The Truth About ADHD & Menopause (Cambridge Psychiatrist Explains)

1. 0:00 – 2:56

   Trailer

   1. SPSpeaker0:00

      People with ADHD who are also anxious tend to do better because the anxiety tightens the screw of focus. An awful lot of people with ADHD will use stress in order to focus, but then when you come into menopause, your estrogen levels drop, so do your serotonin and dopamine levels. So you're left with less serotonin, less dopamine, and you're less able to focus and you're more anxious, and that's when you tip into this crisis. And the strategies that you used before no longer work because the biological landscape has changed. Dr Judith Mohring is a Cambridge-educated psychiatrist ... medical professional and expert in all things ADHD specializing in female hormones Her mission is to help ADHD women manage their symptoms better during the menopause.

   2. APAlex Partridge0:38

      I wanna go through hormone by hormone, starting with estrogen. What role does this play in a woman? How is it affected by menopause, and what knock-on effect can this have on a neurodiverse person?

   3. SPSpeaker0:49

      So estrogen, as it drops, you see an impact throughout the body, and particularly in the brain. You see lower levels of dopamine, lower levels of serotonin.

   4. APAlex Partridge0:56

      Progesterone?

   5. SPSpeaker0:57

      After the body produces an egg, there's something called the corpus luteum, which is like the leftover bit, and that produces progesterone. For many women, progesterone is calming, but for some women, progesterone's kinda depressing, and so they get premenstrual dysphoria.

   6. APAlex Partridge1:08

      Testosterone, how does that play its part?

   7. SPSpeaker1:10

      So testosterone is metabolized to estrogen by aromatization. As women's estrogen levels drop, we also see a drop in their testosterone, and there's some emerging clinical evidence that maybe it really helps with brain fog and clear thinking and energy.

   8. APAlex Partridge1:23

      What hormone would be the key villain in that story, and what moods might that hormone be responsible for?

   9. SPSpeaker1:30

      I would say that

   10. APAlex Partridge1:31

       Loyal listeners and viewers, I can't thank you enough for tuning in to ADHD Chatter, where we ask world-leading ADHD experts the hard questions to give you access to the most cutting-edge information on the topic. If you've ever felt broken or different, I hope this helps in your search for information, 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, including myself. Just one click of a button goes a lot further than you think. We'll promise to listen to your feedback and book the guests you want on topics that matter to you. And remember, you're not broken, just different, and you have always been enough. Judith, welcome back.

   11. SPSpeaker2:25

       Thank you, Alex. Good to see you.

   12. APAlex Partridge2:27

       Likewise. Back by extremely popular demand, um, after your first episode.

   13. SPSpeaker2:33

       Yeah, I maybe wanna hide under a chair.

   14. APAlex Partridge2:35

       [laughs]

   15. SPSpeaker2:35

       I was a bit scared. I don't, I don't... I'm not used to social media, so it was a bit much, but it was very good. Yeah, really good.

   16. APAlex Partridge2:41

       I think half a million people listened, listened to it, so, um, an honor to have you back, um, this time talking-

   17. SPSpeaker2:48

       Thank you

   18. APAlex Partridge2:48

       ... about something a little bit more specific, um, female hormones and m- the menopause.

   19. SPSpeaker2:54

       Yep.

   20. APAlex Partridge2:54

       So I suppose my first question, Judith,

2. 2:56 – 4:13

   What people will learn in this episode

   1. APAlex Partridge2:56

      is why should someone stick around for the next hour? What will they learn from you about ADHD and menopause?

   2. SPSpeaker3:04

      Right. Well, um, it's a really exciting area. It's only recently been researched. There's a lack of research. It's emerging. It's, it's the watch this space, uh, in female m- female mental health, and it's definitely a watch this space in ADHD because, uh, I'm gonna call them sex hormones, although they have many, many different, um, different functions. Um, they really do interact with, uh, neurotransmitters in the brain, particularly those involved in ADHD.

   3. APAlex Partridge3:28

      I was researching for this episode. There is quite a lot of information out there on this topic already. I don't know how much of it is true, but from your perspective, what do you think is unique that someone might learn from this conversation today that isn't already out there on the internet?

   4. SPSpeaker3:44

      So I suppose it's the idea that, um, with, uh, ADHD and menopause, there's kinda dysregulation squared. So ADHD is very much about dysregulation, too little in the way of neurotransmitter or too little in the way of stimulation or too much. And when we add menopause on top of that, we have, uh, dysregulation multiplied by dysregulation. So there's a lot to learn, there's a lot to know, and, um, nothing... There are, there are always surprises in menopause and there are always surprises in ADHD, so there's lots, I say, lots to learn.

   5. APAlex Partridge4:12

      Hmm,

3. 4:13 – 7:17

   How ADHD presents in women during Perimenopause

   1. APAlex Partridge4:13

      fascinating. And I think if we start from the basics, Judith, and, and then maybe get into the more complex stuff a little bit later on, um, could you give us an overview in first ADHD in women and how it presents at perimenopause?

   2. SPSpeaker4:27

      Okay, so I'm gonna start with ADHD in women 'cause that's important. There was a great, um, summary paper in 2020 by Susan Young and her, uh, co-writers talking about how ADHD is missed. So we know it's missed in women, it's underdiagnosed, because it presents slightly differently, slightly differently. And in particular, the kind of inattentive symptoms seem more prominent in women and girls, and it seems also likely that women and girls internalize their symptoms a bit more tha- than men and boys.

   3. APAlex Partridge4:55

      Mm.

   4. SPSpeaker4:55

      So by internalizing, what we mean is that the symptom is a problem for you. You experience it in your inner world, but it's not necessarily something that other people will see or notice. So there may be masking, it may be, it may not be picked up. So it's underdiagnosed, and, um, the other issue is with perimenopause, what happens at perimenopause is very often women who've been coping with their ADHD then can't cope anymore because of the hormonal changes and also because menopause is kinda like nature's glass ceiling. It happens when everything else in your life is happening. You might be senior in your career. You might have a new health problem. You might have elderly parents. You might have teenage kids. Everything else is going on. There's lots of demand, and at that point, uh, that's when your ADHD symptoms often get worse and you get unmasked.

   5. APAlex Partridge5:43

      Mm. And just to continue with the basic stuff, Judith, what is perimo- menopause, what is menopause, and what can a woman f- expect to face during that period?

   6. SPSpeaker5:54

      I'm really glad you're asking that because we watched... [laughs] My husband and I once watched a whole documentary about menopause-

   7. APAlex Partridge5:59

      Mm

   8. SPSpeaker5:59

      ... and nobody defined what it was.

   9. APAlex Partridge6:00

      [laughs]

   10. SPSpeaker6:00

       Uh, which is like, actually, it's really fundamental. Menopause is, is the day that... It's the day 12 months after your last period. It's just one day.

   11. APAlex Partridge6:06

       Just one day.

   12. SPSpeaker6:07

       And yet we talk about it all the time.But it's just that one day, 12 months after your period stops, after that day, you're post-menopausal. Before that day, you're in perimenopause, and perimenopause means around the menopause, and it basically is any period of time from sort of five to 10 years before your periods actually stop, where your estrogen levels vary and your periods are irregular, and it's like your body's gaslighting you. All these weird symptoms happen, um, and you get all these sort of strange symptoms, uh, that you might not be able to put your finger on to start with.

   13. APAlex Partridge6:38

       Fascinating, Judith. And t- I suppose finally with the basic questions, how are these two things intertwined, that being menopause and its effect on ADHD women?

   14. SPSpeaker6:48

       Simple takeaway is very straightforward, which is when you go into perimenopause, your estrogen levels drop because you're having fewer ovulatory cycles. So you get estrogen when you ovulate. You have fewer of those cycles until you stop those cycles altogether. And as the estrogen drops, it impacts your brain, 'cause estrogen doesn't just affect, uh, sex, uh, function, it affects brain function too. So as the estrogen drops, your dopamine also drops, and as your dopamine drops, the inattentive symptoms of ADHD get a lot worse.

   15. APAlex Partridge7:15

       Mm.

4. 7:17 – 13:38

   The 3 key hormones that are impacted by Menopause

   1. APAlex Partridge7:17

      I wanna go through hormone by hormone. Um, th- th- this is a three-part question really, starting with estrogen. What role does this play in a woman? How is it affected by menopause, and what knock-on effect can this have on a neurodiverse person?

   2. SPSpeaker7:32

      So estrogen, um, is, a- again, going back to this idea of sex hormones, they're not sex hormones, they're hormones that impact, impact the entire body. So when a woman, uh, when a girl goes through, uh, puberty and she becomes, um, uh, mature, basically, her body changes. So you get changes in sort of how thick the hair is, and you get changes in skin, bone strength, heart, brain. So you get these impacts of estrogen all round the body, and when you go into menopause and your estrogen levels drop, you get these impacts from the loss of estrogen all round the body, and that's how we see the menopausal symptoms. So estrogen, um, as it drops, uh, you see an impact throughout the body and particularly in the brain. You see lower levels of dopamine, lower levels of serotonin, lower levels of neurotransmitters as it, as it drops.

   3. APAlex Partridge8:18

      Mm. And if we were to ask the same question but for progesterone?

   4. SPSpeaker8:23

      So progesterone's really interesting and really quite complicated. Um, and progesterone is produced by, um, basically after the body produces an egg, there's something called the corpus luteum, which is like the leftover bit, and that produces progesterone halfway through the cycle. And for many women, progesterone is calming, and when the period happens and the progesterone drops, you get premenstrual, uh, syndrome. You, you feel anxious. But for some women, progesterone's kinda depressing, and so they get premenstrual dysphoria, and they feel miserable from day 14 to day 28 because they've got higher progesterone. So you have these different impacts of progesterone.

   5. APAlex Partridge8:59

      Mm.

   6. SPSpeaker9:00

      But for most women, when they go into perimenopause, because they're having fewer ovulations, they get less progesterone, and that means they're often more anxious. So you see more anxiety. And we also see, because progesterone is metabolized to something called allopregnanolone... That's a word I don't have to-

   7. APAlex Partridge9:16

      [laughs]

   8. SPSpeaker9:17

      ... want to have to say too often. Allopreg- pregnanolone. It impacts and acts on GABA receptors in the brain, and GABA is where alcohol hits as well. So when you have your period, it's like being hungover 'cause the pro- progesterone's dropping. It's like alcohol being withdrawn. And when you go into menopause, very often people's anxiety goes up and you see women developing increased patterns of, of, um, problems with alcohol 'cause they're drinking to reduce anxiety and help with insomnia. So really, this is really complicated, you know, interactions between multiple hormones and behaviors. It's not easy to summarize, but this is the kind of landscape we're looking at.

   9. APAlex Partridge9:52

      It sounds like an incredibly confusing time, uh, for, for a woman.

   10. SPSpeaker9:57

       It's in- a confusing time for doctors, if I'm honest as well, and this is where I think, um, my journey on this started. I'm obviously a woman who's kind of around menopause. Um, and so my journey on this started looking after patients of a similar age five, six, seven years ago. I educated myself because I went, when I went to see my GP, my GP said, "You're too young." And then when I was seeing female patients, they were coming in from their doctors and they said, "Oh, I spoke to my doctor, and he rolled his eyes and said, 'Don't talk to me about menopause.'" It's confusing for doctors, and the science isn't that clear. And we see different responses in different women, and we don't really know why. And so it is, it's quite... You, you need really well-trained, um, medical staff to be able to give good advice, and it takes a while-

   11. APAlex Partridge10:36

       Mm

   12. SPSpeaker10:36

       ... to tailor treatments for people.

   13. APAlex Partridge10:38

       I wanna explore some more of those confusions, uh, Judith, but I think there was just one, uh, hormone I wanted to touch on first, and that was testosterone. How does that play its part?

   14. SPSpeaker10:47

       So testosterone is metabolized to estrogen by aromatization. So, uh, women have testosterone as well as men. It's not a male hormone. And we know that as women's estrogen levels drop, we also see a drop in their testosterone. So some clinicians, um, will look at prescribing testosterone for women at low doses. It's not licensed in this country, in the UK, but some clinicians, um, do look at prescribing testosterone for women. And there's some emerging clinical evidence that maybe it really helps with, um, brain fog and clear thinking and energy. It is licensed in other countries for enhancing libido, uh, but for brain fog it isn't, so.

   15. APAlex Partridge11:21

       And going back to the confusions, I mean, uh, it sounds like a minefield of knowledge to try and digest and consume for anyone. I mean, going through it, it must be a tsunami of, of different data points pulling you in a different direction. Out of the women you've spoken to, do you see that confusion taking them sometimes to quite concerning places?

   16. SPSpeaker11:41

       So yeah, it can do. It really can do. Uh, a lot of women present in, at this time of life because their mental health has taken a turn for the worse. One in six women gets depressed in, uh, the perimenopausal period. Um, so we see an increase in common mental health conditions, anxiety, depression, et cetera. And I think this is where, um, having good education is important and being aware, being aware that things may happen that are quite subtle to start with, but then as they, as the, the problem grows, it can be a really big problem.

   17. APAlex Partridge12:11

       Mm.

   18. SPSpeaker12:11

       So having good education is really important to think, "No, this may be perimenopause and it might need addressing."

   19. APAlex Partridge12:16

       If we look at the hormone fluctuations, Judith, and we see, like you've explained, that they can have a significant impact on someone's ADHD and their ability to manage it, what hormone would be the key villain in that story, and what moods might that hormone be responsible for?

   20. SPSpeaker12:33

       Ooh, I don't like villain. [laughs]

   21. APAlex Partridge12:36

       [laughs]

   22. SPSpeaker12:36

       I like to think it as, as, as savior. So I would say that estrogen would be the kind of knight in s- shining armor that can turn up on its white horse and make you feel better. And certainly, I would love every woman in the UK to be given a health check at 45 and given advice about, uh, management of menopause because estrogen for many women is a useful thing to take at that point to reduce low moods, and we know estrogen's effective as an antidepressant.

   23. APAlex Partridge13:01

       Mm.

   24. SPSpeaker13:01

       We've got that evidence. The evidence has been around since the '90s at least. Jayashri Kulkarni in Australia does amazing research, and we just don't use the evidence we have, which is really frustrating. So estrogen is like the savior, and progesterone can be a villain when you give synthetic progesterones 'cause we know those can worsen mood. But bioidentical progesterone is better for mood. Um, so progesterone can be really helpful, and obviously if you're taking estrogen and you have a womb, you need to take progesterone as well-

   25. APAlex Partridge13:27

       Mm

   26. SPSpeaker13:27

       ... to protect the womb from endometrial cancer. So, um, I would say those two are sort of, um, the key players. Testosterone would be a later addition to the, to the, to the scene if that's needed.

5. 13:38 – 15:03

   Advice for partners, family and friends

   1. APAlex Partridge13:38

      And during this time, how can it look for the, the people that are around the, the woman coming into this f- phase of, of her life? Do you have any advice for, for them on how to manage such a tempestuous time?

   2. SPSpeaker13:53

      It's, again, it's a really good question because it's one that men often ask me. So I do talks on menopause for men, helping p- men understand this, this, um, time of life because it can be... it can come with quite a lot of shame and embarrassment. Men don't necessarily like talking about gynecological stuff. Um, and so helping understand it is really important, and also being able to say to your, you know, the people around you, colleagues, friends, family, "I know that, you know, this can be a difficult time. Is there anything I can do to help?" But I think for families, what's... or for, for... yeah, for families and friends, what's difficult is you can see sometimes a woman really suffering, and, uh, uh, not every woman is ready to go and have those conversations. We still see lots of women who are embarrassed to talk about gynecology or who are not well-supported by a good GP or, um, are concerned about thinking about HRT. Uh, lots of reasons why people have anxieties about, about addressing this.

   3. APAlex Partridge14:44

      Mm-hmm. W- we, we talk a lot, Judith, on this podcast about people getting misdiagnosed with ADHD and often presenting with symptoms of anxiety, uh, or overwhelm, and that takes them to care, that takes them to assessment, and they get diagnosed, maybe misdiagnosed, with ADHD.

6. 15:03 – 17:43

   Traits of Menopause that can be confused with ADHD

   1. APAlex Partridge15:03

      But through the lens of menopause, can there be traits of the menopause or perimenopause that could overlap with ADHD and therefore lead to a misdiagnosis?

   2. SPSpeaker15:14

      Um, again, that's a really interesting question because to get a diagnosis of ADHD, you need traits. They need to be lifelong.

   3. APAlex Partridge15:21

      Mm.

   4. SPSpeaker15:21

      So they need to be pervasive, and you need to have had them since before the age of 12, and you need a certain number of traits. But you also need to be distressed by the symptoms. So if a woman, um, copes really well throughout her life, um, and I saw somebody like this today, somebody... you know, you cope really well throughout your life, um, but you definitely have features of ADHD, but you're not distressed, you don't meet the diagnostic threshold. If, say, at 40 or 45, suddenly you become distressed, now you do meet the diagnostic threshold. So it's not so much misdiagnosis, it's more that now you're actually meeting the diagnostic threshold. And then the question is, what do you do for that woman? Do you prescribe HRT? Do you prescribe an antidepressant for anxiety? Hopefully not. Or do you look at actually a treatment for ADHD? But we see, I mean, certainly in the last, I would say, in the past, women were just given antidepressants at this point-

   5. APAlex Partridge16:10

      Mm

   6. SPSpeaker16:10

      ... or CBT, and neither of those things is gonna help with menopause or necessarily ADHD. So it's good that there's awareness now 'cause I think we should be using kind of the proper NICE guidance to support people's treatment at this point.

   7. APAlex Partridge16:23

      Could it be the case that, that the, the, the woman was essentially managing her ADHD? She might not be aware that she has ADHD, but she subconsciously has put scaffolding around herself, and she's put tools and strategies in place to, to get by and to deal with some of the, the challenges that come with ADHD, but when the menopause happens, that kind of adds additional stress, the scaffolding kind of wobbles-

   8. SPSpeaker16:48

      Yeah

   9. APAlex Partridge16:48

      ... and that's what enables her or, or makes it necessary for her to almost not get into a crisis point but adds that extra ingredient of distress that takes her to assessment?

   10. SPSpeaker16:59

       Totally. Absolutely. That's, I think that's exactly what's happening. And, and because people with ADHD who are also anxious tend to do better because the anxiety is like, um, it sort of tightens the screw of focus basically. It helps you to focus if you're a bit stressed. So an awful lot of people with ADHD will use stress in order to focus. But then when you come into menopause or perimenopause, as your estrogen levels drop, so do your serotonin and dopamine levels. So you're left with less serotonin, less dopamine, and you're less able to focus, and you're more anxious, and that's when you tip into this crisis where actually you're overwhelmed with anxiety, your mood is low, you can't focus, and the strategies that you used before no longer work-

   11. APAlex Partridge17:40

       Mm

   12. SPSpeaker17:40

       ... because the biological landscape has changed.

7. 17:43 – 19:17

   Tiimo advert

   1. APAlex Partridge17:43

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8. 19:17 – 24:35

   Does ADHD get worse after Menopause

   1. APAlex Partridge19:17

      Do you know the percentage of women that report to have their ADHD traits worsen as they go into menopause?

   2. SPSpeaker19:25

      There's an attitude survey. So one of the issues we have is there's not much good research. There's very little clinical research. It's almost as if nobody really cares.

   3. APAlex Partridge19:32

      Right. Yeah. [laughs]

   4. SPSpeaker19:32

      The discussion, does nobody care? I think people do now-

   5. APAlex Partridge19:35

      Mm-hmm

   6. SPSpeaker19:35

      ... 'cause we realize what a big issue it is. Um, so for, there was an attitude survey from 2023. I think it shows that about 90% of women with ADHD report an im- a, a worsening of symptoms in perimenopause and menopause.

   7. APAlex Partridge19:47

      90%?

   8. SPSpeaker19:48

      I believe that is the statistic, but I should have to check. It's around that, yeah. Yeah.

   9. APAlex Partridge19:52

      So significant.

   10. SPSpeaker19:53

       It's a really s- it's... Yes, and we also know that women without ADHD get symptoms that look like ADHD and respond to stimulants 'cause there's some, there is some clinical research on giving stimulants to women who don't have ADHD, and you see an improvement in their brain fog 'cause it's the same biochemistry.

   11. APAlex Partridge20:11

       Mm.

   12. SPSpeaker20:11

       So it's all about dopamine.

   13. APAlex Partridge20:13

       Why do you think, Judith, people are talking more about the menopause now, mm, and why do you think they weren't for so long?

   14. SPSpeaker20:20

       Shame, basically. So, uh, it's the same reason people talk about mental health more now. So the nice thing about the internet is you can go online. Nobody needs to see where you're going, and you can go and find groups of other people to talk about menopause, weird symptoms, mental health, and that's really positive, I think, that we're much more open-

   15. APAlex Partridge20:37

       Mm

   16. SPSpeaker20:37

       ... than we used to. So we're talking about it more. Um, also, it affects half the population. Everybody wi' like-

   17. APAlex Partridge20:42

       [laughs]

   18. SPSpeaker20:42

       ... with ovaries will go through the menopause. So yes, that's it. It affects half of us.

   19. APAlex Partridge20:46

       And can the menopause affect memory? 'Cause I suppose if, if you're... We all know, obviously, the ADHD, some of us struggle with short-term memory, and c- can the menopause or traits of be confusing with the natural traits of ADHD?

   20. SPSpeaker21:01

       Yes. So with ADHD, we find people are forgetful, but they're not usually quite as forgetful as they tend to be. So in, in menopause, you have sort of quite specific memory problems like difficulty name, recalling people's names, forgetting what you went into, into different rooms for. So you do, do see sort of, um, minor memory problems. Um, they're slightly different from ADHD, but yes, it's, it's very easy to, to get the two kind of mixed up and also for the menopause to exacerbate the ADHD symptoms-

   21. APAlex Partridge21:26

       Mm

   22. SPSpeaker21:26

       ... definitely.

   23. APAlex Partridge21:27

       I think for me it's like in conversation in public, it's that word recall that I struggle with.

   24. SPSpeaker21:32

       Yes. Yeah.

   25. APAlex Partridge21:32

       You could, you say something that I say every day, like a particular train I get, and, oh, I'm coming from... Sometimes I can forget the city where I live. [laughs]

   26. SPSpeaker21:41

       Really?

   27. APAlex Partridge21:41

       Like, the, the-

   28. SPSpeaker21:42

       Yeah, yeah

   29. APAlex Partridge21:42

       ... the recall of, of, of words that I use all the time. When I'm in conversation, maybe there's a bit of social anxiety coming into play there, but yeah, the recall memory issue is, is big for me.

   30. SPSpeaker21:52

       Yes, so that grip thing where you can't quite grip the thing that you want to get.
9. 24:35 – 29:00

   The Menopausal shame chain reaction

   1. APAlex Partridge24:35

      Speaking about vulnerability, is there a chain reaction that can occur when the menopause strikes? In other words, a person feels more overwhelmed due to the hormonal fluctuations, which then leads to emotional dysregulation, which then leads to lashing out, which then leads to shame, for example.

   2. SPSpeaker24:55

      Yes. Yes, yes. So because the brain's so complicated, like I think of it as being like space, so the brain is more complicated than space.

   3. APAlex Partridge25:02

      Mm.

   4. SPSpeaker25:03

      And so when we try and summarize it, we inevitably get it, you know, it's like it's, it's, we can't summarize it, but it's many, many cycles, many cascades of things that occur very rapidly in the blinking of an eye, literally. And you get these cascades, emotional cascades, where an emotion then triggers a thought, triggers a behavior. And what we tend to find in all mental health is that stability breeds stability, instability breeds instability. So when you have changes in a system, the system has to adapt, and that leads to a degree of dysregulation. And so we see, yeah, a more emotional volatility, lack of sleep, which worsens the emotional volatility, which worsens the impulsivity-

   5. APAlex Partridge25:40

      Mm

   6. SPSpeaker25:40

      ... which worsens the lashing out. So you definitely see these spirals, shame spirals. And, and when people feel better, um, and are kind of coming out the other side, we see the kind of rebuilding of stability in the system.

   7. APAlex Partridge25:52

      How about one's ADHD distractibility? Would this increase due to hormone fluctuations caused in menopause?

   8. SPSpeaker25:59

      I guess it could do. I think pretty much, I mean, I call it men- you know, ADHD squared 'cause it is literally the symptoms-

   9. APAlex Partridge26:04

      [laughs]

   10. SPSpeaker26:04

       ... of menopause are very similar to ADHD, and so you're kind of squaring your symptoms. So yes, there's no reason why it shouldn't increase. And it's not just ADHD squared, maybe it's ADHD cubed, 'cause you've also got the physical symptoms of menopause, so you know, the bone pain, the tingling, the weakness, the weight gain, all the physical symptoms as well of menopause.

   11. APAlex Partridge26:22

       Mm.

   12. SPSpeaker26:23

       So it's like ADHD cubed.

   13. APAlex Partridge26:24

       Right. [laughs]

   14. SPSpeaker26:25

       There we go.

   15. APAlex Partridge26:25

       Yeah. Um, I read somewhere, Judith, in a study, um, someone said, "I never experienced rage or brain fog before perimenopause." Can menopause cause rage in a person who didn't necessarily have that as a personality trait prior?

   16. SPSpeaker26:42

       Definitely seen it. Yes, quite a lot of people describe kind of bouts of rage, and we get unusual symptoms in perimenopause. This is what I mean about it's like your body gaslighting you, things that you didn't know were real symptoms. So my fingers swelled up-

   17. APAlex Partridge26:55

       Mm

   18. SPSpeaker26:55

       ... my joints were big. It's like, what is that? My, I was incredibly dizzy. My doctor thought I had a brain tumor. It was just perimenopause. So yes, weird symptoms, that's, that's perimenopause all over. So rage, definitely, yeah. And some women actually also incre- report increasing libido, which can be really problematic, um, due to kind of emot- uh, hormonal variation. So I've had some women come up and talk about that and say, "This is really difficult. What do I do?" So.

   19. APAlex Partridge27:21

       I- in terms of that being problematic, do you mean then, like, you're talking about i- infidelity and, and affairs happening?

   20. SPSpeaker27:27

       I think for some women, some infidelity, but also this kind of i- inappropriate feelings towards colleagues, things that they were not expecting in kind of midlife when you're, you know-

   21. APAlex Partridge27:38

       Mm

   22. SPSpeaker27:38

       ... working in a paper company in Slough-

   23. APAlex Partridge27:40

       [laughs]

   24. SPSpeaker27:40

       ... for instance. [laughs]

   25. APAlex Partridge27:42

       If anyone's listening in Slough, then keep your chin up.

   26. SPSpeaker27:46

       Absolutely. Beware-

   27. APAlex Partridge27:48

       Yeah. [laughs]

   28. SPSpeaker27:48

       ... residents of Slough.

   29. APAlex Partridge27:49

       Yeah. [laughs] Watch out for menopausal women.

   30. SPSpeaker27:51

       On prowl. [laughs]
10. 29:00 – 30:00

    How to manage the symptoms of Menopause

    1. APAlex Partridge29:00

       And how can a, how can a woman manage these fairly vicious symptoms and help ease them?

    2. SPSpeaker29:08

       So, um, there's lots of ways. I suppose the first things are obviously speak to your GP, obviously think about HRT if that's appropriate for you and you want to go down that avenue 'cause definitely estrogen can help with all sorts of psychological and physical symptoms of menopause. If you don't have an ADHD, um, diagnosis, then it might be worth trying to pursue one. If you haven't previously needed ADHD medication, you might want to think about it. And then beyond that, it's the other things as well, and obviously I'm very much into the other things, the psychoeducation, the group work, the getting together, the talking, the sharing, the learning about what's going on, so that when your body does throw up a new symptom, you don't think, "Oh my goodness, I've got a brain tumor." You think-

    3. APAlex Partridge29:45

       Mm

    4. SPSpeaker29:45

       ... "Actually, this is probably perimenopause." Um, and then on top of that, the things that really help, exercise is key. Weightlifting is really good in menopause because weight gain is an issue, but when you have bigger muscles, actually your metabolic rate is higher. Uh, looking at your diet's important. It's a great time to give up

11. 30:00 – 35:04

    Unusual traits of the Menopause that Google won’t tell you

    1. SPSpeaker30:00

       drinking. I know you, you don't drink, do you?

    2. APAlex Partridge30:02

       That's right, yeah.

    3. SPSpeaker30:02

       Yeah.

    4. APAlex Partridge30:02

       Yeah.

    5. SPSpeaker30:03

       I've pretty much given up myself 'cause it just is a, it's a fool's game at this point.

    6. APAlex Partridge30:06

       Mm.

    7. SPSpeaker30:06

       I can't manage it. It doesn't help anyone. Um, so it's a good time to have a kind of lifestyle overhaul if you can. And also sometimes-Taking a break from work, for me, it's been a time where I've pulled back from work for three or four years and worked differently. Not everybody can afford to do that, not everybody can manage that, but it's certainly, you can talk, talk to your employer-

    8. APAlex Partridge30:25

       Mm

    9. SPSpeaker30:26

       ... about this, 'cause they generally have, um, policies in place for menopause.

    10. APAlex Partridge30:30

        Just thinking about the sort of the traits of the menopause that might come up if someone puts a search query into Google-

    11. SPSpeaker30:38

        Yeah

    12. APAlex Partridge30:38

        ... but from your experience in ha- working with your community, have you noticed any very niche, unusual traits that are to do with the menopause that might not show up in a Google search?

    13. SPSpeaker30:49

        [laughs] So I'm glad you asked this. I, I looked up symptoms of the menopause at the Menopause Charity, a UK-based charity. They came up with 100, but, um, from a brief straw poll of friends, we came up some, with some other ones, one of which was a friend whose feet burn at night.

    14. APAlex Partridge31:03

        Right. [laughs]

    15. SPSpeaker31:04

        She wakes up and she feels like her feet are actually on fire-

    16. APAlex Partridge31:06

        Right, okay. Gosh

    17. SPSpeaker31:07

        ... which is weird. Um, I found that my, my choice of jokes changed, so I began to tell what I can only describe as dad jokes-

    18. APAlex Partridge31:13

        [laughs]

    19. SPSpeaker31:14

        ... which is really weird.

    20. APAlex Partridge31:15

        [laughs] What's your favorite dad-- Don't want to put you on the spot. What's your favorite dad joke? [laughs]

    21. SPSpeaker31:21

        [laughs] Why did the, uh, baker have green hands?

    22. APAlex Partridge31:26

        Why did the baker have green hands?

    23. SPSpeaker31:27

        'Cause he needed to pee.

    24. APAlex Partridge31:28

        He needed to pee. [laughs]

    25. SPSpeaker31:29

        Sorry. It's bad, isn't it?

    26. APAlex Partridge31:31

        You must be going through the menopause.

    27. SPSpeaker31:33

        That's it. Dad jokes.

    28. APAlex Partridge31:34

        There we go. Yeah. [laughs]

    29. SPSpeaker31:37

        Sorry. [laughs]

    30. APAlex Partridge31:37

        That was a good one. Yeah, people-
12. 35:04 – 37:57

    The ADHD Item

    1. APAlex Partridge35:04

       ... ADHD item.

    2. SPSpeaker35:05

       Ooh, the lights have gone down. Now, these are PEZ dispensers. You remember these from childhood?

    3. APAlex Partridge35:10

       Yeah, of course. Yeah, yeah.

    4. SPSpeaker35:11

       Yes, yes.

    5. APAlex Partridge35:11

       Yeah.

    6. SPSpeaker35:12

       So they should contain... So this one here is, I can't remember if it's Chase or Skye from Paw Patrol. This one here's got little, little sweeties in it that pop out. There we go.

    7. APAlex Partridge35:20

       Very nice.

    8. SPSpeaker35:21

       Whoops, there we go. And this one is empty.

    9. APAlex Partridge35:23

       Yeah, okay.

    10. SPSpeaker35:24

        And the, basic- the reason I talk about PEZ dispensers is because somebody with ADHD has lower background dopamine.

    11. APAlex Partridge35:32

        Yes.

    12. SPSpeaker35:32

        So you are asked to do something boring, you get no reward. Whereas someone with- without ADHD, do a boring task, Alex. Complete a boring, like, I don't know what's boring for you?

    13. APAlex Partridge35:41

        Gosh, what's boring for me? Emptying my laundry, doing my accounts.

    14. SPSpeaker35:45

        Doing your accounts. That's a f- So doing your accounts, if you don't have ADHD, you get a reward, a sense of achievement at the end of that.

    15. APAlex Partridge35:51

        Mm-hmm.

    16. SPSpeaker35:51

        You get a little kind of dopamine. I'm gonna eat this. Mm.

    17. APAlex Partridge35:54

        Yeah. I'm gonna have this one.

    18. SPSpeaker35:55

        So you have that one. You get a little dopamine reward.

    19. APAlex Partridge35:57

        How long have they been in there for?

    20. SPSpeaker35:58

        Um. [laughs]

    21. APAlex Partridge36:00

        [laughs]

    22. SPSpeaker36:01

        Actually only about a week.

    23. APAlex Partridge36:02

        Yeah, okay.

    24. SPSpeaker36:02

        But if you have ADHD, there isn't any dopamine in your person, you get no reward, which is why it's really hard to do boring things. So that's lower background levels.

    25. APAlex Partridge36:10

        Right. Yeah. Makes sense.

    26. SPSpeaker36:11

        We think that the neuro- the neuroscience is low background levels, so the empty PEZ.Low background levels of neurotransmitters, but because you've got low background levels, you're very sensitive to dopamine, so actually you're always looking for dopamine in the environment. And there are things like pinatas, things that are really stimulating. So what would be something really stimulating for you?

    27. APAlex Partridge36:29

        Ooh, going for a run.

    28. SPSpeaker36:31

        Going for a run?

    29. APAlex Partridge36:31

        Mm-hmm.

    30. SPSpeaker36:31

        Yeah. Okay.
13. 37:57 – 41:20

    The ADHD agony aunt

    1. APAlex Partridge37:57

       Um, this week, Judith, in the Washing Machine of Woes, someone has written in and asked, "I'm going through menopause as an ADHD woman, and no matter how hard I try, I just can't help losing my temper with my husband. And it must be terrible for him, but he winds me up with the smallest thing. What can I do to help this marriage last?" Gosh.

    2. SPSpeaker38:17

       Gosh. Okay, well-

    3. APAlex Partridge38:18

       This sounds like a real crisis

    4. SPSpeaker38:20

       ... it does sound like a bit of a crisis. The pressure's on, isn't it?

    5. APAlex Partridge38:23

       Go. [laughs]

    6. SPSpeaker38:23

       Um, go. Okay.

    7. APAlex Partridge38:25

       Save the marriage.

    8. SPSpeaker38:25

       Marriage guidance 101. Save the marriage. Um, I think she needs to tell him how annoying he's being, and that she's got a shorter fuse, um, and ask him to give her a bit more space, 'cause I get the sense that she does not like losing her rag. Um, and it might be worth, um, looking at are they distributing the household chores fairly? 'Cause very often women who coped fine with, with life, when they get to menopause, go, "You know what? I can't actually carry the same load," so maybe he could help her a bit more around the house, and she in return could say, "I'll do some mindfulness, or meditation, or some exercise." Exercise is brilliant for rage, so going for a walk, joining a group where she does some exercise with friends, something like that might reduce some of that short-temperedness.

    9. APAlex Partridge39:07

       Mm.

    10. SPSpeaker39:07

        And the joy of any kind of mindfulness or meditation is, and it doesn't ma- have to be sitting still, you can do it when you're walking or exercising, is it gives you the ability to just pause before you respond, even if... Oh, the other thing is time yourself out. So you know how with toddlers we put them on the stairs and time them out?

    11. APAlex Partridge39:23

        Yes.

    12. SPSpeaker39:23

        If I'm gonna lose my rag-

    13. APAlex Partridge39:24

        Mm

    14. SPSpeaker39:25

        ... I'll time myself out, walk out the room. "Just gonna m- take myself outside for a little word"

    15. APAlex Partridge39:30

        W-

    16. SPSpeaker39:30

        Which helps

    17. APAlex Partridge39:31

        ... does, uh, I think we spoke about this in our first episode, RSD, rejection sensitive dysphoria.

    18. SPSpeaker39:36

        Yeah.

    19. APAlex Partridge39:36

        Does it, does, does that come into the equation here? Because you said tell your husband how annoying he is, but if he has ADHD and/or, and/or he's kind of snaps back if you, like, like, RSD could blow this up, right?

    20. SPSpeaker39:47

        Well, it could. It could. Um, but I think that's the situation where actually a little bit of honesty might be called for, that both of you may be quite sensitive. But if we can't be honest in a relationship, that's not helpful. So-

    21. APAlex Partridge39:59

        Mm

    22. SPSpeaker39:59

        ... and, look, it's difficult. Um, and sometimes it takes one or other of the, the, the pair to go off and have a bit of therapy to work out what's really triggering them, what's really making them feel more emotional. But I think if you can come at it from a place of kind of trust, and, you know, if you've been married for a while, you's, this, you've got skin in the game. You've been doing this for a while, and, and so there's a reason to want the relationship to continue, so it's, you're jeopardizing it if you're not honest.

    23. APAlex Partridge40:22

        Do you think without, uh, honesty and without awareness of menopause and RSD, you know, you mentioned earlier sometimes you can get increased libido plus perhaps an increase in irritability, and all this all, all seems, seems like the perfect pressure cooker for, uh, for almost marriages to end sometimes. Do you see menopause being a trigger sometimes for breakdowns-

    24. SPSpeaker40:43

        Yep

    25. APAlex Partridge40:43

        ... in marriages?

    26. SPSpeaker40:44

        Yeah. So Rhod Stewart talked a lot, and his wife talked a lot about the impact of her menopause on their marriage, 'cause she had a really tough time. He didn't know what it was. And, um, I think, you know, many marriages go through a tough time at this point, because the person who you married is changing, and that can sometimes mean when a woman emerges from menopause, you might think, "I no longer will put up with this behavior," or, you know, or the, the, the husband might think, "Actually, you've changed and I'm not sure i- I, the relationship's the same." So e- either way, people, it's a period of change. It's a time of change.

    27. APAlex Partridge41:15

        Mm.

    28. SPSpeaker41:15

        So yes, it is a, it's a, a time of instability for some relationships.

    29. APAlex Partridge41:19

        Yeah.

14. 41:20 – 42:14

    3 Rules To Live By

    1. SPSpeaker41:20

       Yeah.

    2. APAlex Partridge41:20

       Just finally, Judith, I wanna deliver you a letter that was written by the previous guest.

    3. SPSpeaker41:23

       Okay.

    4. APAlex Partridge41:24

       I'm gonna deliver you, Judith, a letter that was written by the previous guest, where they wrote-

    5. SPSpeaker41:27

       Thank you very much

    6. APAlex Partridge41:27

       ... their three rules to live by.

    7. SPSpeaker41:29

       Three rules to live by.

    8. APAlex Partridge41:30

       Three rules to live by.

    9. SPSpeaker41:31

       Okay. Can I read them is the question?

    10. APAlex Partridge41:32

        Yes, please.

    11. SPSpeaker41:33

        Okay. Three rules to live by: find something you love and enjoy and gives you purpose in life, preferably something you can do for work. I love that. Don't underestimate yourself. You have so much more than you realize. Take a proactive lifelong approach to your physical and mental health. Those are fabulous.

    12. APAlex Partridge41:51

        Amazing.

    13. SPSpeaker41:52

        Who are those from?

    14. APAlex Partridge41:52

        Profound. Those were from-

    15. SPSpeaker41:54

        Joe

    16. APAlex Partridge41:54

        ... Joe Per- Dr. Joe Perkins, psychologist.

    17. SPSpeaker41:56

        They're really good. Love them. Yeah.

    18. APAlex Partridge41:57

        Amazing. And I'll kindly ask you to do your three rules, Judith, as we finish. But on behalf of everyone who is experiencing, going to be experiencing, or has experienced menopause, thank you so much.

    19. SPSpeaker42:10

        Thank you very much. [outro music]

Episode duration: 42:15