Podcast Summary

I Have ADHD Podcast

Episode 370: PMS, Pregnancy, Perimenopause: How Estrogen Hijacks the ADHD Brain
Host: Kristen Carder
Guest: Dr. Patricia Quinn
Date: January 20, 2026

Episode Overview

This episode is a re-release of one of the most downloaded and requested episodes, focusing on the powerful intersection of female hormones—especially estrogen—and the ADHD brain. Kristen Carder interviews Dr. Patricia Quinn, a leading developmental pediatrician and renowned expert on ADHD in women and girls. Together, they demystify how hormonal changes across the menstrual cycle, pregnancy, postpartum, perimenopause, and menopause profoundly affect mood, cognition, emotional regulation, and the effectiveness of ADHD medications. The episode provides clarity, compassion, concrete advice, and actionable steps for women and those who love or work with them.

Key Discussion Points & Insights

1. Estrogen Is Not Just a "Reproductive Hormone"

• Estrogen also acts on the brain, influencing the release of key neurotransmitters—dopamine, serotonin, and norepinephrine—that are central to attention, motivation, mood, and executive functioning.
  • Dr. Quinn (18:25): “One of the target organs for estrogen is the brain … Estrogen enhances the release of these neurobiochemicals … about 20% of these chemicals in your brain are the result of estrogen enhancing the release.”

2. Hormonal Fluctuations and Their Impact Across Life Stages

Menstrual Cycle

• Premenstrual phase (estrogen drop):
  • Increased PMS/PMDD symptoms, higher depression and irritability, and pronounced spikes in ADHD symptoms.
  • Many women notice their ADHD medication feels less effective during this time.
  • Dr. Quinn (22:16): “If your dopamine goes down even more, your ADD symptoms go up.”
• Importance of tracking symptoms throughout the cycle to identify patterns and better advocate for treatment or med adjustments.
  • Action step: Record daily symptom ratings for at least two months (attention, motivation, mood, etc.) (23:00–24:26).

Pregnancy & Postpartum

• Pregnancy: High estrogen usually leads to improved mood and often fewer ADHD symptoms; some women can pause ADHD meds.
• Postpartum/Weaning: Sudden estrogen crash can worsen depression and cause a sharp spike in ADHD symptoms; this is often when women feel most overwhelmed.
  • Dr. Quinn (25:15): “When you wean the baby or when you have the baby and don’t breastfeed … your hormones come crashing down very suddenly … and you have a whopping increase in your ADD symptoms right away.”
• Breastfeeding: ADHD meds are generally safe; minimal drug transfer via breast milk per American Academy of Pediatrics. (60:07–61:11)

Perimenopause & Menopause

• Perimenopause (can begin in late 30s): Gradual estrogen decline undermines previous ADHD coping mechanisms; many women experience a sharp worsening of ADHD symptoms, leading to later-life diagnosis.
  • Dr. Quinn (27:15): “Can be 10 years before you go into menopause … hormones are starting to go down. … Why at 38 can they not function anymore? … It’s perimenopause.”
• Menopause/Postmenopause: Estrogen drops further, causing additional mood, cognition, and memory problems—even in women without ADHD.
  • Hormone replacement therapy (HRT) or birth control sometimes stabilizes estrogen levels and mitigates symptoms (32:20–33:35).

Notable Gender Differences

• Men’s estrogen levels remain steady through their 80s (unlike the significant fluctuations and declines women experience).
  • Dr. Quinn (29:00): “Men have the same amount of estrogen well into their 80s… A man of 60 can have more estrogen than a woman of 60.”

3. Approaches to Treatment & Self-Advocacy

• Medication Adjustments: Stimulant dosages may need to vary across the month; sometimes hormonal birth control or HRT is beneficial.
• Treating the Individual: Every woman’s symptoms and experiences are unique, requiring a customized approach in coordination with healthcare providers.
• Self-awareness and acceptance: Understand and accept your limitations; track patterns and plan around predictable low-functioning periods (e.g., don’t schedule major commitments the week before your period).
  • Dr. Quinn’s tip: Visual cues like a “red bandana” can signal to family when extra support or space is needed (47:14–47:56).
• Therapist/Educator Awareness: Many clinicians are unaware of the hormonal impact unless they specialize in ADHD in women; it’s vital to seek providers familiar with these nuances.

4. PMDD vs. PMS

• PMS: Typical irritability, discomfort, physical symptoms, but generally functional.
• PMDD: Severe mood disorder before menstruation: significant dysfunction, depression, or “losing it”—requires professional intervention.
  • Dr. Quinn (51:39): “We’re not just talking about someone who’s irritable. We’re talking about someone who really loses it during this period … and they get very depressed.”

5. Medication & Pregnancy/Breastfeeding

• It’s a nuanced, case-by-case decision involving a dialogue with a prescriber; the risks of stopping medication (especially for safety-critical roles) sometimes outweigh theoretical fetal risk.
• There’s no evidence that stimulant medications significantly harm the fetus or newborn during breastfeeding, according to current research and AAP guidelines (as per Dr. Quinn, 60:07–61:11).

6. Validating the Female ADHD Experience

• The hormonal effects underlying monthly or life-stage “roller coasters” are biological, not a moral failing, laziness, or lack of discipline.
  • Kristen (14:12): “How many women are walking around blaming themselves for something that is largely hormonal … thinking, ‘I’m a mess, I’m inconsistent, I can’t be trusted,’ when really, their estrogen has dropped, and their nervous system is doing what it’s supposed to.”

7. Diagnosis Later in Life

• Many women are diagnosed in their 30s, 40s, or even 70s, often after their lifetime coping strategies collapse due to hormonal shifts or life changes.
• Late diagnosis is not a personal failure but often the first opportunity for transformative treatment and support.
  • Dr. Quinn (69:17): “This is the most hopeful diagnosis you could ever make … things will change and get better.”

Notable Quotes & Memorable Moments

• Dr. Quinn, on the importance of self-awareness:
  • “Don’t set yourself up for failure. … If you know you’re really bad the week before your period, don’t plan a trip.” (47:14)
• On ADHD and perimenopause:
  • “Women with ADHD stay in the closet longer. It’s a very messy closet, but they stay in there.” (65:52)
• Kristen, on feeling validated:
  • “It is very invalidating to be told, like, ‘Why don’t you just make a list or why don’t you just try harder?’” (38:29)
• Dr. Quinn, closing advice:
  • “Don’t take no for an answer in any way, shape, or form. Be a good consumer, ask questions, read, educate yourself, get information and go for it, because things are only going to get better.” (71:29–72:21)

Timestamps for Key Segments

• [04:19] — Kristen introduces the episode’s theme and why this conversation (a re-release) is still so vital.
• [16:57] — Dr. Patricia Quinn joins and sets up the science of estrogen’s effect on the brain.
• [20:59] — Cycle overview: how and when estrogen drops throughout the month; relation to ADHD symptoms.
• [25:15] — Pregnancy and postpartum, effects of hormonal swings on mood and ADHD.
• [27:15] — Perimenopause: what it is, when it starts, and how it derails coping for women with ADHD.
• [32:20] — Discussion of perimenopause, HRT, and individualized management.
• [50:26] — Differentiating PMS from PMDD.
• [54:37] — Nuance around ADHD meds during pregnancy and postpartum; breastfeeding safety.
• [61:31] — How estrogen fluctuations relate to depression/anxiety and ADHD in women.
• [64:05] — Why so many women are diagnosed later in life; impact of life changes, menopause, loss of structure.
• [69:17] — Hopeful message: “This is the most hopeful diagnosis you could ever make…”
• [71:29] — Final advice from Dr. Quinn: self-advocacy and persistence.

Actionable Takeaways

• Track your symptoms over at least 2 cycles to identify hormonal-ADHD patterns.
• Educate and advocate for yourself with healthcare providers—ask if they’re familiar with ADHD in women!
• Consider flexible medication strategies (with your provider’s advice) to adjust for monthly fluctuations.
• Don’t be afraid to discuss hormone therapies (birth control, HRT, bioidentical hormones, etc.) if perimenopause or menopause worsens symptoms.
• Know that seeking help at any age is worthwhile. Optimal functioning and greater peace are possible.
• Release self-blame: Emotional and cognitive ups and downs are often biological, not personal failings.

Tone & Language

Kristen and Dr. Quinn are both warm, down-to-earth, and validating. They balance clear scientific explanation with humor and deep empathy for the lived experience of women navigating both ADHD and the hormonal roller coaster. The message is hope, self-compassion, empowerment, and practical guidance.

For Further Exploration

• Dr. Patricia Quinn’s book: "100 Questions and Answers About Women with ADHD."
• Podcast episodes and resources on the I Have ADHD site.
• Bring any concerns or questions from this episode to your gynecologist, prescriber, or therapist—especially if you notice patterns related to hormonal changes.

Summary by an expert podcast summarizer—this episode is essential listening for any woman with ADHD, loved ones, and clinicians aiming to understand the profound interplay between hormones and the ADHD brain.