B (3:12)

There is a real overlap.

A (3:13)

Yeah, there is. And very often women perhaps are thinking that they've got adhd, and actually it's the perimenopause, menopause and vice versa. How are we able to identify the difference between the two? So women are getting the right diagnoses and then the right treatment.

B (3:29)

You know, from that, it's always going to be a challenge. I think some of it is timing. When are these symptoms coming to a head? Is it in the. In the time where perimenopause is occurring? So that's typically early 40s to 50. So the menopause is when your periods have stopped for a year. It's a retrospective diagnosis. So you're in the menopause once you've not had your period for a year, but the lead up to that point is the perimenopause, and that can last a decade, and that's typically starting in your early 40s. So if you're getting the brain fog, the moon swings, the anxiety, the difficult concentration, multitasking issues, suddenly losing confidence with things like driving, all these things, and you're in that bracket of your life, which could be the perimenopause, it's worth being alert to it. But then, of course, you could also have had undiagnosed adhd, which you've coped with over the years, but it's suddenly become exacerbated because of the perimenopause coming into play. So they both need looking at, really separately and together. So you need to have the treatment and care for the ADHD and alongside that, the perimenopause, menopause care. Because the other thing about some of the ADHD medications, if you get a diagnosis in midlife and you start some medication, some of the side effects are also an overlap with Perimenopause symptoms. So some of them cause anxiety, some of them can cause mood problems, some of them can cause sleep problems. So again, unpicking it is difficult at the end of the day if it's possibly perimenopause and you've had some changes in your periods going on alongside. So in the perimenopause you are by definition still having a menstrual cycle, but it might have changed subtly. Maybe it's a little bit longer, a little bit shorter, some women get heavier bleeding, but you're still having some sort of cycle. And if that coincides with these symptoms becoming more prominent, then there's definitely some hormonal aspect to your symptoms. And I think, Kate, at the end of the day, because the modern body identical HRT is so safe, it's a natural way of just topping up your hormones. They're low dose. You could just almost have a trial of it and see if it helps you. You're not going to have do any harm by having a trial and just see things with that. The new hormones, if you look at the molecular structure of them, they're like for, like for your own ovaries, what your own ovaries make. So when you replace the hormones with this body identical type, your body kinds of recognizes them as if they're from your own ovaries again. And all you're trying to do is top your hormones back up to a physiological level, which is right for you, which worked for you before the perimenopause kicked in. Now, if that is the greatest underlying issue causing your symptoms, it will be resolved with some hrt. And so to trial, it is not going to do any harm. I mean, if you trial the HRT and you get partial response, then you might have to think I'm having an adequate amount of oestrogen replacement. I've had my levels checked, but I'm still not quite there. Well, that could be testosterone replacement that you need because that's the third female hormone which starts to drop in midlife and can give us cognitive problems, exactly the same ones as you said before, into the concentration, focus, brain fog, multitasking problems can be a testosterone deficiency problem or you might need a tweak because it's not uncommon to need a tweak or change of your ADHD medication in relation to hormonal changes as well.

A (7:25)

Do you think that using HRT or sort of bringing in, you know, testosterone can help level out the ADHD again without having to go down the ADHD medication?

B (7:38)

I think potentially yes, definitely. And I think again, you could trial it and see what happens, give a trial of it and see your response. It is going to be so individual. And like you said before, it's holistic, it's lifestyle as well. So it's managing it from all the different angles. But yes, I think definitely you might find that just replacing and topping your hormones back up, you might find that you'll be stable again on your normal medication regime.

A (8:06)

Just before we sort of close, I wanted to ask one last question about testosterone, because that's not something that we often hear. I hear about estrogen a lot and typically testosterone, you know, we hear it's like a male hormone. But can testosterone be of any help to adhd? And I guess what does it bring to, to us during our menopause and maybe with our ADHD as well?

B (8:27)

So testosterone, you rightly say, is associated as a male hormone, but it's very much a female hormone. We produce actually three times more testosterone than estrogen. Before the menopause, we produce about 50% of our testosterone is from our ovaries, and about 50% is from our adrenal glands, which sit just above our kidneys. So as our ovaries start to wind down in the perimenopause and menopause, our testosterone production tends to go down as well. It's different for each individual woman in terms of the rate of decline. And it's also different for each person with regards to the symptoms that that might produce, because some women were probably running on slightly higher testosterone levels throughout their life and others on lower, and it didn't cause a problem from them. So this is very, very individualized. So what we would normally do is if a woman has got perimenopause menopause symptoms, we would get them on estrogen replacements first. That's the usual first step because there's a crossover, again with symptoms of low testosterone and low estrogen. So the cognitive difficulties, which we also has a crossover with ADHD has a secondary crossover with no estrogen and another possible crossover with testosterone. So what we would do is get the oestrogen levels at a good level and then see where that woman is at in terms of her symptoms if oestrogen levels aren't useful before starting HRT. Generally, if you're over the age of 40 or 45, estrogen levels aren't terribly helpful in terms of a diagnosis, but they are helpful once you're on treatment to make sure you're absorbing it well, because the gold standard estrogen is through the Skin as a patch of jello or spray, and then we can monitor that. So if we're monitoring those levels in the blood and we're speaking to a woman about her symptoms and she's saying, well, actually, my hot flushes have gone away, I'm sleeping better, but actually my libido is still in my boots, my energy is still poor, my cognitive function's still not great, I still get my word, finding difficulties. Actually, my mood isn't great still, you know, it's a bit, it's better, but my joy of things still isn't there. My muscle recovery isn't there. I'm going to the gym, I'm doing workouts, actually I'm doing more, but actually my muscles aren't recovering. My tone is going. Despite this, these are potential testosterone symptoms. So we would usually check a level before starting testosterone and then we give what we call a trial of testosterone replacement for hormone. Because not everybody benefits from testosterone replacement. Some women do, some women don't, some women don't need it. For some women, the estrogen alone addresses the symptoms. But if those symptoms are still there to be addressed, a testosterone trial is worth a consideration because it's a terribly safe hormone. It's very easy to use in terms of side effect profile. As long as you're being prescribed it by somebody who understands about testosterone replacement for women, dosage and monitoring, the chances of adverse side effects are incredibly low. So there is that sort of triangle. Adhd, estrogen, testosterone and all the cognitive and mood symptoms. There's definitely connection between them. We don't understand enough about ADHD and testosterone. Definitely not. We need more, you know, more data, more investment in research. And those swings, those natural hormonal swings that occur with a normal menstrual cycle throughout a woman's fertile years are hugely exacerbated in the perimenopause. So those swings of lower estrogen levels go down lower. And that relative to the progesterone levels, gets. The gap gets bigger. And so the perimenopause, when hormones are swinging up and down and it's like a great, a huge exaggeration of your natural menstrual cycle, which you already are explaining. ADHD women get a variation in symptoms. It's just gigantically exacerbated, which is why it can feel like such a horrible roller coaster in the perimenopause for people with adhd. And it's really difficult because when actually your brain isn't working well to try and join up the dots and understand what's actually happening. It's incredibly challenging. And also you, because we are women in midlife, often juggling children, older parents, a career, a household, everything on one day or one month or one week to the next, because our symptoms can be better or worse. We often just put it down to environmental things. We think, oh, that was because, you know, that was happening that week. Oh, oh, that was because something's in. Something was in the news that week. But actually that is just what happens when our hormones swing in the perimenopause. And joining up those dots can be incredibly challenging, particularly without the awareness. So, like you say, the key is self awareness in the first instance and having your radar out for when things are changing or things are getting worse and can be very useful. Kate is having a symptom tracker and having a symptom checklist. And on our website@menopausecare.co.uk, we have a symptom checklist for the perimenopause and menopause, which you can download or print off and you can have a look at the symptoms set and keep an eye on them, maybe redo the symptoms every week, every couple of weeks and see what's happening with them. And then if you're going to go and see your doctor, go in with that symptom checker and say, look, these are my list of symptoms. They fit with the perimenopause and start the conversation there. Because the difficulty, because perimenopause and ADHD have a spectrum and a diverse group of symptoms, joining the dots to make it make the diagnosis can be difficult for doctors who haven't got the awareness there. We often, as medical practitioners, we live in our own little silos of specialities. Oh, that's a heart problem. Oh, that's a mental health problem. Oh, that's a joint problem. And that needs to go to rheumatology referral. They need a cardiology assessment. But actually in the perimenopause, it's realising there's a lot of things under the umbrella and actually the underlying cause is the hormonal changes that if we can address and even out again, all of the symptoms will improve. The biggest tip I'd say, for women is to do the symptom checker. So you've got that objective measurement of your symptoms and a record and take that into your doctor. If you can see a doctor with a specialist interest in women's health, ideally somebody who's got some interest in the menopause, find that out before you go to your GP and then take your symptom checker in and say, look, 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 because when you've only got those seven minutes, you need to use that precious time the best you can. As women we are juggling. We prop up everybody else, don't we? We look after everybody else. We tend to put everybody else's wellbeing before ours. But actually it's that oxygen mask analogy. We need to look after ourselves first in order to give our best to other people. And I think as women we're not even sometimes we're just not really aware that that should be a priority. But it really, I really think it should be.

A (16:27)

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's 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, 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 Show Notes or on my website adhdwomenswellbeing.co.uk see you in the next episode.

B (17:29)

Foreign.

A (17:35)

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 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.