You’ve had the blood work. You’ve heard that everything looks “normal.” But you still feel foggy, exhausted, unlike yourself—or like one symptom keeps joining another. In this listener-question AMA, Dr. Jolene Brighten explores how to make sense of that bigger picture.
Dr. Brighten is joined by Angela, her friend and assistant, to answer questions about lab results, ADHD and hormonal shifts, thyroid conditions, endometriosis, gut symptoms, weight changes, acne, and the mental load women carry. The conversation looks at how symptoms can overlap and where it may be useful to start investigating.
What you’ll hear in this episode
- Why a lab result within the reference range may not explain how you feel
- What your own health baseline can add to the conversation about “normal” results
- Why ADHD symptoms and medication response may feel different across the menstrual cycle
- What Dr. Brighten says is known—and not yet known—about HRT and ADHD medication
- How perimenopause may change the experience of ADHD
- How to think through several conditions at once, including Hashimoto’s and endometriosis
- What hypothyroidism and Hashimoto’s mean, and what thyroid medication options come up in the discussion
- What “root cause” investigation can include, from health history to gut health and environmental factors
- Why weight gain around the middle involves more than the number on the scale
- How protein, fiber, added sugar, muscle, and movement fit into the metabolic-health discussion
- Why adult acne doesn’t automatically mean testosterone is too high
- What the episode explores about endometriosis, gut motility, histamine, mast cells, and SIBO—and where the evidence is still incomplete
When “normal labs” don’t match how you feel
A lab reference range describes results within a population. It doesn’t, by itself, tell you whether a result explains your symptoms or how it compares with your own health baseline.
Dr. Brighten suggests looking at lab results alongside the symptom picture: What changed? When did it begin? What was different when you felt your best? A normal result may be reassuring, but it shouldn’t automatically close the conversation if you still feel unwell.
That doesn’t mean every symptom points to a hidden diagnosis or that every lab needs to be repeated. It means your symptoms, health history, and test results need to be interpreted together.
ADHD symptoms, hormones, and the menstrual cycle
One listener asks whether ADHD can feel worse before a period or during perimenopause—and whether hormone therapy might affect ADHD medication response.
Dr. Brighten discusses how estrogen relates to dopamine and norepinephrine, neurotransmitters involved in attention and executive function. She describes how some women notice changes in their focus, impulsivity, brain fog, or emotional regulation during parts of the menstrual cycle.
She also draws an important line between clinical observations and established research: in the conversation, she says there is little or no direct research on how hormone therapy affects stimulant medication response. Some women report that their medication works better when estrogen is more consistent, but those reports are anecdotal. This is a topic to discuss with a clinician who understands both ADHD treatment and hormonal health.
When several conditions overlap
Another listener describes Hashimoto’s, endometriosis, lymphedema, hormonal changes after hysterectomy, weight gain, and brain fog. The question is not simply which condition matters most; it’s how to decide what to look at first.
Dr. Brighten discusses considering the hormonal and metabolic picture, thyroid function, endometriosis-related concerns, and the person’s overall health history. She also talks about the need for appropriate specialist care, particularly for conditions such as lipedema, which she describes as understudied.
The practical takeaway is to avoid treating each symptom as though it exists in isolation. A clinician can help prioritize concerns, consider medication interactions, and identify which questions need attention first.
Thyroid medication and root-cause questions
The episode distinguishes hypothyroidism—low thyroid hormone—from Hashimoto’s, an autoimmune condition that can lead to hypothyroidism. Dr. Brighten discusses levothyroxine, combining T4 and T3 medication, and natural desiccated thyroid as options that may come up in treatment conversations. The right choice depends on the person’s diagnosis, labs, symptoms, and clinician’s guidance.
The conversation also asks what “looking for a root cause” actually involves. Dr. Brighten describes reviewing medical history, infections, gut health, genetics, and possible environmental exposures. She discusses possible overlap between gut and immune-system factors, endometriosis, and autoimmune conditions, while acknowledging that a full explanation connecting every factor is not always established by direct research.
Weight gain around the middle: insulin, muscle, and support
A listener asks why she can eat well, have regular periods, and still struggle with weight around her middle. Dr. Brighten focuses on visceral adiposity—the fat stored around organs—and discusses its relationship to metabolic health and insulin regulation.
She shares practical nutrition and movement suggestions, including eating enough protein, aiming for adequate fiber, noticing added sugar in foods marketed as healthy, building muscle, and taking a short walk or doing calf raises after a meal. These are the strategies discussed in the episode; individual needs vary.
The conversation also covers GLP-1 medications. Dr. Brighten describes them as a possible tool for some people and emphasizes the importance of support around nutrition, movement, sleep, and maintaining muscle. Decisions about starting, changing, or stopping medication belong with a qualified prescriber.
Adult acne isn’t always a testosterone problem
New acne in your 30s or 40s can have several possible contributors. Dr. Brighten discusses androgen activity, conversion of testosterone to DHT, insulin regulation, diet, and changes in the skin microbiome.
She also points out that acne can have causes that aren’t primarily hormonal, including possible fungal involvement. If acne is new or persistent, a dermatologist can help assess what’s happening with your skin.
Endometriosis, gut symptoms, histamine, and SIBO
The episode explores why endometriosis may show up alongside gut symptoms. Dr. Brighten discusses gut motility, adhesions, and the possibility of small intestinal bacterial overgrowth (SIBO). She also explains a proposed connection involving mast cells, histamine, estrogen, and the DAO enzyme, which helps break down histamine.
She is careful to distinguish a plausible biological pathway from definitive proof of the entire pathway in people. The episode brings together research and clinical observations, while noting that direct studies connecting every step are limited.
“Do less”: the mental load and your health
The final question asks for one small way to support yourself without adding another complicated wellness routine. Dr. Brighten’s answer is simple: do less.
She suggests writing down what is causing stress, identifying what is actually yours to carry, and considering what could be set down or shared. Women can end up managing responsibilities simply because others expect them to—or because they feel they must do everything perfectly. The conversation makes room for boundaries, asking for a different role, and letting other people learn from their own mistakes.
Dr. Brighten also describes healing as nonlinear: progress may include steps forward and steps back. That doesn’t mean nothing is changing.
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Links mentioned in the episode
Dr. Brighten’s protein, fiber, sleep, and exercise plan: https://drbrighten.com/plan
Omega Plus: https://drbrightenessentials.com/products/omega-plus
The 6-Week Endometriosis Reset: https://drbrightenessentials.com/products/endometriosis-reset
Acne and PCOS article: https://drbrighten.com/acne-and-polycystic-ovary-syndrome/
PCOS skincare guide: https://drbrighten.com/pcos-skincare/
ADHD in women: Symptoms, causes, and treatment
Hormones and ADHD: How hormones can affect ADHD
ADHD and the menstrual cycle: Why symptoms can change across your cycle
ADHD medication and your period: What women should know about treatment and changing symptoms
ADHD and perimenopause: Why symptoms may intensify during the transition
About Dr. Jolene Brighten
Dr. Jolene Brighten is a board-certified naturopathic endocrinologist, nutrition scientist, and author. She draws on clinical research, her work in women’s health, and her own experience as a neurodivergent woman to explain the connection between hormones and ADHD.
ADHD and Women is out now. Dr. Jolene Brighten’s book explores how hormonal shifts may affect ADHD symptoms and offers practical strategies to help women better understand and support their brains.
Explore the book and ordering options
Frequently asked questions about ADHD and Women
A result within a lab’s reference range may not fully explain your symptoms. Dr. Brighten recommends considering lab results alongside your symptoms, health history, and, when available, your own baseline.
The episode discusses how hormonal changes across the menstrual cycle and during perimenopause may affect ADHD symptoms for some women. Dr. Brighten notes that research on HRT’s effect on stimulant medication response is limited.
No. Hypothyroidism means thyroid hormone is low. Hashimoto’s is an autoimmune condition that can lead to hypothyroidism.
The discussion covers possible connections involving gut motility, adhesions, SIBO, histamine, and mast cells. Dr. Brighten notes that evidence for some of the proposed connections is still limited.
No. Dr. Brighten discusses several possible contributors, including androgen activity, insulin regulation, skin-microbiome changes, and possible fungal causes. A dermatologist can help assess persistent or new acne.
Write down your main symptoms, when they began, patterns you’ve noticed, and relevant health history or medication changes. Ask which concerns should be prioritized and what additional information would help guide that decision.