Hi everyone.

Welcome back to another episode of Monday's ADHD Women's well Being Wisdom.

And we are here again to give you these more bite sized, smaller, easy to digest bits of information, things that I think are so important that need reinforcing, maybe need repeating so we can really embody it, understand it and process it.

And today's episode is no different.

It's something that I pass passionately talk about in all my episodes and because I'm so passionate about this topic.

It is of course in my brand new book which is out on the 17th of July.

It is the ADHD Women's well Being Toolkit.

And I would not, I, I would not be able to write this book without being able to focus on hormones and the impact of the, the ADHD kind of prototype of women, how it impacts our hormones and vice versa, how our hormones impact our adhd.

It's this sort of dance between the two of them that when we get right, can really help lessen many of our ADHD traits.

But sadly for so many of us, when we have lived undiagnosed for so long, it can be really, really challenging and difficult to live with, especially when we're not getting any further support.

And I wanted to share with you someone who has been an advocate for ADHD women for a long time.

She's been a personal doctor to me and I've brought her onto podcast a few times.

She's been on different workshops.

It's Dr.

Emma Ping.

And the reason why I bring Dr.

Emma Ping into my space quite a lot is because she's a menopause specialist who also works with neurodivergent women.

And she's really passionate about offering women holistic, patient centered, bespoke advice.

So this is about personalized advice enabling more women to feel empowered with their adhd, with their well being, so they can understand that this dance of their hormones and understand how it shows up, when it shows up, why it's being exacerbated at different times in their life.

So we talk about how perimenopause and menopause intersects with ADHD and how all these different symptoms that we've been experiencing, such as brain fog and mood swings and anxiety, can be worsened by hormonal changes during these phases and also understanding and distinguishing between ADHD and menopause related symptoms so we can get more individualized and personalized treatment and understand ourselves better so we can tweak different things and feel more empowered.

So I really hope this conversation with Dr.

Emma Ping meets you where you're at.

And don't forget, she's also a contributor to my book.

She's in the hormones chapter and I was so happy to bring her in to bring her insights on perimenopause and adhd.

And towards the end of this episode, you'll also hear from my fantastic guest.

She's been on the podcast quite a few times.

She's a good friend.

She's the most amazing ADHD advocate.

It's Adele Wimsert.

She is really pioneering more holistic understanding of hormones and understanding the role of progesterone for neurodivergent women, so more women can make informed choices.

But first, here is Dr.

Emma Ping.

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 what happens 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 recognises 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, it's 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 estrogen replacement.

I've had my levels checked, but I'm still not quite there.

Well, it 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 have to need a tweak or a change of your ADHD medication in relation to hormonal changes as well.

Because with hrt, what I should say is if you, you only need progesterone if you've got a womb, generally, because as part of an HRT regime, the estrogen is for the symptoms that addresses your symptoms and the progesterone is to keep the lining of the womb thin while you're having additional oestrogen.

Because what we know from studies is if a woman has a womb and you just give them estrogen alone, without the progesterone, the lining of the womb can grow and get thickened over a period of years.

If you left that and did nothing about it, you can get bleeding problems and some of those cells might become cancerous.

You can get womb cancer.

So we know to avoid that if you're giving a woman estrogen, you have to give them progesterone alongside if they've got a womb.

And there's some other special circumstances that need progesterone alongside, even if you haven't got a wound.

But that's very specific circumstances.

Okay, so that's, that's really interesting.

Yeah.

So what you're telling me here is this is such a specialized area and what you're offering is so tailor made that, you know, God bless the nhs, they just don't have the time or the resources for someone who has got.

Lots of these questions that I've got.

And I'm sure lots of other women do.

And it's, you know, expertise is needed to understand ADHD and to understand menopause.

And here in the uk, you know, what do we get?

I think seven minutes with, with our gp and it's just not enough time to kind of test out all these different options.

And you know, I mentioned before, from reading a lot of the women's testimonials and conversations on different groups, that PMDD and PMS is quite a big thing with ADHD women because of the hormonal disruption throughout the cycle.

So for us, you know, monitoring our cycle is really, really important because that's what we understand when our concentration really.

Dipped, when we really struggle with our adhd.

And I've talked about it on the podcast before that, you know, even if we don't do anything, can we just monitor our cycle?

And we book in things around sort of the first two weeks of the month when our estrogen is high or dopamine is high, we're really, you know, we're thriving under the circumstances.

And then when things start, I think it's post ovulation, things start really dipping.

That's when we kind of take the offer off the accelerator a little bit and give us a bit more compassion and a bit more self care and trying not to book in things that are going to give us anxiety and overwhelm us, because I can feel that absolute awareness.

Awareness is huge, isn't it?

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 variation of 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 is incredibly challenging.

And also 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, that was because something's in.

Something's 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, 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 symptom 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.

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 oestrogen 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?

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.

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 estrogen levels at a good level and then see where that woman is at in terms of her symptoms.

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 entirely 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.

Testosterone that is available on the nhs, but it's only a male formulation, it's not made for women.

We have a female formulation which we can import from Australia and it is made and dosed for women, but it's only available privately, which is incredibly unfair.

We're kind of stuck in this situation at the moment.

Women can use the male formulations which are available on the nhs, but in terms of testosterone prescribing, it is much more unusual to find a GP who has been trained in that for women.

So that's the sticking point.

So there is that sort of triangle.

Adhd, estrogen, testosterone and all the cognitive and mood symptoms.

We don't understand enough about ADHD and testosterone.

Definitely not.

We need more, you know, more data, more investment in research.

So thank you so much to Dr.

Ping.

And now here is my conversation with Adele Whimsit from March this year.

And in this clip, she tells me about the results of a brilliant study she did looking at ADHD women and their hormones.

Now, just to give you a little bit of insight, Adele is a women's health practitioner.

She's a cyclical living guide.

She's also co authored a book called Essential Feminine Wisdom.

And she's incredibly passionate about educating women on how to harness their power, of their cyclical nature.

And she bridges this gap of more of the woo and the science supporting women to balance their hormones.

She's also got ADHD herself and a huge amount of her clients are also neurodivergent.

So so much of what she says resonates with our community.

I really hope that this short clip gives you a bit more empowerment around your hormones, your menstrual health and making more inform choices moving forward.

Here it is.

So, very briefly, this was a study where I took a small cohort of ADHD perimenopausal women, where we tracked their exact estrogen and progesterone levels from their urine, which they tested at home on a device with mira.

It was done in collaboration with mira.

They very kindly provided the devices for us to be able to do this.

And the women tested their hormones every single day, which is as accurate as blood tests, but so much more informative in terms of what it tells us.

And alongside that, they tracked their traits in the evening, so their inattentive traits and their hyperactive traits, and then after three cycles, so three months worth of data, we then gathered their experience and analyzed their hormonal fluctuations within the context of their traits and how they experience them in this season of their life.

And what we found was really fascinating and I believe goes quite a long way to potentially explaining why so many women receive an ADHD diagnosis in perimenopause.

Okay, that sounds really fascinating.

So tell us a little bit about what you found.

Yeah, I mean, this is in, by no means, you know, a double placebo control.

It needs so much more research, but it is still, in my opinion, still statistically relevant because of the consistencies that we found in the study.

And the thing for me is that estrogen is a hormone that gets all the spotlight and progesterone gets forgotten.

And I truly believe that progesterone is where we need to focus our attention in women.

And also looking at this multi systemic experience of adhd, it's not just in our heads, you know, and perimenopause creates this environment for what I call the perfect storm.

And that's what I've called this study, because it really is for women in this season of their life.

So what I found overall was that in the first phase of perimenopause, and I'm talking from 35 years onwards, the hormone that drops off a cliff is progesterone.

And this is where we start to see many more women come forward and say, oh my gosh, this is me, it's been me my whole life and now I just can't keep a lid on it.

The strategies I used to have don't, you know, that worked really well now aren't working and I don't know what to do.

I'm completely overwhelmed.

Well, progesterone from a medical perspective only really gets a look in to protect the uterus, which is very important.

But for me it's a mood stabilizer.

Progesterone acts like Valium on the nervous system.

Our brain is covered in progesterone and estrogen receptors.

But when all we're talking about is estrogen, we completely ignore progesterone's effect on mood, nervous system regulation, sleep, it does lots of other things like protect breast health and bone health.

But for the purposes of this, my hypothesis began as being, look, what we're going to see is where estrogen is high, much more of a hyperactive, hyper focus type type traits.

And in the second half of the cycle we would see more inattentive type traits.

This is what the small pieces of research we currently have are showing.

So that's what I was thinking I was going to see.

That's not what I saw.

There was a bit of it.

What I saw in this cohort and demographic of women was that the traits were kind of all over the place consistently throughout the month, which is really interesting because what we know is happening to women and the mirror data evidence this was that progesterone was not being produced in sufficient amounts, which is very normal and meant to happen in perimenopause.

We don't ovulate as frequently and when we do, the part of the gland that produces the progesterone gets a bit lazy.

So we don't create enough to compensate for our estrogen.

So we go into a state that is very well acknowledged in the functional women's health world.

It's not acknowledged in the medical world, which I think is a problem is we go into what's called an estrogen dominant state.

Now this doesn't mean you're producing too much estrogen.

It means there is not sufficient progesterone to keep that estrogen in check.

Okay?

And I break this all down in the paper.

So we go from 35, we go, we go from our fertile years usually having this really lovely high consistent level of progesterone to keep estrogen.

I call Eastern the party girl.

And progesterone is like the mum who comes home after the party and says, calm down, time to go to sleep now.

Because they're very different energies.

Yeah, now partying is good for us, it's good to have some fun, but all the time it'll burn us out.

That's what Istan does.

She's like fire.

And we need the water of the progesterone.

But when we're going into this season of our life, estrogen is dominating because of this lack of progesterone.

So it makes perfect sense to me that when we know that Eastern on its own has a massive impact on mood when she's not opposed properly by progesterone.

That's a factor.

Okay.

We all have already, you know, have more challenges around regulating our mood, for example, our cognitive function or executive function.

So, so when estrogen is dominating that, it's going to amplify that.

And then if we add in the lack of progesterone to help compensate for that and keep it all in check with, then that's another layer of complexity.

Can I ask, can you give us some examples of what estrogen dominance may look like?

So estrogen dominance has five different types of presentation, but we automatically think, oh, it's too much Eastern.

That's not the case.

So you can have high estrogen, but a normal average level of progesterone production.

Healthy looking progesterone production, but it's just not enough to keep on top of the amount of estrogen your body produces.

So that's one type.

The other type is, the one that I saw most commonly in this study is a normal estrogen but low progesterone.

So a normal level of estrogen, but again, just not enough progesterone to keep her in check.

You can also have high levels of progesterone.

High level, sorry, high Levels of estrogen.

This is day two, kicking in high levels of estrogen and low progesterone and low estrogen and very low or practically non existent progesterone.

So eastern dominance doesn't mean too much estrogen.

It usually much more commonly means there's not enough progesterone being produced in your body for your level of estrogen.

Yeah, I understand.

Yeah.

So that's why in my head I.

See progesterone as like the leveler.

If you've got the amount of progesterone to help level the estrogen.

Yes.

Then things are okay.

But it's when you've got like significantly lower progesterone or you just completely out of whack with estrogen.

The progesterone, I always see it.

It's my analogy because I need visual analogies is, you know, like treble and a bass and an equalizer and, you know, not that I've got any musical background, but you've always got to be sort of working with the treble and the bass to make sure that the bass isn't too high or the treble's overtaking.

And, and that is the way I see it, is that according to whatever that music is, you've got to have that balance.

So it's so interesting because we have been told with these new discovery of hormones related to ADHD is like estrogen is the dominant thing and because it kind of is neurotransmitter alongside, you know, with our dopamine.

And that's all we're sort of thinking about.

But actually from my experience, it was the tweaking of the progesterone that's made a massive difference.

Progesterone is my favorite molecule ever.

I'm like the progesterone queen.

I'm currently in the process of writing a booklet for people because it's so misunderstood, particularly with my neurodivergent women.

I actually get angry at this terminology that prescribers use.

But calling synthetic progestins in the marina, in the pill, in patches, progesterone, it's factually incorrect.

They're different molecules, they do similar things for the uterus, but outside of that they are not the same.

And it creates this really so much misinformation that prescribers don't even generally realize the difference.

The big pharma have done a really good job of making prescribers call them the same thing and they're absolutely not.

And once progesterone is in the right level in your body, it's a complete game changer for mood.

A woman cannot regulate her nervous system or regulate her mood properly without progesterone.

Right.

So why are we not talking about this for neurodivergent women?

When women get their progesterone right, they say, I feel like me again.

I feel like I used to.

Because hormone deficiency is like a slow erosion of your soul.

You don't just wake up one morning and go from here, you know, to suddenly being in this.

This deficient state.

It tends to be, you know, very.

You don't notice it until you're, like, in the trenches.

Right?

So we don't.

We get used to feeling really bad.

You know, I say women are like rivers.

We find something hard and we just meander around it.

We adapt, we find new ways.

We don't go, what's going on here?

Until it's really bad.

And I find this so sad.

Women wait until they're on their knees, usually before going, I need help now.

Because we don't.

It's like this deep entrenched belief that we're not deserving of feeling amazing.

How many women do you meet who go, I've got such great energy.

I sleep pretty well.

My mood's really regulated.

I've got.

You want to hit them, wouldn't you?

You know, and yet look at how we still show up.

Look at the magic we create in the world, generally feeling like we do.

Imagine if we all felt amazing.

We have the right to feel amazing.

And that, in my opinion, which is my bias, comes from regulating the hormones, I think.

Yeah.

What you were just saying before about, you know, women not knowing that they are allowed to feel well, like, not thinking that they are worthy or deserving of feeling energized and good and happy.

And, you know, and I made, you.

Know, I made a joke saying, oh.

You know, that person would be really annoying.

But actually, we should.

We should feel like that.

But we are looking back behind, you know, generations of women.

We know that as women who are maybe in their 40s and 50s listening to this 30s, we're probably that first generation who are getting this awareness of, oh, so it's neurodivergence that we've been dealing with.

That's why there's been hormonal mental health problems throughout the generations of the women.

And that's why I've seen addiction patterns and chaos and all sorts of things going through all different family members.

And now we just look at them and kind of think, well, that's just the way it was.

And that's the way I am and that's the way it should be.

And we've not had any sort of benchmark for change.

But what we are doing, you and I, you know, we've both got teenage children is going, actually, there's an alternative here.

We can track apps, the mirror, we've got options, we've got more information, new research, we've got podcasts coming out.

We are in this incredible situation where, yes, medical knowledge or expertise isn't quite there, but we can start demanding change and we can start helping the next generation be, become more aware, which is what I try and do with my kids, even though half the time they don't want to listen.

But I really hope that it's filtering through through, you know, whether it's filtering through on influences on, on TikTok where they're listening or finally there'll be a penny drop moment of what we're saying will land with them.

How can we start creating a change for good?

You know, we're listening to this podcast now and it's overwhelming.

We're both angry, but how can we take this passion and start being like, you know what, I'm going to make a change in my life, like small steps.

How can I ask for help?

Where can I go?

You know, we've got this progesterone cream people can use.

What would you suggest?

Oh, my gosh.

There's so much that I want to say to that.

I think the first step is acknowledging that as a woman, you are a cyclical being.

Okay?

We are not like men.

We're not linear, we're cyclical.

We have this dance of hormones going on inside us and it affects everything.

And really, like that is a fact.

You know, this isn't a woo woo thing.

And that in itself can be really validating.

So I'm not meant to show up all this all the same every day and find out what is going on in your body.

If that's an option, at least.

Track tracking is free.

You know, you can download a free tracker from my website.

It's free.

You can start seeing your dance and your pattern.

And I know this point sounds really cheesy, but what really came to me as you were saying that, Kate, is we have to be the change we want to see.

You know, people often say to me, what can we do about the medical system and change it?

Nothing really, because it's massive and it's in jade.

What we do is we stay in our lane and we say this.

This is how as a woman to Feel great.

This is what you need to do and how you need to live in order to feel great.

And then we start doing that.

Because when one woman starts doing it, we are like this ripple effect.

It's why multi level marketing companies work so well with women in them.

Because when one woman does it, we ripple out, right?

We talk to people about things.

When we feel good, when we find something, we're like, do you know what I've been using?

Or do you know what I've been doing?

And I feel so much better.

That is how we become the change for our daughters.

Daughters.

You know, when you start talking about your period with another woman, you give permission to her to start talking about it.

Every single woman I know really deep down wants to talk about our hormones and periods.

And once we give that permission by one woman doing it, we have this ripple effect.

Whether I'm teaching in a boardroom full of CEO women or I'm in a yurt with women, you know, talking about womb wisdom, every single woman wants to talk about their hormones and periods.

I get loads of questions all the time.

And if you can be that woman in your community to say, I've had this great podcast and I really understood this and I've learned this.

That's how we start to make the changes.

And for some women, you know, on a personal level, it's about getting up in the morning, making sure you have a glass of water.

You know that that can be the first step because we get up and we're like we're leading a marching band.

You know, we wake up sometimes being like we staple gun to the bed, drag herself up, and then we're off for the rest of the day, not once checking in, what does my body need?

How do I feel?

How do I meet that need in a really empowered way?

When was the last time we did that?

Make sure you're having 30 grams of complete protein within an hour of waking up.

You know, I would be really cautious about fasting, for as a woman, it's not said there's not benefits, but be very cautious.

You better make sure your adrenals and thyroid are absolutely optimal before you even consider it.

And then you want to do it cyclically, taking this feminine model of health and applying that to our to make an ADHD friendly lifestyle for us as a woman in a female model, not a masculine model.

So I hope you enjoyed listening to.

This shorter episode of the ADHD Women's Wellbeing podcast.

I've called it the ADHD Women's Wellbeing wisdom because I believe there's so much wisdom in the guests that I have on and their insights.

So sometimes we just need that little bit of a reminder.

And I hope that has helped you today and look forward to seeing you back on the brand new episode on Thursday.

Have a good rest of your week.