ADHD Women's Wellbeing Podcast: Estrogen Fluctuations – ADHD & Hormones

Host: Kate Moryoussef
Guest: Dr. Jeanette Wasserstein, Clinical Neuropsychologist
Date: July 30, 2023
Episode Focus: Understanding how estrogen and hormonal fluctuations uniquely impact ADHD symptoms in women, with a focus on life stages such as puberty, pregnancy, postpartum, perimenopause, and menopause.

Overview: Main Theme & Purpose

This bonus episode features a condensed conversation between host Kate Moryoussef and Dr. Jeanette Wasserstein, an expert in adult ADHD and women’s hormonal health. The episode centers on the intricate, often underexplored relationship between hormones—specifically estrogen—and ADHD in women. Dr. Wasserstein shares insights from decades of clinical practice and outlines how hormonal transitions (puberty, pregnancy, perimenopause, menopause) can profoundly affect cognitive functioning, mood, attention, and the presentation of ADHD. The discussion aims to help women understand these dynamics in order to foster self-compassion, find effective management strategies, and seek suitable medical or lifestyle interventions.

Key Discussion Points & Insights

1. The Science of Estrogen and Brain Function

• Neurotransmitter Modulation:
  • Estrogen influences key neurotransmitters such as acetylcholine (memory), epinephrine (attention), and serotonin (mood).
  • Quote (Dr. Wasserstein, 07:22):

    “Estrogen...modulates and controls the creation of a lot of very important neurotransmitter substances which relate to mood regulation and attention.”

• Knowledge Gaps:
  • The full impact of puberty’s estrogen surge on ADHD symptoms in girls is poorly understood—science is still “catching up.”
  • There is more research on the impact of pregnancy, perimenopause, and menopause than on the teenage years.
• Puberty Paradox:
  • Despite increased estrogen (which should enhance cognition), many girls are diagnosed with ADHD during puberty, presenting a scientific puzzle.

2. Hormonal Life Stages and ADHD

• Pregnancy:
  • Estrogen spikes dramatically, often resulting in cognitive and mood improvements for women with ADHD—even allowing some to stop medication.
  • Quote (Dr. Wasserstein, 09:19):

    “Many women with ADD...do way better with no medications during pregnancy because the estrogen itself is helping the underlying nervous system vulnerabilities.”

• Postpartum:
  • Estrogen drops sharply after childbirth, increasing vulnerability to mood dysregulation and postpartum depression—especially common in women with ADHD.
  • Women with ADHD may react more intensely to this hormonal swing.
• Perimenopause:
  • Characterized by erratic hormone fluctuations. Symptoms can worsen or become apparent for the first time; previously effective interventions may lose efficacy due to instability in estrogen levels.
  • Quote (Dr. Wasserstein, 11:46):

    “Many women who are kind of borderline ADD their whole life will fall off the cliff... it’s gotten to the point where it’s very clear.”

• Menopause:
  • Declining and ultimately low/stable estrogen often leads to exacerbation of cognitive and emotional ADHD symptoms.

3. Medical Interventions & Challenges

• Stimulant Adjustments:
  • During menopause, increasing stimulant dose can be helpful, but during perimenopause, fluctuating hormones make effects less predictable.
• Hormone Replacement Therapy (HRT):
  • Estrogen supplementation (HRT or oral contraceptives) can benefit cognitive and mood symptoms; however, clinical comfort and expertise are lacking among most psychiatrists, OB-GYNs, and psychologists.
  • Breast cancer risk is a critical consideration; those with increased risk must approach estrogen therapy cautiously and with close medical oversight.
  • Quote (Dr. Wasserstein, 17:09):

    “Hormone replacement therapy is a great, great way to go. The only women where there’s research to back this up are women who...develop premature menopause.”

• Alternative Pharmacological Options:
  • Drugs like Aricept (used for memory—boosts acetylcholine) may be tried for cognitive symptoms, though evidence is limited.
  • Quote (Dr. Wasserstein, 18:20):

    “Anecdotally, some people have tried Aricept with ADD years and found good, good results...worth trying.”

4. Lifestyle and Naturopathic Interventions

• Sleep as Priority:
  • Of all lifestyle interventions, quality and quantity of sleep is emphasized as most essential and accessible for ADHD symptom management.
  • Quote (Dr. Wasserstein, 19:25):

    “The easiest and maybe most important is sleep...that can make a big difference.”

• Other Recommendations:
  • Exercise boosts attention regulation, though beneficial effects are time-limited post-activity.
  • Diet and holistic/naturopathic approaches (e.g., SAMe for mood) may help, but research for ADHD-specific benefits is sparse.
  • Self-compassion is encouraged—central to sustainable management and self-acceptance.
• Systemic Challenges:
  • Medical professionals’ lack of integration (psychiatrists, OB-GYNs, psychologists) leaves many women to navigate ADHD and hormone treatment largely on their own.

Notable Quotes & Memorable Moments

• On the Complexity of Puberty and ADHD Diagnosis:
  • “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...science is catching up.”
    (Dr. Wasserstein, 08:22)
• On the Impact of Pregnancy:
  • “Many women with ADD and many with bipolar illness do way better with no medications during pregnancy...the estrogen is helping the underlying nervous system vulnerabilities.”
    (Dr. Wasserstein, 09:23)
• On the Difficulty of Managing ADHD during Perimenopause:
  • “During perimenopause, it’s not so straightforward because you have those fluctuations. So sometimes [stimulant medications] help, and at other times they’re too much.”
    (Dr. Wasserstein, 13:59)
• On Navigating HRT:
  • “Psychiatrists will play with hormones because they say, ‘I have no training in it’...OB-GYNs, they vary in their willingness...[yet] hormone replacement therapy is a great, great way to go.”
    (Dr. Wasserstein, 15:56 – 17:09)
• On Lifestyle Management:
  • “Even the women who don’t have time to exercise, or...modulating their diet, sleep is something we all need to focus on so...can make a big difference.”
    (Dr. Wasserstein, 19:25)

Important Timestamps

• 06:17 – Science overview: estrogen and neurotransmitters
• 07:22 – Scientific gaps: puberty and ADHD in girls
• 09:19 – ADHD symptom improvement during pregnancy
• 09:50 – Postpartum estrogen drop and depression risk
• 11:46 – Perimenopause and “falling off the cliff” with ADHD symptoms
• 13:59 – Medication management complexities in perimenopause/menopause
• 15:56 – HRT and the healthcare “gap” between specialties
• 17:09 – HRT, breast cancer risk, and specialist access
• 18:20 – Use of Aricept/memory drugs for ADHD
• 19:25 – Lifestyle interventions: sleep, exercise, diet

Tone and Delivery

The conversation maintains a frank, informative, and compassionate tone. Dr. Wasserstein blends scientific rigor with accessible explanations, while Kate grounds the discussion in real-life experiences and the day-to-day challenges women face navigating ADHD and hormonal shifts. Both underscore the need for self-compassion, better medical collaboration, and individualized approaches.

Conclusion

This episode is a vital resource for women with ADHD seeking clarity about their symptoms across hormonal transitions. Dr. Wasserstein’s expert perspective highlights the evolving science, current gaps, and practical routes—medical and lifestyle—for managing ADHD with self-awareness and advocacy. Women are encouraged to seek supportive specialists, prioritize sleep and self-care, and pursue community support as they learn to thrive with both ADHD and hormonal complexity.