, and often that's related to testosterone.

    21. AP

      Mm. Is there a, um, a light at the end of the tunnel for neurodivergent women going through menopause? What, what's the, what's the sort of the beacon of hope that, that they, you would like to tell to that group?

    22. LN

      I think the most important thing is thinking about ... When we think about menopause, so many people think it's just a transition, it's just something we go through, but it lasts forever because our hormones, once they're low, are low forever, so they'll be low in our brain forever. So having the right dose and type of hormone, once they've got that, they can continue it forever, and that is a massive beacon of hope because there's nothing worse than being, felt great on something than being told, "Oh no, actually, you can't carry on." Hormones are very safe. They're very effective. They are-- They just naturally replace what we've, what's missing in our bodies. And so many people then, once they're on hormones, find that they can think better, they can function better, they can exercise, they can do all the things that they know they should be doing but they're not doing as well. Um, and the other thing I think is really important, 'cause it sounds like I'm just pushing hormones, but-

    23. AP

      [laughs]

    24. LN

      ... um, is that, you know, we can try them and see if they work. They can be taken very safely with other medication, and if they don't work, we can stop them as well, so people don't have to be on them forever if it's not right for them.

    25. AP

      Mm-hmm.

    26. LN

      Um, but it just seems so ridiculous almost that so many people are either scared away from hormones or they're not being given them when so much is related to the hormonal effects-

    27. AP

      Hmm

    28. LN

      ... especially on the brain.

  13. 50:26 – 56:43

    The ADHD item

    1. AP

      Just finally, or penultimately, I should say-

    2. LN

      Yeah

    3. AP

      ... I wanna draw attention back to your ADHD item that's been patiently waiting underneath that cloth.

    4. LN

      Ah, yeah.

    5. AP

      I ask all my guests to tell me an item that most represents ADHD for them.

    6. LN

      Yeah.

    7. AP

      And we're gonna reveal yours underneath this cloth now.

    8. LN

      Aha. Ta-da.

    9. AP

      Right. That is ... Well, it looks like a diary.

    10. LN

      Yeah.

    11. AP

      Don't open it. Oh, you can. So [laughs]

    12. LN

      I can open ... Can I open it?

    13. AP

      Yeah, of course. Yeah, yeah, if you're happy. Yeah.

    14. LN

      So, so it's a diary, but it's, it's got each day has a whole page dedicated to it, and my writing's quite messy. But I will write a list of things that I need to do, so it's not a diary. I used to write as a teenager all the things that happened to me, all my emotions. It's not that at all. It's literally a list of things that I need to do. And in fact, when you asked me for the item, I was like, "Oh dear, yes, I do have ADHD."

    15. AP

      [laughs]

    16. LN

      I've never had it diagnosed, but I'm sure I do. And some of it is 'cause I'm so busy, but like, you know, my computer's always got loads of tabs open. I've always got loads of WhatsApps popping up. I'm always thinking, "Oh my goodness, I've gotta do X, Y, Z."

    17. AP

      Hmm.

    18. LN

      There's something very therapeutic about writing it down because it's empty- A lot of my ... Way I can do so much is just try and empty my brain because it, once it's empty, I can think and probably fill it up again.

    19. AP

      [laughs]

    20. LN

      But as soon as I've written something down, then I don't think about it-

    21. AP

      Hmm

    22. LN

      ... 'cause I know it's there, and it's something very tactile about having paper and a, and a pen. I, I know I could use notes on my phone, but it's just not that. I've tried it so many times. It's not the same. But the best thing about it is that I can tick off when I've done things as well.

    23. AP

      Hmm.

    24. LN

      And if I haven't done it on the day, I transfer it to the next day and the next day, and so eventually it makes me do things. Um-

    25. AP

      Yeah

    26. LN

      ... so that is ... And it, and again, it's, it is a very, like, it's a ni- It's a really nice ... It's like my real treat. It's my Christmas present every year. But I like touching it. I like feeling it. It's a bit of, it's a bit of a comfort blanket as well.

    27. AP

      Hmm.

    28. LN

      Sounds a bit silly, doesn't it? But, uh-

    29. AP

      [laughs]

    30. LN

      You know.

  14. 56:43 – 1:01:30

    The ADHD agony aunt

    1. AP

      But this week, Louise, someone has written in for the washing machine, and they have asked, "My daughter, who has ADHD, is going through adolescence and the mood swings that come with it. What can I expect from the next few years, and how can I better understand her hormonal changes and her ADHD?"

    2. LN

      Mm. Great question. Having three daughters, the youngest one's still a, very much a teenager, I sympathize, but this is what I was saying before, we can't be normalizing it, because it's really difficult for those children. And we've known for decades, even in 1961, there was an article in the British Medical Journal showing that girls who have PMS or PMDD fluctuations in their hormones achieve worse if they have exams bef- just before their periods. And so we need to be helping girls understand what's going on with their hormones, but also thinking about how we can help them sometimes as well. It's harder when they're under 16 or under 18 because of just medically treating them, 'cause they've got lots going on in their bodies, but we see a lot of people who are 18, 19, and giving just s- usually just some progesterone, you know, that big graph that I said that drop off-

    3. AP

      Mm

    4. LN

      ... giving a little bit can be transformational for these people, and it's just so awful that there's so little research, um, in how the hormones can have such an effect. Because adolescence is a bit like a flav- bit of a taste of perimenopause, you know, these hormonal shift, changes. Um, so talking about it, getting understanding is really important, but actually thinking about how hormones might just smooth out a little bit as well, um, is something to, to consider. The other thing is, I know it sounds really obvious, just thinking about nutrition, because all these inflammatory diets, processed food, will have massive effect, the sugar cravings, you know, will have a big effect on our hormones as well. And it sounds really boring, doesn't it, to eat a really healthy diet, to, um, you know, s- even snacking regularly can help with progesterone levels as well-

    5. AP

      Mm

    6. LN

      ... but snacking on healthy things, not un- unhealthy things. And it's so easy to eat badly, to drink the wrong things. Um, but looking at nutrition, looking at any exercise as well, which I know is quite hard for teenagers to do. Um, anything that's going to help that, thinking about that cortisol and that balance, anything that's going to be calming, going outside, going for a walk. Um, I know certainly with a lot of people, especially with my children as well, it's so much better talking to someone that you're driving-

    7. AP

      Mm

    8. LN

      ... or you're walking, 'cause you're not looking at them. Um, and it's quite hard getting children to, to go out for a walk, but in the car is sometimes easier. Because actually it can be quite isolating and scary for those teenagers as well. I've said how hard it can be for perimenopausal and menopausal women, but young girls, you know, they learn everything from TikTok and social media, don't they?

    9. AP

      Mm.

    10. LN

      And everyone looks perfect on social media. They of course all catastrophize and make it sound awful. So actually talking about it is really, really important. But if you think you need to get help, then making sure you see someone who understands how hormones can change and what can be done as well.

    11. AP

      Mm. So interesting that you mentioned that there was an actual study that showed girls performed-

    12. LN

      Mm

    13. AP

      ... lesser in exams-

    14. LN

      Mm

    15. AP

      ... just after their period.

    16. LN

      It's before.

    17. AP

      It's before their period.

    18. LN

      So that's when that drop of progesterone-

    19. AP

      Mm

    20. LN

      ... that drop of estradiol, the brain is just not working. You haven't got the same connectivity of the brain, you haven't got all those synapses firing in the right way.

    21. AP

      Mm.

    22. LN

      You've got probably less blood supply to the brain, memory's not as good, sleep might not be as good. Um, yeah, I mean, isn't it madness? That was 1961 that study came out, um-

    23. AP

      And that alone-

    24. LN

      Yeah

    25. AP

      ... almost summarizes our entire conversation-

    26. LN

      Yeah

    27. AP

      ... how much-

    28. LN

      Yeah, totally

    29. AP

      ... hormones affects cognitive ability.

    30. LN

      Totally does. Yeah. Yeah, yeah, yeah. And so it's just, it's just such a shame that women are often- You know, not working to their best ability

  15. 1:01:30 – 1:04:02

    A letter from the previous guest

    1. LN

      Okay

    2. AP

      The previous guest wrote three rules to live by, they put it in this envelope, and they posted it in that post office. I'm going to deliver it to you

    3. LN

      Okay

    4. AP

      If you could kindly read out the three rules

    5. LN

      So right, three rules to live by. One, people are going to judge you no matter what, so you may as well do what you want. It's your life. I like that. Everything is figureoutable. Oh, I don't think everything is, but most things maybe. The only perfect thing in the world is you because you're the only you that exists. Be nice to yourself. Aw.

    6. AP

      Mm, that's interesting. I, I, you know, I kind of agree with the second point. I'm trying to... What would you think is an example of something that isn't figureoutable?

    7. LN

      Working out why some people behave as badly as they do

    8. AP

      Mm. Like the extreme, like, uh, criminals?

    9. LN

      Well, no. I think there's probably reasons why criminals... I've done quite a lot of work in prison, and you couldn't work out often why. No, I think bullied, I've, I get bullied quite a lot for what I do. Like, i- in the media, it's fine. People can read about it, and I can't stand people's motives sometimes. I can't understand why people are mean, actually. I've, I've sort of grown up wanting to be kind, and I don't think it's a bad thing being kind. Doesn't mean you have to like everyone, but you can still be kind and polite and courteous. And so I can't figure out why people don't want to be kind or why they have this feeling that they can be mean

    10. AP

      Mm

    11. LN

      'Cause meanness is, like, such a horrible thing

    12. AP

      Who's mean? What, what are they saying?

    13. LN

      Well, there's, there's a lot of meanness when it comes to women's health and hormones, and often it's come from misunderstanding, and I think also it comes from fear, fear of women being in control-

    14. AP

      Mm

    15. LN

      ... and women being in control of their bodies. And people don't like change as well. So if you're changing a narrative, that can be quite difficult

    16. AP

      Meanness coming from men?

    17. LN

      No, it's mainly from women-

    18. AP

      Really?

    19. LN

      ... actually. Isn't that interesting? Yeah, yeah. So I think that's hard to figure out, like-

    20. AP

      Mm

    21. LN

      ... w- what people's agenda is when they're being nasty, and that's the same, like, I was bullied at school for being clever. You know, when I see my children, if they've ever been bullied, you think, "Oh, actually, what are these people? Why are they-"

    22. AP

      Mm

    23. LN

      ... "doing this?" You can just ignore it if you don't like something, but don't be mean

    24. AP

      Mm. Envy, maybe, disguised-

    25. LN

      Yeah

    26. AP

      ... is your success-

    27. LN

      Maybe

    28. AP

      ... and thank you so much

    29. LN

      Thank you. It's been great. Thank you [upbeat music]

Episode duration: 1:04:03

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