ADHD and Perimenopause: Why Perimenopause Is Worse for Women With ADHD | Dr. Jolene Brighten

[00:00:00] 

Track 1: More than half of women with a DHD experience, severe perimenopausal symptoms, often starting in their mid thirties, not their late forties, not menopause their mid thirties. Let that sink in for just a second there

because if you've ever been told you are too young for perimenopause, or this is just stress, or maybe your A DHD should be getting better as you age. This study says that assumption is wrong. A large population-based study published in European psychiatry found that women with A DHD are not only more likely to experience severe perimenopausal symptoms, but they experience them earlier, more intensely and across more systems of the body than women without a DH.

D. And once you understand that data, it becomes [00:01:00] very clear why so many women feel blindsided during this stage of life. Before I get into how much more severe perimenopause is for A DHD women, and yes, we're gonna break down the symptoms. Can you take 30 seconds to subscribe and review the podcast because I think it's about time women with a DHD get the hormone help they deserve, and it's your support that helps me get the info out to the women who need it most.

So if you've already done all of this, thank you so much. Okay. Now here's the deal. This study that I just referenced, this wasn't a small or niche study. Researchers followed over 5,000 women between the ages of 35 and 55 using a large population based cohort in Iceland, about 10% of those women had a DHD. Which is consistent with what we're seeing globally as adult.

A DHD is finally being recognized in women. So there's gonna be a lot of critics who are like, that's a small amount of women. Well, A DHD doesn't make [00:02:00] up as far as we know, like 90% of the female population. So it tracks with what we see globally 

And what they measured were A DHD symptoms and perimenopausal symptoms, and they used validated rating scales for this, and they looked at things like physical symptoms, so pain, fatigue, sleep disruption, palpitations, nobody talks about it, but it's one of the worst things that my patients report about perimenopause and all of this matters because like.

This wasn't a study where they just asked if like women were filling off. They really tried to look at what specifically they were experiencing, 

And they use tools that quantify symptom severity, which is really important. Now, here's the first like headline result takeaway that like I, I still, as a woman with A DHD feel astounded by 54% of women with A DHD had severe perimenopausal symptoms. 54 compared [00:03:00] to 30% of women without a DHD. That is not a subtle difference.

Friends, that's nearly double double the symptom experience. And so when we look at symptom scores, okay, let me break this down. Women with a DHD average, a total symptom score of about 18. So looking at all symptoms, they would score about 18. Women without A DHD averaged about 13 and clinically that difference is meaningful.

It's the difference between this is uncomfortable, but I'm managing and like this is affecting my daily function, and I feel like I'm falling apart, and why am I losing my mind kind of vibes. Now we're gonna get into the specifics of the symptoms. But before we do that, I wanna invite you to grab my free five day A DH ADHD hormone course that teaches you how to make your hormones work for you instead of against you.

Sounds good, right? You can grab it at dr wrighton.com/sync. That's [00:04:00] D-R-B-R-I-G-H-T-E n.com/. SYNC. Okay. You can grab that and keep listening 'cause we need to get into the systems that are being affected.

Now one of the most important and misunderstood, uh, findings is that this wasn't just about mood. So everybody always thinks like, well, A DHD women already have anxiety and depression, so of course they're gonna have more anxiety and depression and perimenopause. 'cause women and perimenopause tend to have more anxiety and depression.

That logic follows suit, but women with A DHD had significantly higher rates of severe symptoms across every single category. So yes. Psychological symptoms like depression, anxiety, irritability. Yeah. If you know, you know, uh, that got worse. We also see fatigue that amplified as well, and the study showed in the psychological category that about 59% of women with A DHD reported these [00:05:00] symptoms, whereas 36% of those without A DHD said they had these symptoms. So again, a big differential there. Then there was somatic symptoms. So hot flashes, sleep disruption, something you already have with A DHD, like 70% of people do. But also heart palpitations, joint and muscle pain. 30% of those with A DHD reported these symptoms. 14% of those without A DHD reported these symptoms. This was the largest relative difference. This is. This is not something to be ignored. Now your genital symptoms, sexual dysfunction, vaginal dryness, bladder issues.

These were also reported at a higher rate if you had a DHD. Well, with the women who had a DHD in this study. So 43% versus 28% of the non A DHD women.

So A DHD women had nearly double the rate of severe general physical symptoms like pain, headache, digestive issues, and [00:06:00] exhaustion as well. So this tells us something critical.

Track 2: A DHD

Track 1: DHD in perimenopause is not just a mental health story, and it is often something where A DHD is relegated to only being a mental health disorder and like this is happening in your head, but A DHD is a full body experience and so it makes sense that the perimenopause transition is also a full body experience that's amplified in those who have a DHD.

So A DHD, it's a neuroendocrine whole body story, but I wanna talk about who is affected the most because I think this might shock you. And listen, I don't wanna just offload info. I wanna give you solutions. So I want you to stick around to the end so you can get some tips to manage A DHD through perimenopause as well. So this is the part of the study where every clinician should stop, stop, look, and listen. I feel like a kindergarten teacher, but this is the part that should fundamentally change how we screen women. The largest symptom burden in women with A DHD occurred [00:07:00] between the ages of 35 and 39, suck at every doctor out there that says you're too young for perimenopause. Meanwhile, their patients are like spiraling into hormonal hell. That is where the symptom severity tends to peak with A DHD brains. Meanwhile, women without A DHD didn't peak until their late forties.

What, so they might have like symptoms going on, but like almost a , decade earlier. Like what? So in other words, eight H women are experiencing perimenopausal level symptoms up to a decade earlier at an age when they're routinely told things like, you're too young. Or maybe like, this is just stress.

This is just anxiety. How about I put you on an SSRI and call it a day? Hey, your labs are normal. And women with A DHD are like, nothing about me is normal. And this aligns with genetic data showing that women with A DHD tend to reach [00:08:00] menopause earlier. But this study shows that their suffering starts long before a menopause itself.

Now remember, perimenopause is the countdown to your final menstrual period, the final menstrual period. That's the day you arrive into menopause. Happy birthday next day. You are now postmenopausal. So women with A DHD, they have a higher prevalence of severe perimenopausal symptoms. These symptoms present at an earlier age than among women without A DHD indicating an earlier onset age of perimenopause.

For those with a DHD. Say what? Yeah, and I've got theories, and I've definitely been writing about this in my book and I will be sharing more episodes with you. Why I think it is that those of us with a DHD hit perimenopause sooner, and I don't think that it's a given, but I do think we need to start asking the question of like, can we be doing better screening with women?

Because another [00:09:00] critical finding of this study was about. 30% of A DHD women in their late thirties and early forties had also severe A DHD symptoms, and that lasted even into their fifties. One in four still met the criteria for severe symptoms of A DHD. And then I think this is also especially important.

Around 8% of women without an A DHD diagnosis reported severe A DHD symptoms during this stage of life.

And this raises some key questions. Is it perimenopause worsening A DHD, or is it unmasking A DHD? That was never recognized before. And the answer is both. It's both. And this is what I'm seeing. We're not seeing that there is a late onset A DHD. What we are seeing is that. Either you are A DHD and it got a hell of a lot worse and you already knew you were A DHD, or you were not ever diagnosed with a DHD.

[00:10:00] But as you get into perimenopause, it becomes impossible. Just impossible to mask, to keep it up. 'cause your brain energy is shifting. I've done an entire episode of like what happens, um, to your brain as you're going through perimenopause and so there are women. Who are not A DHD. They experience a DH ADHD like symptoms for the first time in their life during perimenopause.

But what research tells us is that all goes away. That all just goes away post menopause. Usually within two years of your final period, your brain comes back. Everything's working again. That doesn't happen for the A DHD brain. You are A DHD for life. What may happen is that because you're no longer cycling, it's no more, no longer amplified in the luteal phase, like I've talked about in other episodes. So if you haven't caught my other A DHD episodes, let me say this. Estrogen plays a direct role in dopamine signaling. When your estrogen is fluctuating in perimenopause and then declining [00:11:00] attention, executive function, emotional regulation, impulsivity, working memory, they all start to take a hit.

And that's especially in brains that are already dopamine sensitive. And there are a lot of people who like to also use the argument of like, this is in hormones, this is in A DHD, it's just trauma. Now because this study came from a trauma focused cohort, the researchers specifically tested whether PTSD explained the findings and it didn't. Okay, so we're gonna just shut that argument down right now.

Even when they separated women with and without a history of PTSD. A DHD still independently predicted more severe perimenopausal symptoms. Across psychological, somatic, and physical domains. So it's not just worsening A DHD, although that's there. It's also overall worsening perimenopausal symptoms. And so trauma does matter, okay?

And we must acknowledge it, but it doesn't always [00:12:00] explain away everything that is happening to a woman with her hormones in perimenopause or with A DHD. Okay? So we wanna be clear that. When you're getting a diagnosis for a neurodevelopmental condition as an adult, PTSD and trauma needs to be accounted for in that, and it should be in the diagnosis and it should be as part of your treatment plan as well. Now, one of the most important takeaways, especially for clinicians who are listening to this. Is women with A DHD are entering a high risk window that's perimenopause earlier with fewer supports and less clinicians recognizing them than what this study calls for is earlier screening for perimenopausal symptoms in those with A DHD.

So we need to start having this conversation earlier. They, this conversation should be happening in their early thirties, talking about what's coming down the road ahead, not waiting until symptoms are just like hitting her like a Mack truck, right? We need to recognize that worsening focus, [00:13:00] mood, sleep, and physical symptoms, maybe hormone driven.

We need to address those hormones and we need to remind our patients that it's not a personal failure. Because it's not, and feeling like you're struggling in perimenopause, like we are all struggling in perimenopause. Right. The medical system, they just like not cared about any of us. Right. That have gone through perimenopause and menopause and like I think about the generations before us and like, oh my God, I don't even know how they did it, but especially.

Every protocol, every, uh, you know, person out there who is talking about perimenopause, menopause, trying to get it like at the forefront of people's minds, even like trying to change like hormone protocols in clinical practice. They are not thinking, they're not even caring about the neurodivergent brain.

I'm gonna be honest about that. Um, and you know what, they're not neurodivergent, so I don't really want them speaking for us anyways, but also like, I, I wouldn't expect them. To know anything about our experience because it would take not just living in our body, but listening really intently and having enough patients [00:14:00] who are neurodivergent for you to be able to cultivate those skills.

So I'm not trying to blame anyone for that, but I am saying that A DHD women are being completely left behind in this perimenopause menopause conversation. Even in the hormone therapy cookie cutter approach that is being done. We're being left behind in that conversation. And this study is very disruptive because it's saying.

You gotta wake up and you gotta help these women. You gotta help them sooner.

I am gonna talk about specific things that you can be doing, uh, a ways for you to help yourself, but integrative care that addresses the A DHD woman in perimenopause. This is what it should include, and I want you to know what you should be thinking about with your provider. So they should be talking to you about hormones.

They should be talking to you about A DHD treatment across your lifespan. 

Track 2: And

Track 1: they should be talking about your full body experience. Because A DHD is not just a brain experience, we know it's related to the gut, it's related to the immune system, it's related to the hormones. It is related to your entire body.

And the authors of this paper pointed out that like, we don't have data on hormone [00:15:00] therapy for women with A DHD on how like stimulants should change on nonstimulant meds for these women. Um, how all of this should change in the conversation of perimenopause. And I wanna say to my clinicians who are listening, that's not a reason to do nothing.

It's a reason to do better research and better clinical care. Okay, so we gotta call for research. If you're a researcher, get on it please. But we gotta call for research, but we also need to listen to our patients, and we need to fine tune with the individual because they deserve better clinical care. No woman has time to wait around for research to finally acknowledge that we exist and that we deserve the care.

Like it wasn't. And, I mean, I could go through the history, but like we, we didn't even have women included in trials until like the late nineties drug trials and like, we ain't even really included now. Okay. They're just like, psych, we're kind of including you. It like looks good on paper, but it's not legit.

Like we as women have waited around forever for medicine and research and I think about, like, Dr. Amy Shaw always says like, no one's coming to save you. No [00:16:00] one's coming to save us. So that's why I'm here. That's why I'm doing this podcast because I'm like, uh, we, we ain't gonna wait around for that. We're gonna feel better now. But if you are a woman with a DHD and you felt like, oh my God, my thirties have been so hard and it's just getting harder, you're not imagining it. And if you were just told that like it's just stress, it's just aging, it's just anxiety. It's just like, have you tried losing weight? Like this study says that the ex, that explanation ain't gonna cut it.

Like this study is telling us that like, yes, you are having it a harder time and medicine should be treating you better. 

Track 2: So

Track 1: before we get into solutions of what can help, I just wanna say, and especially if you're a clinician listening to this, the message is super clear perimenopause and A DHD starts earlier. It hits harder and affects more than just mood. And ignoring that reality is no longer scientifically defensible.

There is no defense on this planet that you can just keep ignoring women.

Track 2: Okay,

Track 1: so we talked about how estrogen supports [00:17:00] dopamine signaling. It also supports mitochondrial energy production. That's how your brain actually has energy, like your whole body has energy. Um, it's supporting blood flow to your prefrontal cortex. So estrogen is gonna be really important. And we are gonna talk about hormone therapy.

I'm gonna talk a bit more about that. But I just think like estrogen is something that has been vilified for so long that people are afraid of it. But I wanna like shine some light on like, you know, estrogen. It helps the A DHD brain buffer, like the capacity, it helps with executive functions, but when it goes down as it does in perimenopause, executive function becomes dysfunction and it becomes more expensive to even try to do that.

'cause you don't have the brain energy. Emotional regulation becomes harder. The nervous system shifts towards threat mode. Oh my God, I need to do a whole podcast just about that. About what happens to us going into threat mode. We've already been. Surveilling and, and, you know, doing surveillance and making sure that like, we're [00:18:00] fitting in and we're camouflaging and we're masking and all of that, and then we hit perimenopause and woo hoo.

HPA axis is off the train. 

Track 2: So

Track 1: when we talk about solutions, we have to look at what estrogen was doing. We need to increase the dopamine, . We need to help with neuroinflammation. We need to stabilize stress hormones. We need to support brain energy, not just like having a good mood. We gotta literally support brain energy.

So I wanna talk about my first tip. Uh, but before I get there, I do wanna say, I am gonna talk about supplements. Hormone therapy is. So please be sure to stick around. But the first one I gotta say, please don't leave me, I got more for you than just this. But, uh, movement is non-negotiable for the A DHD brain.

So we're gonna talk about the most under prescribed intervention for A DHD women in midlife. And you might wanna run away when I say exercise, but friend movement is medicine for the A DHD brain. I'm gonna get very specific with you here. So it's not just like move your body friend. It's gonna be like, this is exactly how to move your body, especially in perimenopause.

To help your brain. So [00:19:00] this is not about weight and it's not about discipline when we talk about exercise, although like this is definitely gonna help those things. But this is about movement directly increasing dopamine availability. BDN of alpha. So that's like your neuroplasticity. So good for the brain.

We love it so much, and.

Track 2: We

Track 1: know from the research and from my clinical experience. That movement matters more for the A DHD brain in perimenopause because that exercise is not only gonna help with the neurotransmitters, but it helps with their receptors. So the brain receptors increases dopamine receptor sensitivity, so dopamine that's there actually works better.

It improves your executive function, it improves your working memory. It reduces neuroinflammation. We absolutely need that in perimenopause and especially A DHD. Put it together, drop that neuroinflammation please. It also helps with your cortisol when it's done correctly. It can help with lowering baseline [00:20:00] cortisol, but here is the key distinction that I think a lot of people miss, is that more is not better.

The right type is better. So what tends to work best is that two to three times a week, you're doing moderate intensity strength training. That's gonna help you with building mitochondria storehouses. We love that little powerhouses in ourselves, so it's gonna help with improving insulin sensitivity, dopamine signaling.

Um, and this is so important because as estrogen goes, we become less insulin sensitive. The A DHD brain. It's very, very sensitive to changes in blood sugar and insulin dysregulation. Insulin dysregulation can change how our A DHD operates. Now the other thing you gotta incorporate at least once a week is in zone two cardio.

It is 20 minutes. Just 20 minutes. If you can do 40, great. . This is gonna support blood flow to the brain without spiking your cortisol. Spiking cortisol sometimes is good, okay, but we do wanna get some cardio that helps our VO two max helps that [00:21:00] blood flow.

What did they say estrogen does? It helps with blood flow. So if we're losing estrogen, we gotta do other things that help with blood flow. Not to mention that, uh, you know, 'cause we're gonna talk about hormones, um, and I'm not gonna go. Super deep into like all the risks and the pros and cons and all of that like, 'cause I've done that in a lot of other episodes.

But I do wanna say that exercise also significantly reduces your risk for breast cancer. So that's something that you are concerned about. One of the most positive things that you can do is exercise. And then the next one is, don't drink alcohol. And your A DHD brain's gonna love that.

Now the other type of exercise that A DHD brings really love are short bursts, especially of novelty based movements. So like, uh, if hiking is great and you love that and like doing a little trail running, um, dance, uh, you know, doing like kettlebells uh, Pilates if, if you like that, um, but running sprints on a bike or actually running.

Sprints, but doing like bursts of like five to 10 minutes of like really intense exercise. [00:22:00] Um, like Norwegian four by four is another really good one. I will put that in the show notes so that you can check out what that is. Um, but we do need those little, like high intensity bursts. Our brain likes those, but what fires is when high intensity bursts, like HIT training is chronic and it's all we do every single day.

If we're fasting. We're not eating and then we're doing like a really intense workout. If we're training so hard that like we don't recover for three days, we're depleted, we're emotionally fragile. Afterwards, we're more irritable, more foggy. But literally, if it, if you work out and you are sore like three to five days later, like you went a little too far, and that's just data, you didn't screw it up.

It's not a reason to throw in the towel, quit everything. It's just data, it's information, and we don't wanna be pushing through, uh, when the intensity is too high all day, every day. Now, before we talk about nutrition, I want you to know that I have a framework for you. It's at dr brighton.com/plan, [00:23:00] where you can grab a free recipe guide that's not heavy on cooking, a structured outline of what to eat and when it's a done for use solution that checks all the boxes on your protein, your fiber, making sure you're hitting everything that you need in perimenopause to optimize your blood sugar, your brain function, and your hormones, and it's.

Done for you so you don't even have to think about it. So drbrighten.com/plan. You can grab that. Now the best way to eat is hands down an anti-inflammatory diet, sometimes referred to as a Mediterranean diet, but like, you know, we're gonna break it down here. I just want you to know going into it, this is not about perfection.

It's not about never having a piece of chocolate or never enjoying a cookie. It's about reducing inflammation that is blocking your neurotransmitters from functioning right in your brain. And this study that I've been talking about, it showed that A DHD women had much higher physical symptoms. So it's a much higher physical symptom burden of pain, palpitations, fatigue, sleep, disruption.

That can all be [00:24:00] inflammation, nervous system dysregulation related, and nutrition can help support you. So let's go through some core principles that can help. So the first thing is. Protein anchors every single meal. Protein is how we make our neurotransmitters. It's how we keep our blood sugar optimal.

We're gonna get 25 to 30 grams per meal. Maybe you need more. That's a possibility, but this is a minimum. We wanna try to hit again, drbrighten.com/plan. I got you covered. If you're like, oh my God, what I got you, I, I make it really easy for you. If you, if there's one time a day, we're gonna hit it, right?

It's gonna be breakfast. It's gotta be breakfast. You've gotta get your protein in first thing in the morning.

Track 2: We

Track 1: need to focus on that blood sugar stability. And it's because blood sugar crashing, that's gonna worsen A DHD symptoms. It's gonna worsen anxiety. You higher propensity towards visceral adiposity that's gonna be belly fat.

Packing around your organs, that's gonna increase your risk for cardiometabolic disease. Okay? We're dodging diabetes and heart disease on this, , this show. Okay? Like, I don't want none of that. Um, and blood sugar swings are gonna also gonna [00:25:00] impact more night weight gains. You're gonna struggle more with going to sleep.

So when we're eating carbs, we're eating fat and protein. That's what I want you to focus on if you grab that meal plan. It also focuses on fiber. When you get 25 to 35 grams of fiber a day, that can feel really overwhelming at first. That's why I really want you to grab that meal plan to make it just really easy.

Now anti-inflammatory fats are gonna be essential. This is another pivotal part of this. Omega threes, they're gonna support how your brain receptors function. We're gonna eat olive oil. We're going to eat fatty fish like salmon, mackerel, sardines. We're gonna get walnuts. We're gonna get nuts and seeds. Uh, chia seeds, soak 'em, grind them up.

Whatever you need to do to digest 'em better. And then the fourth thing I want you to think about is reducing inflammatory load, not food joy. Okay, .

Track 2: Ultra

Track 1: processed food, refined sugar. Uh, these foods are not nutrient dense and I don't want you to think about like eliminating this.

This is like, you know, a strict diet and we're gonna crowd it out, [00:26:00] okay? Because the goal is steady brain fuel, not metabolic stress, not taking away everything you love. Okay? I won't, if you write it is this normal? I'm like, I want you to have your cake and enjoy it too. I don't want you to be stressed out about food and at the same time, we need to make sure we get enough nutrient dense foods to come in. We need enough variety of fiber. As we are aging through menopause. We are losing gut microbiome diversity. Spoiler, A DHD guts are kind of already messed up in that arena, but you can do a lot by just increasing your fiber and the diversity of fiber that is coming in through your diet. 

Track 2: So

Track 1: as a doctor, as a nutrition scientist, as a foodie, I never like to take food away from people, but I want you to be able to enjoy that food knowing that you have given your body everything it needs for the day. Now I do wanna talk about supplements for cognitive health. There are definitely things that can help, especially through perimenopause.

So if you haven't heard about creatine five milligrams daily, that can help with brain energy. I know a lot of people take it for the muscle gains. It works for [00:27:00] that too. But it is really great for helping with brain energy. I'm a big fan. 

Track 2: These

Track 1: next three, I personally take Bacopa 300 milligrams, 

Track 3: milline,

Track 1: 250 milligrams, and Saffron specifically Aron, that version 30 milligrams supports memory, mood focus. And this is something that when I was struggling with my own like horrible perimenopause. A DHD brain issues. I developed my Radiant Mind formula and I designed it so that I didn't feel scattered, I didn't feel overloaded.

I was less emotionally reactive and I was less foggy, especially under stress. And it is something that I take personally every day. It also has, uh, zinc in it as well, which helps neurotransmitters function better. 

Track 2: And

Track 1: if you are someone who deals with cyclical mood changes that make you feel like getting divorced or running away from home, uh, this is something that's really helped me.

So I don't have those vibes, those PMDD vibes, if you [00:28:00] know, you know, so. Other supplements to think about. Magnesium glycinate, 300 milligrams nightly can help with sleep. Neurotransmitter function, a sense of calm, stress, resilience, it's something we tend to need more of. And magnesium helps with our aging brain, not age, that's rapidly.

So vitamin D, we need to make sure our levels are optimal. So get a blood test. Aim for about 50 to 70 nanograms per milliliter 'cause that impacts your A DHD symptoms. Also your bones, your immune health. And then if you're not going to eat the cold water fish, if you are like yuck when I said that, it's okay.

But you may need Omega-3 fatty acids, whether you're eating it or not, and aiming for about one 1000. Some clinicians go up to 4,000. Sometimes we do need 4,000 to help with brain health and to help with inflammation, but it needs to be a high quality fish oil. I can't emphasize that enough. Okay, now onto our HRT conversation. HRT Hormone replacement therapy. Some people call it menopause hormone therapy. I [00:29:00] mean, people are like trying to the name every single day I feel like, and I'm like, oh my God. Can we just like, just get people to like, know about hormones first and get clinicians to be able to, uh, feel confident in prescribing it before uh, we start changing all the names and getting it all confused.

Okay, anyhow, let's talk to you about hormones. I have said this a thousand times, and I will say it a thousand more. Estrogen is not optional for brain health in women with A DHD. Estrogen enhances dopamine signaling. It is gonna support synoptic plasticity, so brain plasticity. It's gonna improve prefrontal cortex function.

It is gonna help with mitochondrial function, so energy production, but also reducing reactive oxygen species. So oxidative stress on the brain. It is also going to help with neuroinflammation. Every woman with a DHD has felt her symptoms getting worse in the luteal phase at some point, . And that's a sign of what it's like to have lower estrogen. [00:30:00] If postpartum was hell for you, that was a peekaboo window into what perimenopause is gonna be like for you.

So if perimenopause is kicking your booty right now and you're thinking back to like postpartum, and you're like, yeah, that was hard. That was a preview. That was a prelude of the things to come. 

Track 3: And

Track 2: it's

Track 1: not just a DHD symptoms that get worse. We know that A DHD medications don't work as well in the luteal phase or in the absence of estrogen. Now, what women with A DHD often notice when they start estrogen is that they start to have improved focus. There is better emotional stability. Sleep starts to get better.

Progesterone can also be involved in that. All, all of that as well. Um, having reduced brain fog. Improved response to A DHD medications, uh, can definitely happen, but the timing and the formulation matters. So there's some key consideration for a DHD brain. So firstly, transdermal estrogen is often better tolerated because it's more stable, less hepatic impact, so [00:31:00] it's not passing through the liver.

Um, and there's lower risk of blood clots compared to taking it orally. Birth control is not hormone therapy, it's birth control. It's great for birth control. It's not great for perimenopause, especially perimenopause, A DHD brains. So estrogen can be great. However, there are times when women will start estrogen and they feel a lot worse.

There's usually a histamine component going on, and I'll talk a little bit more about that, but I just want you to know that if you started estrogen and things started to feel worse, that's not the end of the story. And hormones aren't. The end all be all right. I just talked to you about exercise, about sleep, about nutrition, about supplements, about all these other things that also need to be in place during perimenopause.

I need you to also understand that by the time you get on hormones, neuroinflammation may be up regulated. Mitochondria function may be suffering. And if that is the case, the hormones are not gonna 180, that they're not gonna change everything for [00:32:00] you. They're gonna help and they're gonna help you get to the gym and they're gonna help you eat better.

And they're gonna help you do all of those things because they're gonna help you in terms of your executive function. They're gonna help you in terms of your joint pain, your muscle aches, so, so they're gonna help you. But I don't want anyone to ever think I can just get on hormones and like that's the end of it.

It's gonna fix everything. It's gonna help, but if you don't feel like it's not an, it's not enough, that's because hormones alone are not enough.

Now progesterone. Progesterone sensitivity is common in women with A DHD. Again, dosing and timing matters. I have an entire episode about this that'll link to, in the show notes all about progesterone intolerance, progesterone side effects, sensitivity, what can be going on in different strategies for you.

So. You know, I want women who are listening to this right now and clinicians to understand that HRT needs to be framed as neuroprotection, not just symptom control. And so, you know, the study I've [00:33:00] been talking about this whole time, it didn't evaluate HRT, but it clearly shows that waiting until symptoms are severe.

Is too late. Like it's too late and it's not like too late like, oh, we can't do anything about it. It's too late. And then like, how much time did she just lose of her life with her family? So, you know, it's really important that we start looking at how these can support, how these hormones can support the brain.

And we start looking at quality of life and, and seeing that women deserve quality of life, that women deserve to fill their bus every single day that they can. 

Okay, let's talk about. What may be the typical starting dosages that your clinician will start you on? I have other episodes about lab testing, symptom tracking, like everything all around HRT plus pros and cons. I just wanna talk about what might your provider start with? So typically we're starting with one to 200 milligrams of oral micronized progesterone.

That is gonna be something that may be used just in the luteal phase [00:34:00] if you're still cycling regularly, but you're really struggling in the luteal phase with like sleep anxiety. Again, we have to be careful sometimes. 

Track 2: with

Track 1: the A DHD brain and progesterone, as things progress and we start to have the symptoms of low estrogen come on.

Point zero two five milligram patch of estradiol applied twice weekly may be what your provider brings on. And that is gonna be enough to help start supporting the brain without pushing too much of a histamine issue, if that's an issue. And so sometimes starting slower with estrogen is better.

Sometimes clinicians will start you on a higher dose. Sometimes they're gonna use, um, you know, different forms of estrogen. It just really depends on your case. And if you do start to have histamine issues, then we're gonna look at what do we need to do in the gut? What's going on with your gut? We may bring on DAO enzymes, vitamin C, uh, nettles, so other things to help you with processing out that histamine. And some people may even need antihistamines for a period of time while all [00:35:00] of that's being worked on.

We may also consider five milligrams daily of testosterone or maybe 10 milligrams of DHEA using these topically typically. Um, and that's because these matter for A DHD Health too. I should do a whole episode about A DHD and testosterone as I'm thinking about this. Now, while this may be a starting place to consider.

We do know that if there's progesterone intolerance, we're gonna have to do things differently. So if that happens, we may use a slow release capsule of progesterone, we may use it vaginally. I find it's better to stay continuously initially, rather than doing the six days on one day off with progesterone.

And that's just because we want the brain to adapt. We want the GABA receptors to adapt. But my point in saying all of this is that if HRT doesn't work at first, that doesn't mean it doesn't work for you at all. It means we have to change things up. We have to find what does work for you. And I have another episode specifically [00:36:00] about what happens to A DHD brains going through perimenopause. And into menopause that I want to invite you to watch. I give some deeper insights on hormones and about what's happening in the brain that can help you understand your brain better and working with your hormones better.

Track 3: Now

Track 1: as always, thank you so much for being here and if you can take two minutes to leave me a comment, let me know what helped you or what you wanna learn about in a future episode, I would really appreciate that. It is you who drives the conversation and is always, thank you so much for sharing your time with me.