← ADHD Women's Wellbeing Podcast
ADHD Women's Wellbeing Podcast
Estrogen Fluctuations - ADHD & Hormone bonus episode with Dr Jeanette Wasserstein
Loading summary
Transcript13 lines
- [00:02]
A
So, hi everyone. Welcome back to another bonus episode of the ADHD Women's well Being podcast. And I'm really delighted to be able to bring to you one of my earlier episodes. It was actually episode number eight. This is with Dr. Jeanette Wasserstein. Now, Dr. Jeannette is a New York based ADHD clinical neuropsychologist who specialises in the diagnosis and treatment of ADHD in adults. And she's been doing this for the past 30 years. And she also has a very special interest in hormones, ADHD in women, menopause, and really understanding the role of estrogen and the fluctuations within girls, pregnancy, postpartum menopause. So I wanted to bring you this episode because it was way back in my journey when I started to realize that there was huge differences in the way ADHD manifested in girls and boys and men and women. And when I spoke to Jeanette Wasserstein, it was really eye opening because she is pretty much one of the founding doctors who has started to understand the connections between hormones and adhd. And so to speak to her was a huge honor. She also has done a few presentations and written articles for Attitude magazine. So I really do urge you to have a little read and maybe listen to some of the stuff. But if you go back to episode eight and you'll be able to listen to the full episode. Now the reason why I'm bringing in these short episodes is because I've launched my ADHD Women's Wellbeing Hormone series. Now, I'm sure you've heard me talking about it, but I'm not going to stop banking on about the impact it's having and what I'm bringing to you. And this is a rolling product. So I have got at the moment nine different experts and this is growing as we speak. I'm currently interviewing new people, different experts, and really building on these foundations of these fantastic episodes that I've been bringing you. And the feedback has been really fantastic. And I just wanted to read out to you some a message that I received recently from someone. I'm getting them all the time. I'm getting people emailing me, messaging me, telling me how certain episodes are really resonating with them, how they're having light bulb moments. And this is what I want to bring to you. I want to be able to bring the experts and the knowledge and the expertise that is few and far between. I'm really sort of like clutching at stores, speaking to different people who have decided that is just as important to understand the impact of all hormones than Understanding all the other components of adhd. I just wanted to read this message I got the other day. I'm slowly working through the Hormone workshop and have just watched the Elizabeth Swan episode. Wow, I really subscribed to this for my daughter. But so much of what was being said said resonated with me. I was even thinking things before you said them. My daughter even asked if I thought my sickness in pregnancy was connected and then you said it. It's also amazing to see my daughter watching in the light bulb moments. And also I feel like she's starting to understand. I do really understand some of her issues and I'm not just saying I do. I am definitely undiagnosed and it's helping me to be kinder to myself and understand more about my past and hope I can support myself through all the things I felt and supported through. I honestly cannot thank you enough. When she was diagnosed, the psychologist recommended attitude to me and I think all females diagnosed should be recommended to follow you. Now obviously that's a lovely message to receive, but I wanted to read that to you because I wanted you to fully understand that if you've got a daughter, teenage daughter with adhd, and you're trying to understand the ups and the downs, the moods and the dysregulation and really just having almost like a different child through the month, then I urge you to to maybe watch some of the episodes of the Hormone series. But also so many women are coming to me and saying they're watching it and they are having these epiphanies. They're suddenly understanding all the cycles. Perhaps they've suffered with postnatal depression. We talk about this in today's episode. Maybe we suffer from pmdd, you know, really low mood towards the tail end of our cycle. So this is just a way of understanding ourselves so we can give ourselves more love and kindness and compassion, but also bolster ourselves with different lifestyle tools, with medication, with help, so we can really, really start living our life without having to feel like there's something wrong with us. I really hope that Today's episode with Dr. Jeanette Wasserstein helps and helps you connect some dots. But also if you are starting to have more questions, please do head to the Hormone series, which is on my website, ADHD womenswellbe and you can head to the show notes as well. So here is my brief chat from a longer episode with Dr. Jeanette Wasserstein and as I mentioned, just head to the full episode. It's episode eight to listen to my full conversation with her Also, you'll hear that Dr. Jeanette mentions breast cancer and HRT. Now, there is an old school opinion on this and it has been historic. However, I do want to address quite a few messages and conversations I've had with women who have gone through breast cancer and cannot take HRT or they do have breast cancer in the family and they don't want to put themselves at risk. So I just want to acknowledge that because I know that in lots of my episodes I talk about HRT and I talk about how impactful it can be. But I also want to acknowledge many of you who can't take HRT and do feel a little bit lost and not sure where to go. So if you are going through the menopause and you are starting to understand your ADHD journey but you're unable to take hrt, there are other options. This is when you need to speak to your psychiatrist and really sort of hone in on where you struggle and what you need throughout the month to help you. So please don't feel that if you can't take HRT that you're a lost cause because I really do believe there are other options. So I know that a lot of other women would be very interested to understand how hormones play a role in our ADHD fluctuating throughout our lives.
- [06:18]
B
You're again describing a lot of things that the science is catching up with or beginning to explain the dynamics and the impact of puberty on add to my knowledge, that's not well mapped out at all. We know that in general women fluctuate. All women neurotypical and ADD women fluctuate in their verbal fluency as a function of where they are. Sorry about speaking in scientific ease depending on where they are in their menstrual cycle, but that to my knowledge has not been well mapped out. Where we know much more is what happens in pregnancy, post pregnancy perimenopause and menopause that we know much more about. It's the. It's a shame about the teenagers, but we'll get there. But it's. It, it's. That's why I was asking about your experience with teenage girls. It's not been mapped out. On the one hand it should be better because increasing amounts of estrogen are associated within increased and enhanced cognitive functioning across the board. Because estrogen, it's good for neurons and it also modulates and controls the creation of a lot of the very important neurotransmitter substances which relate to mood regulation and attention. For those of you who don't know when I'm speaking in scientific ease and talk about neurotransmitter substances, those are the chemicals that flow between the neurons and enable basically the smooth functioning of different brain regions. So estrogen is very important for the control of acetylcholine, which is really important for memory, and epinephrine, which is pivotal in add, and serotonin, which is very important in the regulation of emotions and is actually the main mechanism that underlies the effect of antidepressants. So that's kind of basic science about what estrogen does, and it makes sense in terms of the stuff that I'm about to cover. I don't know where it falls in with puberty, because one would think girls would get better during puberty because that's when they're getting an influx of estrogen. On the other hand, that's when a lot of ADD gets diagnosed in girls. So how those come together is not clear yet. Certainly not in my thinking and in the science. Certainly when estrogen kicks in for whatever reason, girls get more depression and anxiety. I don't, don't know how that plays out. I don't know if it's about regulation of the underlying nervous system, mechanisms not being fully developed. Don't know. But where we do know more is what happens with pregnancy, birth and afterwards. And there you're being a textbook case, because during pregnancy, what we know is that estrogen just skyrockets. And what we find is that many women with ADD and many women with bipolar illness frankly, do way better with no medications during pregnancy because the estrogen itself is helping the underlying nervous system vulnerabilities. With a delivery, there's a sharp drop off of estrogen and other hormones, but mainly estrogen. And that's when you get the mood dysregulation problems. Postpartum depression is one of the most dramatic manifestations, and apparently it's more common in women with add. So we're talking about a baseline, perhaps under production or under regulation or under responds to estrogen before and then with the delivery of a baby, there may be being a disproportionate reaction to the drop off of estrogen. That's a mechanism I'm positing. In any case, the external observation is that women with ADHD have a higher incidence of postpartum depression than non ADHD women, and that women with ADHD often can do quite well off medication during pregnancy, which is good news because that's a question that lots of ADD women have, which is, now that I'm pregnant Should I continue taking my stimulants? It's not 100% clear whether stimulants are harmful, neutral or no. There's no indication that they're helpful. But whether they might be harmful or neutral during pregnancy, that's the bad news. But the good news is that there's every indication that the natural hormones that your body is producing during pregnancy do a great job compensating for being off the med. So take that in your pipe and smoke it then. Perimenopause is another weird time hormonally because all of our hormones fluctuate all over the place during the perimenopause period. Up, down, up, down. And if you look at my podcast, I that I just did with attitude. Anybody interested reviewing a lot of these same things? Anyway, there's a figure that I think is terrific that shows what happens with estrogen during the different stages of life and shows estrogen going up during pregnancy, dramatically falling off after pregnancy, and then being pretty stable until we get to perimenopause. And then it's all over the place again. So you can have a lot of fluctuations in that period. And women will talk about sort of where perimenopause ends and menopause begins is after the fact diagnosis. You get diagnosed as having had menopause or having being menopausal is when you've been without a period for a year. So until that point, you're in perimenopause when it's going up and down and up and down and up and down. That's a period when many women who are kind of borderline add, their whole life will fall off the cliff. And it's not. It's not on the border anymore. It's like it's gotten to the point where it's very clear. It's also a period where women, even if they've been diagnosed and been taking medication and doing well or pretty well on all their interventions, they may no longer work or they work inconsistently because the hormones are fluctuating up and down. In particular, estrogen. We don't know much yet about how progesterone affects all these things. The fluctuation in mood around periods, especially after ovulation. It's more. I mean, it happens to neurotypical women as well. But again, it's one of those things that happens disproportionately to women with add, probably because of the underlying hormonal sensitivities or extremes in production. That's a well addressed with an SSRI serotonergic medicine done at the end of the month, I mean, after ovulation. So you do it like two weeks before your period. And that's what they do to regulate the extreme mood fluctuations. For women with and without ADD who have this symptom.
- [13:51]
A
Is there anything that can be done at this point when we're feeling like, you know, the other stuff that we used to do isn't working?
- [13:59]
B
I mean, one of the first and easiest things to do in menopause or after menopause is to increase the level of the stimulants during perimenopause. It's not so straightforward because you have those fluctuations. So sometimes they help, and at other times they're too much and you're overstimulated. So it's trickier. The other interventions, pharmacologic interventions that are not at all, to my knowledge, have not been applied to the perimenopause. Is hormonal intervention meaning some way to either stabilize the underlying estrogen profile or supplement the diminishing or diminished estrogen profile? That's tricky, A. Because no psychiatrists will play with hormones because they say, I have no training in it. I mean, rightly so. At this point, they have not been trained. So they say, go to your OB GYN problem. There is that obgyns, they vary in terms of their willingness to do that. And it's interesting, all of the early literature on the effect of estrogens on thinking and cognition and mood regulation actually comes from the obgyns. They were the one who did the research and told the world. Nevertheless, they're still not all that comfortable intervening in cognitive things because that's not what they're trained in. So the two, you know, the three disciplines, because psychologists are not that knowledgeable either yet, have not come together, but they will. But right now, they haven't come together. All that said, if you can find a psychiatrist who will send you to an OB gyn, who's willing to do this or who is willing to maybe do it themselves. Estrogen supplementation or leveling out with birth control pills is one way to go. The caveat in that is that a lot of women have a risk or an increased risk for breast cancer, and a lot of breast cancer is sensitive to estrogen. So that's tricky. I mean, if you have a family with a high base rate of breast cancer, particularly those with the BRCA gene, it's hard to know what to do. Or if you decide to do it because nothing else has worked, you got to have really close monitoring I'm not saying throw it out and it's not an option, but you have to have really close monitoring.
- [16:26]
A
So when you talk about this, is it, are you referring to HRT or is this something different? Because would you say that HRT can help with your ADD symptoms? If you are going through a sort of atypical menopause and if you've been managing your lifestyle and maybe you've had medication or maybe you just manage your ADHD through, you know, lots of lifestyle interventions, would you recommend HRT to help with the ADHD symptoms?
- [16:56]
B
Oh, for sure. That's what. That's when I said estrogen replacement treatments.
- [17:00]
A
Okay, the same thing.
- [17:02]
B
I'm sorry about that. HRT stands for hormone replacement therapy and the hormone that they're replacing is estrogen.
- [17:09]
A
Okay.
- [17:09]
B
So all the, all the concerns that I was expressing apply that psychiatrists are unfamiliar, obgyns may not be comfortable using it for cognitive complaints, and psychologists are not yet all that aware so that they can make the recommendation in either direction. So hormone replacement therapy is a great, great way to go. The only women where there's research to back this up are women who either are postmenopausal or women who've naturally postmenopausal or women who've had their ovaries removed and abruptly develop premature menopause. And the findings are variable in terms of whether it helps or not. It helps some things and not other things. So hormone replacement therapy is definitely an option, but you got to get the doctor who's willing to do it. So the stimulants in complement with some form of estrogen or hormone replacement therapy is a good way to go if none of those work. Another option that there is no, to my knowledge, science or very little for is Aricep or the class of drugs that increase the availability of acetylcholine in the nervous system. The reason that's relevant is acetylcholine is really important for memory. So drugs of that class, of which Aricept is the first, might help. Worth a try. They're pretty benign. There's no, to my knowledge, if you can tolerate them, there's no long term effect to worry about. So they're worth trying. And some people have anecdotally tried Aricept with ADD years and found good, good results for some of them.
- [19:00]
A
Feels like, you know, we're on the back foot a little bit, aren't we, as women where we're battling the hormones alongside the adhd. Would you say that you see this with some of your patients? That they are leaning towards their lifestyle to, to help because perhaps the doctors and the drugs aren't quite working for them.
- [19:21]
B
It's certainly something I recommend. You know, all the things, and I'd say of all the things that you're talking about, the easiest and maybe most important is sleep. So even the women who don't have time to exercise and don't have the inclination, they're not foodies to do much in the way of modulating and monitoring their diet. Sleep is something we all need to focus on so that that's something that can make a big difference. Again, I'm somewhat inclined towards the pharmacologic or naturopathic pharmacology interventions. There are lots of things that are good for mood regulation. Sami is very good for depression. It's like SAM with capital letters and then a little. So it's like same with the first three letters capitalized. That's very good for depression. I don't know that it's been found to be that good for mood regulation. And since it has kind of a stimulant property, I don't know of any research that addresses the question, but logically it should affect attention as well. Then I would talk to your holistic naturopathic doctor about other things that other interventions might work for. Mood regulation and even attention. Exercise has unequivocally been found to improve the attention regulation problems with add. Only problem with exercise though is that it only lasts for a little bit after the actual exercise, during the exercise and for a short window of time afterwards, which is very good for people who, you know, you hear about athletes who have a history of ADD and yet they function well. Well, they're medicating themselves with their exercise. So to the extent that people can do that, that's a really good way to treat ADD with or without concern about the hormones.
- [21:19]
A
Thank you so much for joining me on today's episode. I hope you found what you were looking for in this conversation and it has helped guide you towards some further self healing, self exploration and most importantly, self acceptance. And if you have enjoyed this conversation and would like to experience more of my work, such as access to exclusive live workshops and opportunities for group coaching sessions, connecting with other like minded women and a general feeling of belonging, please come and check out my monthly membership, the ADHD Women's well Being Collective. I've made it as affordable as possible and I offer you lots of resources and opportunities for connection and support from other women all around the world. Being diagnosed with ADHD later on in life I'd absolutely love to see you there. All the details are in this episode's Show Notes or on my Website Website ADHD womenswellbeing.co.uk See you in the next episode. I hear from so many of you every week that this podcast has helped you immeasurably and if that is the case, and it really has helped you understand and validate yourself and your experiences as well as giving you options and ways to move forward positively and finally believe that you can thrive at life with more insights, more guidance, I would absolutely love it if you could support the podcast with a small tip. I actively choose not to hand over the sponsorship or advertising of this podcast to ensure that it's the most pleasurable and easy listening experience for you as the listener. So any tip or any contribution is greatly appreciated to ensure that I can carry on with with this podcast with the content. All the details are in the Show Notes. There's a link there. Thank you so much and see you for the next episode.