Welcome back to the ADHD Women's Wellbeing podcast.

It's 2025.

Wow.

Wishing you all, happy, healthy, expansive and yeah, I think a kinder new year for everybody.

And I hope that this year brings us all a lot more evolution and growth and love and compassion and safety and peace throughout the world and within ourselves as well.

And today, having a bit of a break from having our new guests, but we still have a fantastic expert here.

We have Dr.

Assad Rafi.

He is the owner of Sanctum Healthcare here in Manchester and he is an ADHD specialist.

He is part of the Ask the Psych new feature that we've been putting in the Toolkit.

But I thought it'd be so fascinating for you guys to hear his expertise here on the main podcast.

Now if you are interested, we have other clips from him on the Toolkit which is why I believe the Toolkit is such a fantastic resource.

We've really got amazing experts and specialists diving deeper and having these more sort of specific conversations and teachings and workshops.

So that is the, the Toolkit.

It's out every other week, it's out on a Monday, it's 4.99amonth.

And it's incredible value for what you're getting.

It's really allowing you to get that deep dive into your ADHD and how you want to manage it and treat it and make it your friend with your well being and your lifestyle.

Now today we are talking with Dr.

Raffi about the influence of hormonal changes, particularly how it shows up for us during perimenopause, but also puberty on menstrual cycles, the role that estrogen progesterone play in creating a bit of havoc and really sort of unearthing our ADHD later on in life.

So we talk about how our hormones, especially with adhd, impact our sleep, our mood, the many different ADHD symptoms, such as our emotional regulation, our restlessness, our energy.

And it's so powerful to know that we do that we're learning this, that we're learning that hormones are have a massive correlation to how our ADHD shows up.

So Dr.

Rafi gives us some advice about potentially some progesterone only treatments.

He really emphasizes the need that we do need, this hormonal balance.

But sometimes the synthetic hormones or different things, the way we've experienced it through our lives perhaps have exacerbated our ADHD symptoms, such as the contraceptive pill.

And there's so many different ways this could have shown up and unfortunately we're still waiting.

We're still waiting for science and research to catch up.

But to have these conversations and to have it validated by a doctor gives us this opportunity that we can find more advocacy, we can find more empowerment in recognizing that a doctor is telling us this and we can seek alternatives.

And we also talk about the importance of considering that perhaps there is early puberty and how that impacts girls, especially on our brain development and the impact that it's having on our mental health.

So I think the long and short of it is this is massively cementing perhaps what many of us have experienced throughout life from early onset of puberty throughout, you know, whether we've had children so postnatally and creeping towards perimenopause and in and out of menopause that it is not our imagination, that our hormones have played a huge role in how we have felt mentally.

So I really hope that today's episode is helpful for you.

For girls and boys, when you've got puberty, okay, and you've got those hormone changes.

And this is something that we've got to be really, really understanding of when it comes to females, when it comes to girls.

We see so many at that 12, 13 year old stage because of that transition from a more nurturing environment into high school.

But also the onset of puberty in most cases.

Okay.

The advent of menstrual cycles and knowing that link between the luteal phase, which is after ovulation, just before you, during your period, seven to 10 days before we start to see an increase in ADHD symptoms, we start to see sleep worsening.

We start to see a liability towards some of those coping strategies, potentially some of those addictive behaviors, food, nicotine, caffeine, whatever it might be.

Also very low mood.

People with ADHD are more likely to have pmtd.

Yep.

So mood and emotions, or is it the RSD getting worse?

Yeah, definitely in the mix.

So let's understand why that happens and I'll try and keep this as simple as possible.

But if we think about our female reproductive hormones, I'll talk about estrogen and progesterone because to be honest, we don't know enough about testosterone and females.

But that is an emerging area.

Okay, well, let's just.

We're going to stick to estrogen and progesterone.

And what we know is that estrogen, and this is again, it's coming from a man, is the most potent, most important hormone transmitter in the human body.

Most of us guys can't relate to it.

Hormonal fluctuations and the role of Estrogen, progesterone is so significant that when you start to see the impact of those fluctuations, it helps you to try and understand it from a, from a male, certainly from.

Forget being a doctor, just from a male perspective.

I don't think any one of us could even walk one day in those shoes compared to what women have to go through.

And if you look at the impact of estrogen on the brain, forget anywhere else, because it works on every single bodily system that we know of.

Your bone health, your cardiovascular health, your immune health, everywhere.

Kate.

But let's just focus on the brain.

Estrogen, in simple terms, helps how Dopamine, which is central to your adhd, that's where the imbalance occurs.

Okay, so estrogen works in a very positive way to help how dopamine works, but also how serotonin, your mood neurotransmitter, works.

So when your estrogen levels start to drop, ADHD symptoms are going to get worse.

Progesterone has the opposite effect.

So when progesterone levels go up, you're going to see worsening of ADHD symptoms.

This is why the Mirena coil, progesterone only pill, Mirena coil releases synthetic progesterone, it annihilates and it sets ADHD on fire.

And this is where I say, please, God, do not take progesterone by itself.

Do it in combination, because you need the two to balance each other out.

You've got to do it in balance with estrogen.

And I'm not even an endocrinologist or a hormone specialist, but I've de facto become one, okay?

You cannot assess, you cannot manage women, girls, without thinking about hormones.

Fundamentally important.

And what we're seeing now is that ovulation, you're getting that sudden surge of estrogen, and then you get the rapid decline.

And there's a recent paper which indicates that in that initial drop, the likelihood of impulsivity, hyperactivity, increasing is quite significant.

And get a further drop, which appears to be more linked to the inattention phase.

So you're seeing these phases and trends.

And what's really important is start tracking your cycle, start logging the symptoms, and then as clinicians collaboratively dose flexibly.

So what we will do is in that week prior to period, if you need a higher dose of medication, that's fine.

It's got to be justified.

Look at hormonal intervention, look at cognitive behavioral approaches, looking at stress management, diet, all of those things as they will all play a part.

But this is where we've got to understand Managing those hormones.

And I walk into schools and girls schools, and I will speak to them and I will say, listen, if we look at a third of the month, typically, where girls are going to be facing those hormonal fluctuations, their ability to concentrate, focus, sleep, well, all the things that we've just talked about with adhd, it's going to be compromised whether they've got ADHD or not.

Yeah, yeah, but it's going to be.

Exactly.

It's going to be more amplified if they've got ADHD and if they're not on the pill.

Okay.

Because some, sometimes parents are horrified when I say, I think your daughter needs to go on the pill.

Oh, my God, what do you mean?

And I say, no, it's not for the fact that I'm suggesting they need birth control.

The purpose here is to correct that hormonal imbalance.

But then what happens?

Then going to a GP and not closely advising them, what ends up happening?

Progesterone only, or even.

Even the coil.

Your doctor should be asking you about which contraceptions you've taken, what you've had, even asking about when you started puberty.

Because what we now know is that people who went through puberty early, that neuroplasticity process, your brain's maturing process, if that's arrested early, the likelihood of that prefrontal cortex, that junction box in the brain that coordinates all of the activities that underpin ADHD, doesn't work as effectively.

What do you consider early?

8, 9, 10 years old.

Wow.

Yeah.

What we're then seeing is there's that mismatch between the different parts of the brain.

So you've got your executive function that's coordinated by the prefrontal cortex, and then you've got the overactivity within areas that manage emotion, like the limbic system.

Okay.

And this is where we've got to be really mindful about understanding.

Then how do we manage it?

If we understand that whole process around when did puberty take place, what's likely to have happened?

How do those symptoms manifest over time?

It's all about that neuroplasticity process.

And when that, you know, how mature your brain was at that particular time, that will then aid us or help us to understand how we manage that client moving forward.

And unfortunately, none of this can be done in the eight or 10 minutes that a GP has got.

And going back to what you said about contraception, I mean, from my perspective, I was put on the wrong pill several times and everything just collapsed when I was on those hormones.

It was hideous.

It was awful.

It was the worst time of my life.

Then after baby number three, I went on the Marina coil.

Even more hideous, horrific.

And my gp, my female GP assured me.

I kept saying, I don't do well in contraception.

It's like the hormones have never agreed with me.

She said, oh, it's such a small, localized.

She literally was like, there's no way you're going to impact badly with the Marina.

So I put my trust, my faith in her.

Three days later, I was throwing things, screaming, crying.

I was up and down.

My poor husband was just like, didn't know what to do with me.

He was like, you need to go and get this thing taken out.

Thankfully, I did.

Within six weeks, it was out and I felt better within again four or five days.

And for me, the, you know, hrt.

But I still, I was so nervous, so, so nervous for the progesterone side.

I kept saying to my wife, thank God, specialist and menopause ADHD doctor who was very sort of knowledgeable on both sides.

She said, right, we're going to play really safe with the progesterone.

We're going to go in and we're going to just try.

We're going to, you know, do whatever I can within my medical remit.

And thankfully we came up with a way.

And now I can't wait.

I get so excited to take my progesterone in the second period of my cycle because it calms me.

I feel.

I sleep better, I feel maybe lower in mood and I would say probably sort of just a bit more.

Like, I just want to kind of hide away and sleep a little bit more.

But that's not a bad thing because as women, we need these cycles of energy and then know when to pull back and when we're having our.

Our days where we just want to kind of like, have quiet time.

And I think that's really good.

We should have ebbs and flows and.

But it has to be manageable and it can't be at the detriment to our mental health.

If you have been listening to this podcast for a while, you'll also know how passionate I am about understanding our hormones and really protecting them and finding ways that we can live better, we can thrive, we can feel healthier as women with ADHD.

So I loved listening to Dr.

Rafi affirm and also validate how important this really is.

And I have one more clip for you.

And in this one, Dr.

Rafi and I are looking at how we see ADHD and see These messy stereotypes of perhaps what people think ADHD looks like.

And actually sometimes it's not.

We think, oh, how can you have ADHD if your house is tidy or your desk is in order?

But actually, many of us need this structure and we need order so we can feel calm and rested and grounded within us.

So I really, really enjoyed having these conversations with Dr.

Raffi and just having him there to bounce ideas off and have his confirmation.

So here is the clip with me, Dr.

Rafi.

I hope you find it very helpful.

I'm going to break this question down, actually, just because I think it's important and it kind of talks about a little bit.

What we were just saying is that someone's come and said they've been diagnosed combination and adhd and she has this real sense of do I really have it?

And the reason being is because a lot of people I've read say that ADHD people are lazy.

And I don't feel particularly lazy.

I'd say I'm clean.

She cleans her house once a week.

During the week, the partner does all the washing up.

So, in short, is it possible to have ADHD but not have a house that looks like a bomb's gone off?

And I am just going to put an extra caveat to this of this social media.

The memes of showing kind of like one ADHD room looks like or a house and people can't tidy up, or there's just a lot of people collect items and like the hoarding.

And I just want to say that it's nice for, for someone to be like, you know what, I think I've got adhd, but it just doesn't present in that way, especially as a woman where this sort of social conditioning is.

If your house looks like a tip, then you've definitely got adhd.

But if your house is presentable and you look presentable and you're clean and tidy and then there's no way you can have adhd, because I have that, I have a tidy house, I look presentable most of the time.

My desk may be a bit messy, but on the whole I would like to say my house is in order because for me, order, tidiness, cleanliness, hygiene, I would say is part of my self regulation.

However, the weekend got four kids, they've all got friends over, chaos, people in the house all weekend.

I feel so different on a Sunday night when I'm cleaning, tidying, there's chaos everywhere, shoes washing to how I feel.

Probably on a Wednesday morning on my own in the house.

When everything's tidy and clean.

Just wondered what your thoughts are on this whole situation.

You don't need to tick every box.

And that's the key thing here.

That again, when you've got that not necessarily myth, but you've got this perpetuation of certain presentations on social media, people feel that that then becomes the narrative or the norm.

It's not necessarily the case, however, with this particular question.

I found this question quite interesting because on the one hand, she's already given me a load of the answers, which are, she's clearly got a partner there who is potentially compensating for some of her challenges or helping.

Absolutely right.

So, you know, if.

And that could be anyone.

That's.

That's you, that's mum at this moment in time.

So you're compensating potentially for.

If your children have ADHD or not, whatever, you're compensating for them.

So it changes and evolves over time, depending on circumstances, depending on your lifestyle, depending on.

Depending on the people around you.

So, yeah, it doesn't necessarily mean just because you're not, you know, hugely disorganized.

You may well have been disorganized in the past, but because you faced consequences, okay, you've started to develop adaptive strategies, but it will be certainly be evident in other areas.

So this is the point I was making before.

ADHD evolves over time and its presentation will evolve as well, depending upon the outcomes, the consequences that you face.

And if those consequences are meaningful enough, you will adapt to them and it will change.

Yeah, I mean, I had an interesting conversation.

My son yesterday, he's 19, he's going off to university this weekend and obviously there's lots of big emotions there, but he's got adhd and interesting.

He'd been away working, didn't some work over the.

Over the week.

And he said, you know, I notice Mum, you.

He said, because he's not.

He's obviously gone to school, he's had some jobs here and there, but he did a week of work to get some money before he started uni.

And he said, I've really noticed that I can't multitask.

And he always shouts at me because I get.

If I'm writing an email or texting on my phone, my kids can go, mum, mum, Mum.

A million times.

I just won't hear.

And then they have to shout, Kate.

And then I jump out of my skin because, you know, that breaks.

But.

And he said, I noticed myself doing that, that I was doing one thing and someone was Shouting my name and they asked me to do something else and I couldn't hear.

And that's, I guess, his first foray into being out of like an academic structure.

He was in a different environment, away from home and all of that.

But I said to him, I'm really glad that you noticed because that's okay, you know, you've got adhd, you can see how it manifests in me.

And he just said, I really did notice, I couldn't multitask.

And I said, fine, good, I'm glad that you noticed that.

We'll work on that together.

But it's just going back to this noticing, isn't it, how it shows up in our life and I don't know.

Yes.

To interrupt, Kate, not that I've got to prove that I've got ADHD there, but just to address that point that you've just made about your son, because it's really, really important.

What type of school did he go to describe the type of school did it give him?

Structure, discipline, accountability, all of the things that will help an individual with ADHD to remain accountable?

Yeah, I mean, we're very, we're in a privileged situation.

He went to an all boys, very good school.

He thrived in it.

And the reason why he thrived in it is because the teachers were used to working with boys, were similar to him, clever boys with busy brains, active.

Although he started in year five and in year five he almost got thrown out because first of all, we didn't know he had adhd.

And the reason why he was thrown out, nearly thrown out, is because he dug a hole in his wooden desk using a compass and he obviously had done it during lessons, fidgeting and trying to sort of concentrate in his own way.

And he destroyed a desk.

And we got pulled into the school within, you know, six months.

And thankfully I always thank this teacher.

She just saw something in him and she went, we're going to find something else for you.

You know, you're going to fidget with something else.

We're going to get you at the front of the class.

Like this is way before we, you know, he knew we knew we had adhd and he was nurtured in that school and he had teachers who just got him and they directed him towards the subjects he enjoyed.

He did three A levels which are couldn't have been more different.

And I'm going to just say them here because I'm so proud of him.

He did art, he did economics and he did Italian.

So none of them were connected.

To, you know, if you look at them on paper you kind of think, what's he going to do with that?

But each subject he loved and remember having the conversation after his GCSEs with the teacher and he went, do what you love.

That was his direction.

Do what you're good at.

You're exactly your instructions, what you're passionate about and what are you interested in.

Don't do like they even say I should do maths with economics because that's what really I should do.

You're conforming to, exactly, to societies or you know, people's expectations.

What was it for me, you know, do the sciences, okay?

Believe it or not, I didn't have any kind of family pressure on me to become a doctor.

I booked that, that stereotype.

But there was know, a pressure there because maybe the non science subjects just didn't excite me and that's the route that I went down.

But I had a different driver and a different motivator and, and again this, this brings me back to having that structure, that discipline.

Your son was blessed in a lot of ways.

Absolutely.

Not everybody is blessed to be in that type of an environment where they're understood and they're supported and nurtured.

He was nurtured.

But there's a blessing and a curse here, and I'm going to tell you why.

Because these types of environments, especially when you're high performing, highly intelligent and you know what, you're getting away with it, okay?

When you don't face consequences in life, human behavior doesn't change.

We think about it.

We only change what we do and how we behave.

Once we face a meaningful consequence, if we keep getting away with it, we don't face those consequences.

Those behaviors will continue in some way, shape or form.

And if we as parents continually compensate, that becomes a problem.

We will nurture them, we will support them.

None of us, I always say this, none of us went to parent school, okay?

We learn on the job.

We learned by our mistakes.

We're still learning.

I'm still blagging it and winging it as a dad, believe it or not, my kids will tell you that, okay?

But none of us were taught, you know, how to manage children with, with adhd.

So looking at investing time in understanding parenting strategies isn't me saying that you're a crap parent.

It's saying actually learn the skills, learn the abilities that will help you to understand the condition and how your child operates.

That's fundamentally important, okay?

But ultimately we will do our best to support and look after our children to prevent them from facing difficulties and challenges that we may have faced.

That is fundamentally what we do.

We always give our kids or we compensate, you know, for our children, for the things that we may have encountered, we may have come across.

So if I've forgotten my games kit and got into trouble, I can't let my daughter go through that.

I'm now going to go home and I'm going to get her games kit and I'm going to drop it off at school.

But she's not going to learn.

She's got to face consequences.

And, and it's, and it's a bit of tough love.

But the problem here is they don't face consequences if they don't face adversity.

My kids have not faced adversity.

I did, I, I didn't grow up in, in a particularly, you know, not did come from a wealthy background or anything else.

It was, it was tough, it was hard.

You know, not as tough and hard as for some people, but it wasn't easy.

But ultimately I became resilient, I became hard, I became tough.

I learned from that and it gave me what I call my psychological toolbox to be able to manage things later on in life.

Okay.

The problem that we then have is if we're creating an environment where children are constantly compensated for.

They're on, they're going to school on the same buses, their peer group, they're in school, they're, they've got the same social circles at home.

They've not faced the realities and the harsh facts and realities of everyday life.

We plunk them in some inner city to go to university or college or wherever it might be and then what happens?

The wheels fall off.

Okay.

And invariably it may well be that this high performing child then no longer is able to perform at that level.

They drop out.

Worse still, you know, they end up going down the route of coping mechanisms that they will, you know, previously they were protected from.

So be that alcohol, be that substance use which ultimately they didn't wake up one day and decide I fancy starting taking cocaine or cannabis or drinking alcohol excessively.

It's built up over time.

They've come across something that's given them that therapeutic release and ultimately then, you know, it spirals into a situation where that becomes a primary problem and again the ADHD is missed.

Right?

So this is where, when we see those transitions and you'll see those spikes in referrals, primary school into high school, high school into college, college into university, university then into the workplace because what's happening there is the net's widening.

You're expected to become more independent.

And as you're expected to become more independent, symptoms of the ADHD can start to become more apparent.

So thank you so much for listening to today's episode.

I really think that to have this validated by a doctor who specializes in adhd, who has ADHD himself, has ADHD in his family, to know that he is seeing this right now with so many of his clients, sees it within himself, and he sees it across the board that we're learning so much more, especially about ADHD in in Women and Girls.

So the next brand new podcast will be back on the 9th of January, and there are lots of toolkit episodes out there for you.

So if you are diving in and you want to learn more, please do check out the toolkit and wishing you a very happy New Year and a positive 2025 ahead.

Take.