Podcast Summary: ADHD Women's Wellbeing Podcast — "Joining the Dots Between ADHD and Perimenopause"

Host: Kate Moryoussef
Guest: Dr. Emma Ping
Date: July 23, 2023

Overview

This bonus episode in the Hormone Series is dedicated to exploring how ADHD symptoms in women can overlap with, mimic, or be exacerbated by perimenopause and menopause. Host Kate Moryoussef is joined by Dr. Emma Ping to clarify the intersection between hormonal changes and ADHD, provide practical guidance for symptom management, and offer advice on advocating for oneself within the healthcare system. The discussion is both empathic and evidence-based, aimed at midlife women experiencing puzzling cognitive or emotional shifts.

Key Discussion Points & Insights

1. Symptom Overlap: ADHD vs. Perimenopause

• Identifying Overlapping Symptoms:

  • Anxiety, sleep disturbances, concentration issues, low energy, irritability, and low mood are common to both ADHD and perimenopause.
  • Many women may not realize that these experiences can be driven by hormonal changes rather than (or in addition to) ADHD.
  • Importance of distinguishing symptoms "so women are getting the right diagnoses and then the right treatment." (Kate, 03:13)

• Onset Timing:

  • Perimenopause typically begins in early 40s and can last up to a decade prior to menopause (defined as 12 months without periods).
  • If symptoms align with changes in menstrual cycles, there may be a strong hormonal component.

    “If you’re getting brain fog, mood swings, anxiety, difficult concentration, multitasking issues… and you’re in that bracket of your life… it’s worth being alert to it.” (Dr. Ping, 03:29)

  • Some women may have undiagnosed ADHD that gets "exacerbated because of the perimenopause coming into play." (04:20)

2. Challenges of Diagnosis and Management

• Interplay of Symptoms:
  • ADHD medications started during midlife can have side effects similar to perimenopausal symptoms (anxiety, sleep issues, mood).
  • This complicates "unpicking" the root causes and necessitates looking at both ADHD and perimenopause together and separately.
• Cycle Changes as Clues:
  • Subtle shifts in menstrual patterns (length, heaviness) plus cognitive/emotional symptoms point towards hormones.

3. Hormone Replacement Therapy (HRT) and Testosterone

• Trialing HRT:

  • Modern "body identical" HRT is safe and mimics natural hormones.

    “All you’re trying to do is top your hormones back up to a physiological level, which is right for you… If that is the greatest underlying issue causing your symptoms, it will be resolved with some HRT.” (Dr. Ping, 06:04)

  • Trials of HRT are not harmful; they can clarify whether hormones are driving symptoms.

• Testosterone’s Role:
  • Not just a male hormone; women have higher baseline testosterone than estrogen pre-menopause.
  • Decline in midlife can lead to cognitive issues (focus, brain fog, motivation), low energy, mood issues, poor muscle recovery, and low libido.

    “There is that sort of triangle: ADHD, estrogen, testosterone, and all the cognitive and mood symptoms. There’s definitely connection between them.” (Dr. Ping, 12:35)

  • Doctors typically replace estrogen first, and consider testosterone if symptoms persist.
• Safety and Research Needs:
  • Testosterone is deemed very safe under medical supervision.
  • There’s a lack of research into the impact of testosterone on women with ADHD.

    “We don’t understand enough about ADHD and testosterone… We need more data, more investment in research.” (Dr. Ping, 13:34)

4. The Exacerbation of ADHD in Perimenopause

• Hormonal swings during perimenopause are “a huge exaggeration of your natural menstrual cycle,” which can make ADHD symptoms far more pronounced and erratic.
• Environmental stressors may be mistakenly blamed when they are actually hormonal in origin.

5. Tools for Self-Advocacy

• Symptom Trackers:

  • Regularly monitoring and documenting symptoms helps women communicate patterns to doctors.

    “The biggest tip I’d say, for women, is to do the symptom checker. So you’ve got that objective measurement… and take that into your doctor.” (Dr. Ping, 14:46)

  • Bringing clear records enables more effective discussions, especially during brief GP appointments.

• Finding the Right Practitioner:

  • Seek GPs or clinicians with a women’s health or menopause specialty for optimal support.

6. The Importance of Self-Care and Prioritization

• Many women instinctively “put everybody else’s wellbeing before ours.”
• The analogy of the oxygen mask: prioritize self-care so you can also care for others.

  “We need to look after ourselves first in order to give our best to other people.” (Dr. Ping, 15:38)

Notable Quotes & Memorable Moments

• On Symptom Overlap:

  “So many women are thinking that they've got ADHD, and actually it's the perimenopause, menopause – and vice versa.” (Kate, 03:13)

• On the Role of Testosterone:

  “Before the menopause, we produce actually three times more testosterone than oestrogen.” (Dr. Ping, 08:27)

• On the Value of HRT Trials:

  “To trial [HRT] is not going to do any harm.” (Dr. Ping, 06:28)

• On Self-Advocacy:

  “Take your symptom checker in and say… 'these are my symptoms, this seems to me fits with the perimenopause, I would quite like to consider a trial with some HRT.' And that’s a good starting block…” (Dr. Ping, 15:10)

Timestamps for Important Segments

• 00:02–03:12 — Introduction & the rationale for the hormone series
• 03:12–04:20 — Symptom overlap and difficulties in diagnosis
• 04:20–07:25 — Menstrual changes and the role of HRT (estrogen & testosterone)
• 07:25–08:27 — ADHD medication, HRT, and symptom balancing
• 08:27–12:35 — Testosterone as a key hormone in perimenopause and ADHD
• 12:35–14:46 — Hormone swings, environmental misattribution, and symptom tracking
• 14:46–16:27 — Advocating for oneself in healthcare, using tools and reframing priorities

Practical Takeaways

• Use a symptom tracker/checklist to monitor changes and patterns for both ADHD and perimenopausal symptoms.
• Bring documented symptoms to appointments; ask specifically for women’s health or menopause experts.
• Consider trialing body-identical HRT, and discuss testosterone if cognitive and mood issues persist.
• Remember the importance of self-prioritization; managing your own wellbeing benefits you and those around you.

Tone & Language

The conversation is supportive, practical, and grounded in lived experience. Dr. Ping offers clinical guidance, while Kate validates listeners’ emotional journeys and stresses empowerment and self-advocacy.

This episode is an invaluable listen for women navigating midlife cognitive and emotional changes, especially those with ADHD or who suspect they might be neurodivergent. The guidance is affirming and actionable, encouraging women to claim agency in their health journeys.