What Is ADHD Masking? The Perimenopause ADHD Connection

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Dr. Brighten: This fact absolutely pisses me off, and it should make you furious too. Most women with A DHD do not get diagnosed until their late thirties or early forties. Hi. It was me in my early forties. That means we're going decades.

Decades thinking we're the problem. Decades not getting support. We get report cards in school that say, oh, she's smart, but dot, dot, dot, fill in the blank. We get told that like this, probably depression. Just go on an SSRI. We are met with labels like, you are lazy. You're too emotional, you're just too much. You need to try routines. Get a calendar. Why don't you set a reminder?

Why don't you try harder? Oh, Susan can do it. What's wrong with you? And for so many of us, we suffer mental health issues because we have internalized all those messages. And when it finally clicks for so many women, is the intersection between perimenopause, hormones beginning to decline and their child getting evaluated.

Now, maybe your childless, but those with [00:01:00] children absolutely know. That was my moment. That was the moment where I was like, oh. So I'm not normal, which by the way, there is no normal, but I got diagnosed with A DHD later with autism all intersecting. At the same time, I got an endometriosis diagnosis, which is what made me dive into the literature and say, there's something here.

There's something connected. I will link to that episode where I broke down the research on A DHD and endometriosis, but this episode. Is about masking, and today we're gonna talk about why masking stops working, why your brain feels hijacked by your hormones, shocking health risks that no one else is talking about, and exactly what to do about these things.

Now, stay until the end because if you're an A DHD woman, I have this super exciting project I've been working on. It's gonna be a hundred percent free resource for you. Stay with me at the end. I'm gonna share it. I wanna share it right now. That's the A DH ADHD impulsivity of me. But we're gonna wait until the end because the first thing that we need to talk about [00:02:00] is the fact that.

We are losing years on our life. .

A DHD is associated with a significantly shorter life expectancy up to about a decade in some research, a decade. Now, before anyone twists this into fearmongering, I wanna talk about why and what's going on, because it's not because just having a DHD in itself is a fatal condition. It's because A DHD affects sleep.

Dr brighton.com show notes. I have a whole episode on how 70% of us have sleep problems and what to do about it. It also has to do with stress, physiology, metabolic health, accidents and injuries. We are more impulsive, but also we are more distracted sometimes. And, uh, there's also impulsive health behaviors like, um, drugs and alcohol use, especially in populations who don't get adequate treatment.

Women, we also are hitting chronic burnout. We [00:03:00] miss medical care and appointments, and then there's an inflammatory component as well. And when you spend decades living in a nervous system that's constantly. Overclocked. Like you never get to clock out. You are under supported. You are misunderstood.

Medicine doesn't support you. That has consequences. And this is why women deserve earlier diagnosis and earlier support because A DHD for women, it's not just about focus. This is about our long-term health. Now listen, if you're new here, this is the Dr. Brighton Show. I'm Dr. Jo Brighton, board certified in naturopathic endocrinology, nutrition scientist.

Audio, DHD, girly, and I'm really glad you're here. If you can take like a second, share this, like it, comment, subscribe. It is tremendous support for this podcast. It's a little act for you. Really big deal for me and my team. . 

But I don't wanna hold you up any longer. So let's go into why the mask breaks. [00:04:00] So here is the shocking truth that we are not told the mask holds until hormones. Start to go. So for years, many women survive on things like people pleasing. You can let me know which one is you in here? Perfectionism. That one's me.

I'm the perfectionist, also overachievement. I'm also that person. Oh. And, um, anxiety, anxiety driven compensation. Mm-hmm. Yeah, I, I could fall into that bucket as well, but also like, just sheer force of will, like you're just white knuckling through it. And then perimenopause hits. And I wanna be clear that like everyone talks about estrogen and yeah, you might even be like, yes, girl, you're the one that put estrogen on the map.

Yes. I know that I talk a lot about estrogen too, but I want you to know that if anyone ever tells you that A DH, D and perimenopause is only an estrogen phenomenon, they do not understand even half of what is [00:05:00] happening because estrogen is only one part of the hormonal storm that's eye jacking your brain.

We also have to talk about progesterone shifts, progesterone intolerance, cortisol dysregulation that comes along with this insulin instability, uh, what's happening with DHEA and um, our testosterone as well. Not to mention thyroid changes. Thyroid changes can look a lot like a DHD, so you always have to rule that out.

They can totally go together. And then, uh, there's also like sleep hormones, like melatonin that matters. Histamine, surges matter, stress hormones, amplifying other systems matter. This is a full endocrine event. It's not just estrogen. Okay? And your brain, it's being hit from multiple directions, which is why we have to look at things from multiple directions and listen.

For an A DHD woman like me, like if you're like me, you are often carrying a higher sensitivity [00:06:00] and sensory load plus a cognitive load, and that effect can become super dramatic. So we know that there's a high co-occurrence of A DHD and autism, but doctors still believe that women can't be autistic. Um, or the fact that like I can sit here and talk to you somehow.

I can't be autistic, but. If our mask starts to break because noise becomes unbearable. Transitions are impossible. Our executive function collapsed just like an A DHD person, emotional regulation that gets, uh, that gets way harder and the mask becomes way too expensive to wear. It's too expensive, it's too costly.

You are not failing. You just can't keep surviving this way. This is. Your hormonal changes colliding with years of compensation and you cannot keep it up because literally you will burn out. It will hurt you. Masking and camouflaging are slowly killing us. They are part of what wears [00:07:00] us down. So what is masking and what is camouflaging?

Masking is suppressing, hiding, trying to hide your traits. Okay. And I wanna be clear, because whenever we talk about masking, a neurotypical will be like, oh, so you're faking it. Oh, so you're pretending to be someone you're not. Yeah. I'm trying to survive. That's what masking is. Masking is survival, and we as humans have to have community.

Our brains, they die without community. Our bodies die without community. I know I sound dramatic, but research has shown that being isolated, it has the same negative effects as 15 cigarettes a day. You're 50%, five 0% more likely to die if you do not have community. You don't have a social circle, so. Us as neurodivergent individuals, we are going to find a way to fit in, to survive, to have that community.

Also, [00:08:00] we've been bullied. I would venture to guess. Every single person who is listening to this that identifies as a DHD has been bullied. So you learn the ways to fit in. So masking can look like, not interrupting mid-sentence. I, you know, that's a really benign thing. And people would be like, oh, you just learned self-control.

Well, I mean, kind of. But my impulsivity, like I, I takes a lot of energy. Not to interrupt your long-winded story, which you could have just started with the point, but for some reason you had to spend 15 minutes giving me a backstory that had nothing to do with what we were talking about. If you know, you know,

Masking is also spending an enormous amount of energy trying to look like you have it all together, trying to stay on top and compensate for the executive dysfunctions you are experiencing. Like it's spending a lot of energy trying to make up for the inherent deficits of your executive function.

That does not mean you are deficient [00:09:00] as a human. Okay. What a DHD is, is a significant executive dysfunction that interrupts your daily life, your relationships, your school, your work. And that was first brought to me that definition by Dr. Ann Louise Lockhart. I will link to her episode. She's a tremendous resource if, if you have a teenager or a kid with a DHD, by the way.

Now Camouflaging is like the umbrella that masking sits under because with Camouflaging we're taking it a step further. We are copying other people's traits, we're emulating other people. We are rehearsing scripts before we go out. Um, thinking through conversations how we'll react to that we are, um, mirroring.

What our colleagues are doing at work so that we look like we are a good worker too. And we're like, that's, that's an archetype of what people are looking for and says is good. I want to emulate that archetype. Now, if [00:10:00] camouflaging was a bad thing and there was anything sinister about any of this. Why do we have mirror neurons?

Why do we have entire sections of our brain dedicated to mirroring people, to making sure that we match their facial expression? So this can also look like trying to maintain contact, eye contact and, and making sure that it appears that you are listening to a conversation in the right way. So like, as an autistic person, I will, um.

I will have to monitor my face because I will hear what you're saying and then I'll have another thought and another thought, and I'll be connecting it to other things. And then sometimes I get this face that's like scowling and I'm like, oh, they just said this and that might mean this. And that connects to this.

And like this happens a lot in science conversations where I'm like, Hmm, putting all the puzzle pieces together. I have to make sure that I'm monitoring myself and that my facial expressions match what you expect of me. I have to [00:11:00] match what your expectation is. Otherwise, the perception is I'm rude. Um, I've been called the B word by people because they think that I am, um, being rude to them because of, uh, you know, like different interactions, which was like I wasn't even aware of.

So this camouflaging masking. Ease our way of constantly surveying ourselves and often not just shall we show up so that we have community, but so that the way we show up for people makes them feel good, makes them feel like they're, they feel good to be in a relationship that we also are, as women especially, we wanna care take to their emotions.

So now that. Like you understand that aspect of like what actually is masking camouflaging. We talked a bit about why it breaks down. Let's go into the part that medicine keeps missing

and in fact. This is the part I gotta say with my whole chest, because medicine has treated women like an afterthought for far too long. Most A [00:12:00] DHD research and treatments, those frameworks were built around what symptoms look like in boys and men, and then women were handed those same solutions and basically told, figure out a way to make it work for you.

Make it work for yourself. When you're like, this isn't working for me and I need more help, they're like, oh, you're just so broken. Like something's so wrong with you. No. That doesn't fly. It's not even like, if you think about it, like it doesn't even make sense to say that we would have the same experience as men.

Men's hormones, up and down one day, I like to call 'em like the sun. They rise and they set, they're super boring. That's why I don't like to do men's health. Women who we are complicated hormones. They change women's brains. They don't exist in a hormonal vacuum. So as you cycle. Throughout the month, day after day, your hormones are changing.

I mean, month to month, decade to decade, our brains are responding to ovarian hormones, adrenal hormones, sleep hormones, blood sugar changes, like it is a [00:13:00] whole cascade of hormones, plus like the inflammation that can come along with them. And so it's important to understand you are more like a moon cycle.

You are having these phase changes. You get to perimenopause, then it starts to get like really wild menopause hormones just bottom out. But all of the hormone transitions, including pregnancy and puberty, postpartum, they affect our brain. 

So what often happens in these hormone transitions is it looks like you suddenly got worse and like you are not able to mask. So something that is like seriously wrong with you. But the reality is, is that that was underlying the entire time you lost your hormone ability to compensate. And now instead of saying, oh gosh, we should have supported you, you needed accommodations, we needed to have things in place like.

Instead, it becomes blame. It's like, why can't you just hold it together? Why aren't you trying harder? Why can't you just do this? And people in your life, they sure don't like that you always showed up for them. You mass and you camouflage in a way that made them [00:14:00] feel comfortable. And now you're not able to do that.

Like, oh, how dare you? How dare you have your experience? That affects me. So. I want you to understand that hormonal transitions, they don't necessarily make like our A DHD, worse in the sense that like, now you're broken, something's wrong with you. What they do is they really take off a layer that shows you what you've been hiding and compensating underneath, and there's no shame to be had in that somebody else along the way should have recognized the support that you needed and you.

Losing your hormone allies in, in those transition periods. You need more accommodations, you need more support. So I wanna talk to you about some solutions and how to help yourself. But if you find that you cannot mask and you are in a hormone transition, not just perimenopause, you are not alone. It is near impossible to mask.

And if you followed my journey, I tend to share my journey on [00:15:00] particular social media platforms. People on Instagram aren't so nice to me. Hopefully you guys will be nice to me here. Um, but when I talk about my experience, there is always somebody challenging and being like, you can't, you can't be a DHD, you can't be autistic because look at all these things I've seen, and I'm like, if I had a bank account.

It would be overdrawn because what you see is such a big cost to me, and you don't understand that if I wanna fill that bank account back up, that's why I disappear for like two weeks at a time. Like, and people don't see me in my life because I cannot keep up the mask. I need to recalibrate my nervous system, but also like reenergize myself.

So let's talk about some solutions for you.

And if you are new to this podcast, I just want you to know that we always talk about solutions. 'cause I firmly believe that awareness without support is absolutely useless. 'Cause I'm like, what are we gonna do about it? We need a plan. So number one, [00:16:00] audit your load.

The first thing you need to ask yourself is, what am I carrying that's draining my executive function before my day even begins? Because mental load is not. Invisible to the brain. It has a real biochemical demand. And so if before you even start your day, you're feeling like, oh, I'm overwhelmed. We need to audit that.

So unfinished tasks, uh, decisions that you really don't have to make every emotional obligation that is consuming your bandwidth. Audit it and ask yourself, do I really need to handle this? Is this really something I have to be a part of? I'm gonna give you, uh, an example of how life can shift as well. So I am working on a book right now.

It is about to come back to me with, uh, the technical copy edits this, that's like the hardest part of the book because that is like 1000 micro decisions that have to be made. And for an A DHD brain that's exhausting. I'm like, I need that back in my ovulatory phase. Like [00:17:00] pre ovulation, not like mid luteal phase.

'cause I will. I will fail. There are, they're, it's a short turnaround. Usually you're gonna get like weeks upon weeks. With this, I'm getting days, so I have already audited, looked at things and I'm preparing and I told my husband, I will not be deciding dinner. Anything that needs to be DEC decided in our life, if it's urgent, that's on you, bro.

Like, I gotta, I gotta let that go. I gotta trust you, you, otherwise you're gonna bring it to me after I get that done. Because that load on me having a thousand micro decisions to be made, I'm gonna hit decision fatigue. I'm gonna be exhausted. I'm not gonna have any more to give. So we are getting things lined up and in place to accommodate my needs during that.

I want you to do the same thing in your life If you know there is a major stressor. And look, these things come outta nowhere. Sometimes you got my permission to start dropping things that are not necessary. Like I told my husband, like, it's gonna end up being [00:18:00] five days on this book. Don't tell me I stink if I don't shower.

Uh, and like I, someone's gonna be like, that's disgusting. Look, I'm gonna be working like 12 hour days, okay? Like, gimme a break here. Um, but also like, I'm gonna probably wear, like, I'm just gonna wear whatever, whatever I pull out. My outfits are gonna be ridiculous. My hair never gonna be done. Like my food.

I just need things to be put in front of me. I need food and water put in front of me during a schedule because even making the micro decisions around that are gonna be too much for me. So you have to audit and just give yourself permission to really start to get rid of the things you don't need to make decisions on.

You know, Dr. Leann Borman was on the podcast and something she talked about is just even. Showering and the like. I, the routine of like, I have to like shampoo my hair and then condition my hair and like how when you are going into that burnout phase, that's too much. I have pump bottles in my shower and everything [00:19:00] has to be lined up in the order that I do it.

So that I and I, I do like my routines, but that way it's not even a decision, it's just autopilot. What I can do, and these things sound ridiculous to neurotypical people, but these are the real strategies that actually offload your brain and make it so that you can show up the way you wanna show up in life.

Now in perimenopause, this is really relevant to you. Estrogen drops, insulin sensitivity becomes less sensitive. Visceral ADI adiposity accumulates inflammation rises, including neuroinflammation. Insulin is one of the most under-discussed hormones in A DHD women, so when we have blood sugar crashes, we get irritable like everyone else.

We also can get impulsive. We can have lack of concentration, lack of focus, lack of mental motivation. We can become more emotionally volatile. So if there was one thing, just one thing I would say to you, you get 30 to 40 grams of protein at breakfast. [00:20:00] Non-negotiable.

Pair that with whatever else you like. Honestly, if it's just the one thing you can do, protein at the start of the day is going to affect your entire. Metabolic system, not talking about weight loss, talking about insulin regulation for the rest of the day, we have a propensity to just like do coffee and forget about food.

I know, 'cause I've worked with enough. A DHD women, if you are a, I gotta do coffee first. Collagen, my friend, please add collagen. Please try to get 20 grams of protein in that coffee. And if you just had a little bit of cream and you get a good collagen, you're not even gonna taste that.

The next thing you have to do in perimenopause is protect sleep like it's medicine because it absolutely is. Sleep loss worsens A DH ADHD symptoms dramatically, and it amplifies cortisol. People who are not A DHD miss sleep and they look like someone with A DHD. So what do you think it does to us? We got sleep problems.

I know this is easier said than done. Dr [00:21:00] brighton.com show notes. I got you covered in episodes. Lots of sleep strategies. But if you need to use something like melatonin, phosphatidyl seine, l-theanine, um, progesterone, then do it. Do what you need to do to get good sleep because there is absolutely no way you can protect your perimenopause menopause.

A DHD brain, if you ain't sleeping.

Now we have to address hormones comprehensively. Oh my God. The number of conferences I lecture at where I talk about A DHD and hormones and everyone's like. Estrogen, and I'm like, yes. And okay, so it's not just estrogen. The question is what system is destabilizing your brain right now? And for some that's estrogen, but for others it can be progesterone sensitivity.

So you actually have fine progesterone levels, but you're sensitive to it. It can be insulin dysregulation, it can be cortisol. It can be that they gave you estrogen. 'cause they were like, oh, estrogen, A D, H, D, and then boom, histamine problem. So this is [00:22:00] why personalized support matters. You need to work with an A DHD competent hormone prescriber.

Ideally someone who has been doing it for a long time, not someone who just started a few years ago, but if they did start a few years ago, this is one screening question that I always ask. Do you use compounding hormones? If they say, no, I never use compounding hormones. Red flag, I'm gonna tell you why.

But if they say no, those are not FDA approved, she like, burn it down. Red flag. Okay. Hormones at compounding pharmacies are FDA approved. That is willful disinformation to keep women, um, basically in someone's practice and keeping them in the cookie cutter model and saying like, you have to fit into this.

so compounding hormones are FDA approved. The FDA does not approve medications that are made for an individual. That's what we're doing here. They approve medications that go out to everyone. So maybe that provider just doesn't understand how the FD works.

That's a, that's possibility. But why it's a red flag if they [00:23:00] never use compounding pharmacies is they've never worked with a neurodivergent women. I will tell you that. We are more sensitive. We can have progesterone sensitivity. Okay, so 100, 200 milligrams of Prometrium. That doesn't necessarily work for all of us.

Sometimes we gotta start on 50 milligrams. Sometimes we gotta go a different route with things. The other thing is. We can have more sensitivities and issues come up. So you might be more prone to have a localized, um, allergy, but not like anaphylactic allergy, just like a sensitivity to an estrogen patch.

Um, you might be someone. That they tell you, oh, do testosterone and squeeze a pack and just do a pea size amount, and like that's not working for you. You might be someone who's like, yeah, I've done topical estrogen. I can't do oral estrogen 'cause I have a clotting risk factor. I need to do injectable estrogen instead.

If they're not working with compounding pharmacies, I will tell you they're not working with hormone sensitive women. They're not working [00:24:00] with the type of women that we are who. Tend to have more adverse events with prescriptions. So I think that's a really important screening question to ask someone.

And also if they're being dogmatic about it, they're letting their beliefs and their dogma ahead of the science and the patient's needs.

I just also personally think it's ableist af to be like, no, I won't use a compounding pharmacy. Like this is the way I prescribe hormones and you should just be fine. You should just take it. Why do you have such a problem with it? All my patients are fine. And it's like, well, yeah, because like our, us being a DHD, um, our systems are different.

We know genetically our systems are different, and so no, we're not gonna respond the the same way that everyone else does.

Now. With all that said, this is actually why I'm really excited to finally tell you what I have been building. I am launching a brand new A DHD and Women YouTube [00:25:00] channel so that I can nerd out with you and get into the specifics about hormones, A DHD, and the female experience.

I am dedicating a home built specifically for women's brains and because far too long women have been expected to just like figure this out all alone. And I, for one and done watching this community struggle while being handed male default advice that doesn't reflect our biology. I am making this channel and I'm super, super excited because I'm Audi, DHD as I said, and like.

Autism, A DHD. Hormones, brains. This is like my special interest, so I get to do something that I am so thrilled to be doing. This is the work I'm obsessed with, and this channel is going to be built around entirely what women actually need.

We're gonna talk about, uh, you know, hormones, perimenopause, postpartum, puberty, what to do with your teen daughter, um, [00:26:00] executive dysfunction, sensory overwhelm. We're gonna talk about, uh, being pregnant. We're gonna talk about. What happens in menopause? We're gonna be hitting every phase of women's lives with practical science-backed support, and this is a place that is gonna be all ours, and I am excited about this.

This came to me because I have found there are just places I cannot talk about my autistic or a DHD experience without being judged or people trying to do harm. So. I wanted to create a safe place where we could talk about all of these things, and you can get your questions answered. Please go over, subscribe now.

Uh, videos are coming soon. I have never been so excited to work on a project.

And it also means my husband doesn't have to listen to me all day, every day talking about, uh, A DHD brains and, and our hormones. So I get to have a place where people actually care to [00:27:00] listen to all of that. Now, listen, if this episode hit home, please share it with women who are wondering what happened to their ability to show up and compensate in life, because I want you to take away that nothing is wrong with you.

Your brain deserves support that actually reflects your biology and you're not getting that. But now you finally have a place built for just that. So keep following the Dr. Brighton show, 'cause I'll keep doing episodes around this. I'll keep having expert guests around this, but the A DHD and Women Channel.

It's just gonna be all about information around A DHD. There will also be autism talk 'cause of course, like that's my experience as well. But I wanna have a place that is just ours and I'm building it now. So if this episode has helped you, I appreciate your support, comment, like, subscribe. I will see you on the A DHD and Women Channel and as always, it's such a delight to get to share time [00:28:00] with you.

So thank you.