How Hormones and Menopause Affect ADHD: What No One’s Telling You | Dr. Jolene Brighten

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Dr. Brighten: Did you know that estrogen is one of the most powerful brain hormones and when it drops during perimenopause and menopause, your A DHD symptoms can skyrocket. Welcome back to the Dr. Brighton Show. Today I wanna talk about something I wish every woman with A DHD knew how your hormones impact your brain and why perimenopause and menopause might be making your symptoms so much worse.

if you found yourself thinking, wait, why does my A DHD feel so much harder? Now, you're not alone and you're definitely not imagining it. In this episode, we are going to dive into why estrogen is your A DHD brain's secret weapon. What happens to your focus mood memory during perimenopause and menopause, and what you can actually do to feel better starting today?

As [00:01:00] a reminder, my sponsors make this show possible. So big thank you to them and big thank you to all of you who've taken the time to subscribe, to leave me a comment, and most importantly, leave me a review, which helps this podcast so much. With that said, let's get into it. it.

A DHD isn't just about distraction. In fact, it's a really awful name. Attention deficit hyperactivity disorder. Not all of us bounce off the wall. Some of us bounce around in our heads, and it's not that we have a deficit in our ability to be attentive, it's just that like we wanna hyperfocus where we wanna hyperfocus and we don't wanna focus other places.

So beyond just feeling distracted, A DHD is also about how your brain manages your motivation, your memory, your emotional regulation, and all of this is executive function. And guess what helps regulate all of those things. [00:02:00] Hormones, specifically estrogen, progesterone, cortisol, testosterone, and insulin.

So let's start with our main diva, which is estrogen. It's the unsung hero for A DHD women, if you will. Estrogen boosts dopamine, helps with dopamine production and utilization. The very neurotransmitter that is often low or dysregulated in A DHD brains.

So when estrogen is high, like we see in our first half of our cycle, when your period starts, you might feel like your brain is finally working. You're like, I'm more focused, I'm more driven, I'm more me. It's a great filling, but then estrogen drops, whether it is in the luteal phase, taking a backseat to progesterone or your postpartum or your late phase. Perimenopause going into menopause, and then you fill it. You fill the brain fog, the emotional sensitivity, forgetting why you walked [00:03:00] in a room and feeling emotionally unstable.

Let's not forget that emotional regulation is an executive function. Executive function is the key things we struggle with A DHD 

now when I frame estrogen, taking a box seat to progesterone makes progesterone look like a villain. Progesterone's not a villain. Progesterone is a natural anti-anxiety hormone. It helps with our regulation of our nervous system. It helps with sleep, which impacts executive function. I have an entire podcast about sleep and A-D-H-D-I will link to that, 

But during our cyclical years, while we produce that progesterone, you have to ovulate Through ovulation. We make the corpus lium and the ovary that produces progesterone. So during our cyclical years when we're producing progesterone, estrogen takes a backseat, and that can make the luteal phase feel a lot harder.

In addition, if you're someone who's progesterone sensitive, it can actually increase [00:04:00] irritability and mood swings. I have a whole podcast talking about PMDD and progesterone issues. I'll link to now cortisol. Our stress hormone is also acting as a neurotransmitter in our brain, and it is more likely to be dysregulated.

If you're neurodivergent, you combine that with a DHD and hormone fluctuations, and you've got a perfect storm for overwhelm. Something that is very common in A DHD women is having already this baseline of cortisol and stress dysregulation, a dysregulated nervous system that can cause us to make less progesterone.

Less progesterone means more emotional dysregulation, more anxiety, more trouble sleeping, more trouble sleeping, leads to more cortisol problems. Don't worry, I'm gonna talk about solutions today, but I want you to understand that every perimenopausal woman struggles with stress and cortisol and nervous system [00:05:00] dysregulation.

If you have a DHD. You, you just got, you got an extra layer there all together, which makes the transition from perimenopause to menopause so much more difficult. This is why I said you're not alone. It's not in your head. You're not imagining this. These things are real and they're due to your hormonal changes.

I will also link to my podcast episode about insulin dysregulation in the exact labs and what values you should see to be checking on your insulin. Because insulin dysregulation, it's like 80% of women in perimenopause and menopause will experience it. It's so much worse when you're neurodivergent. And why does insulin matter?

Well, it plays a really surprising role as well in your brain functioning and your executive function. So when your blood sugar's swinging. So does your dopamine availability, which can lead to more impulsivity, irritability, and mental fatigue. And then let's not forget testosterone. It's [00:06:00] often overlooked in women, but it's super, super important.

It is key for drive motivation, risk tolerance, and when testosterone is low, you might feel flat, unmotivated and disconnected from like your usual spark. You're like, I don't recognize myself. My like, wake up kick ass set boundary self is gone missing.

So that is how our hormones can affect our A DHD brain and executive function. And in fact, these hormones can affect executive function and it leads some people to conclude that women have late onset A DHD. There is no such thing as late onset A DHD. To be diagnosed with a DHD, your symptoms must have been present as a child.

So what is going on here? You are ignored. You were gaslit. your symptoms were not taken [00:07:00] seriously. You were told to be polite, sit still, smile more, stop being so chatty and don't doodle in class. But nobody stopped to think, Hmm, could these be signs of a DHD? So, I hate the term late diagnose A DHD because it's incredibly invalidating to your entire life struggle, and you deserve to be recognized for the fact that you were never supported despite being neurodivergent.

You were never supported, you were never taken seriously, and you still made it to where you are today. So I don't like disempowering statements. I don't like statements that act like, um, this is just some new thing that you are experiencing when that's not the truth of all of us who are late diagnosed.

A DHD, myself included.

And did you know that brain [00:08:00] fog, forgetfulness, emotional overwhelm in menopause aren't just signs of aging. They can actually be signs that your A DHD is colliding with your hormones or lack thereof in some cases. Perimenopause is a wild hormonal rollercoaster leading up to menopause, which officially begins one year after your last period.

And for women with a DHD, this can feel like falling off a cognitive cliff or slowly sliding down the hill into a pit of despair. And I want to change that narrative in perimenopause because none of us should feel like that. We have options and things available to change that for women, but it starts with understanding A DHD and the hormone connection.

I gave you an overview of how these hormones are interacting with your [00:09:00] brain and how they can affect A DHD. And I wanna give you a bit of a behind the scenes, if you will, of like what is happening in perimenopause with these hormones that's making things worse. So if you remember what those hormones were doing.

Keep in mind that in perimenopause, estrogen starts fluctuating unpredictably, and then it starts just sliding downhill. It is dropping, dropping, dropping. That's in that late phase. Perimenopause, progesterone tanks, it's the first to go because you have to ovulate. And what's perimenopause? We're running out of eggs.

We're ovulating less frequently until we're out of eggs, and then we're not ovulating. We're not gonna have any progesterone. You also can become more insulin resistant. That is gonna affect your brain energy. A DHD brains already struggle with energy production. Cortisol can spiral. And with all that added stress, we can have more dysregulation overall.

And then for some women, testosterone tanks not [00:10:00] true for everyone. But if it's true for you, you wake up and you're tired, you're unmotivated again, you lost that spark.

Now, did you know that many women aren't diagnosed with A DHD until perimenopause? Because that's when their symptoms become impossible to ignore. This is why it's not late onset A DHD. It's just, I can't handle it anymore. A DHD, the hormonal turbulence doesn't just affect your body, okay? It's affecting your brain as well.

And if you already have a DHD, you know you have it, then you will recognize the intensity of these symptoms, the shifts that are happening. If you don't know what that you have a DHD, you might just be like, why is everything breaking? Why is my brain not working? Because what it can look like is.

Word finding difficulties, memory lapses, increased overwhelm. So you used to have this to-do list and you could handle it like a boss, [00:11:00] and now that is overwhelming to you. Maybe you have kids in school and you're like, just keeping up with the homework is so overwhelming. It, it can also feel like I used to be sharp.

And now what happened? Like I was, uh, the person that could keep my to-do list in the brain and, and, and, you know, all of it logged in my brain and, and now I can't do that anymore. So things that, you know, are part of A DHD with the executive dysfunction, those can be new to you or they can be so much worse.

Or the strategies you used to use, they don't work anymore. And the worst part is most doctors don't connect the dots. And women are being told things like, it's just aging. You're just stressed, you're old. I hate that so much, when really it's brain chemistry changing due to your hormones.

and if we're not talking about hormones when we're talking about female A [00:12:00] DHD, we are missing a huge aspect of how to effectively manage A DHD and give you all the tools you need. And listen, if this is resonating with you, I have created an a h ADHD Hormone Sync little mini course for you.

You can go to dr brighton.com slashy, that's D-R-B-R-I-G-H-T n.com/s YNC. And what that is, is it's a series of just like little bite sized five day email that I will deliver to you that helps you understand how your hormones are affecting your A DHD and some quick wins so that you can fill at your best.

Okay, I wanna take like five minutes now to talk about how A DHD shows up in real life because so many people can't get access to diagnosis and they're wondering like, do I have a DHD? And I wanna [00:13:00] share things that I hear from my patients, my community that I've experienced. 'cause I have a DHD.

So some of the ways it might show up is that. I used to manage so much and now I can't even keep up with my laundry, or I've always had these A DHD like symptoms. Wasn't sure if I had a DHD, but now it feels like they're completely running the show. Other ways it might show up for you is that you are constantly interrupting other people and you, you don't know why.

Or maybe you are shopping and buying things that you're like, I don't need, why am I buying this? These can be impulse control issues going on. You may also find that you are reaching for and maybe even binging on foods that you wouldn't normally eat. I mean, I love making some chocolate, but sometimes we're eating too much chocolate.

We're eating too many chips, like we are [00:14:00] having impulse control issues, but we're also having bingeing because that is helping our dopamine get up. And that feels good, but it also can be a situation where that's coupled with insulin dysregulation. You may also find that the littlest things make you explode.

People are always asking you why you're angry, why you're upset. Set. Why are you so emotional? By the way, if someone's having big emotions, don't ask them why they're so emotional. That's not gonna end well. But you may find that you feel more explosive as progesterone goes down. We don't have the GABA break system in our brain, and if your brain is already a DHD, it's got so prone, it's so prone to be like explosive, angry.

You may also feel that rejection, sensitivity, dysphoria, it used to be a bit problematic. Now it's destroying relationships, so that might look like you physically feel pain. You [00:15:00] are emotionally reactive. You feel like people hate you. They're talking bad about you when they're giving you the littlest amount of criticism.

Maybe it's not even criticism, but this thing, these things feel so much more amplified. If this is resonating. You're shaking your head yes, you're nodding yes, like as a doctor. I want you to get evaluated. I want you to see what's going on. Maybe it's a DHD, maybe it's a DHD with autism. Maybe it's a DHD with anxiety and depression or um, PTSD.

Like there can be layers to this and I want you to get individualized support, but I say that. As a doctor, but as a patient, I know how damn hard it is in the United States to not get gaslit by a doctor, to get a doctor to believe you, to get fairly evaluated and to be able to afford those evaluations, let alone affording two or three evaluations.

Because we know with most women's health conditions, we're gonna see two to three providers before somebody actually believes our story of living in our body. And that's super lame, [00:16:00] which is why I'm gonna give you things that you can start today that can help support your body, help support your brain, support your hormones overall while you seek out getting that diagnosis.

So there's no reason why we can't do things today, to start to improve our health. And the reality is, is that the majority of things that you are gonna need to do to optimize your hormones, your brain health, and really flow through perimenopause and menopause, they're gonna happen at home. They're gonna be the things you do every day.

It's not gonna be the things you do in the doctor's office. So I don't want you to feel disempowered or discouraged if you're like, I can't get a diagnosis

now as a reminder, because everybody does better with repeating of information so they can commit it to memory, and especially, especially A DHD and especially those who are having that estrogen decline now. So I'm gonna remind you, when your estrogen drops, so does dopamine, and when dopamine drops, your brain's ability to initiate tasks.

Remember, info, information, [00:17:00] and manage emotions goes down with it. For many women in menopause. That's when A DHD is finally diagnosed because their previous coping strategies stop working. Is this true for you? Let me know in the comments. But this is also when shame can kick in and you might start to believe the story that you're just bad at life.

That is a lie. Okay? Your brain lies to you. A DHD brains absolutely lie to us. Sometimes your brain needs support, not self-criticism. Easier said than done. There's so many podcasts with myself and other guests who talk about how caring and supportive we are with our patients and how awful we can be to ourselves.

So if you struggle there, no. Then like all women struggle there. So let's talk about what you can do when hormones and A DHD collide. Number one, [00:18:00] scaffold your brain. You don't need to rely on memory. You can build systems that hold your executive function for you. Timers, reminders, sticky notes. Yes. Even for things you should remember, like make this a practice.

Body doubling, working alongside a friend or a virtual coworker. Even, um, sometimes scheduling FaceTime when you've gotta fold the laundry. So what is body doubling? It's basically like, I gotta do this task. I don't wanna do this task. I know I'm gonna wanna like walk away from this task. I need another body there.

So that can be virtual or that can be in person. You will hear so many people in the A DHD community talk about body doubling. It's because it's so powerful and it helps. So we want to just be hypervigilant in some ways about setting reminders. I will [00:19:00] literally, in my luteal phase, set reminders on my phone all the time to be going off, um, setting all of these things digitally.

So I get this, um, break from work. Okay. 'cause that, that can lead to burnout. So I need breaks from work. I need reminders to work out. Sometimes depending, like in my luteal face, how things are vibing. I need reminders to drink water, to move my body and to eat food. There's no shame in doing that. Okay?

These are strategies that can work. We're certainly gonna talk about hormones because like, you know, those are gonna be important. But I, I do think having lifestyle hacks is super important as well.

So set the timers, get the sticky notes, get the body doubling in place, and people don't even know, need to know your body doubling. Um, you know, sometimes I'll set up a call with my sister when I know I have stuff to do around the house and I'm like, if I'm on the call with her, I will sit there and I will do it.

Um, so again, you can do it where you ask somebody for help or you can [00:20:00] just be like, this is just how I'm getting my community as well. We also wanna look at how we can break tasks into micro steps. Like what is the first two minute action? Instead of being like, oh gosh, here's like, I've gotta go from point A to point z.

And I don't even know how to do the rest of it. So you just wanna ask, what's the first thing I need to do and do that? What's the next thing I need to do? And do that so you're not overwhelmed In perimenopause, nutritional support becomes super, super important as does exercise, and that's even more so for the A DHD brain.

Your brain is an energy hungry organ, and hormonal shifts are gonna affect the metabolism and your brain producing energy. So I wanna give you some food specifics and also want to acknowledge that eating with A DHD can be a challenge in general, let alone getting nutrient dense foods that you need. Now if you're somebody who's like, I need guidance, I need a [00:21:00] support.

I have 21 anti-inflammatory recipes that are not only delicious, but they're gonna support your hormones and your brain during perimenopause and menopause. You can grab it at dr brighton.com/plan D-R-B-R-I-G-H-T-E n.com/plan, and it's completely free. It helps you with understanding how to structure meals so that you're getting enough protein, fat fiber at every single meal, helping you optimize your blood sugar, but also doing all the recipes and it's even got like the shopping list so that that helps with your executive function there.

Grocery lists, going to the grocery store, making selections, coming home, unpacking the groceries, putting it away, remembering what you bought. Then coming up with a recipe, then having to like figure out what order to do things that can be overwhelming for the A DHD brain. I wanna acknowledge that and that's why I put together that plan for you.

You can go ahead and [00:22:00] grab it, but I want to talk about specifics in nutrition. 'cause you're here right now. So since you're here right now, let's give you some specifics that you can implement.

 Every single meal. We need to prioritize protein, healthy fats, and fiber. So if you're a meat eater, we're like chicken, fish, grass fed beef, healthy fats, avocado, cold press, olive oil, even bringing in nuts and seeds, fiber, that can be chia seeds, it can be raspberries, it can be root vegetables.

We, we wanna focus on vegetables there. Every single meal. We wanna have those components. We want to focus on balancing our blood sugar so that we can stabilize our mood and energy. And having those three things will help you do that. And then having Omega-3 fatty acids is part of your diet. Cold water, fish, mackerel, sardines, uh, salmon, that can also help support your brain.

It's gonna give thyroid support as well, which we also need in menopause and perimenopause. [00:23:00] And then when it comes to exercise strength training, yes we wanna do that, but also walking and any movement that you enjoy enjoying the movement is important and that's gonna help with reducing stress. So it's gonna help your cortisol levels.

It's also going to help with insulin sensitization, right? Here's the other thing that's very specific to A DHD. When you work out and you feel that burn in your muscles, and that's lactic acid building up. Your brain can use that for energy. So even though your mitochondria, the inflammation, the estrogen, I should do a whole episode on, on just this.

As I'm saying all this, even though that can be dysregulated, that's affecting how your brain produces and utilizes energy. Lactic acid can be the backup system. So exercising, if you can, first thing in the morning, can actually help with focus throughout the day and help you with that executive function.

Now, if you're gonna be [00:24:00] working out, I'm gonna link to an episode. It's a, it's an episode on perimenopause weight loss. But it's, I think it's really important 'cause it talks about, um, different exercise strategies gives you a lot more, um, about exercise. But if we're working out, we need to be fueling before and after.

So if you're someone who's like, well, I work out at five 30, I can't eat before then. Okay, same. I feel that, so that, I mean, that's a different story, but if you're working out at like seven, eight, try to get yourself even if you're just like. I'm having a cup of coffee with collagen in it, and then, you know, I'm, I'm eating like some, like an apple and some peanut butter.

Uh, you know, if it's something light and easy, if it's like a smoothie or chia seed pudding, you make the night before something small just to get yourself a little fuel. It's gonna work so much better in your workouts. And then after you're done, working out in the 30 to 30 to 60 minute window is really best.

If you go 90, maybe that works for you. But, but you [00:25:00] know, there's something to be said about , refueling your body for exercise and, and the benefits of that. But for the A DHD brain, we don't wanna have a blood sugar drop because a blood sugar drop means a cortisol spike means chaos in the nervous system.

 Now resistance training, whether it's body weight, your weightlifting, any of that is so powerful for hormonal health and brain health. So I do wanna encourage that and I wanna talk about supplements. And so in segwaying into supplements, creatine five grams a day, um, after it usually takes about two weeks.

That can help not only with your, uh, gains in the, in the gym, but also with how your brain functions. Now, keep in mind, supplements are not gonna cure your A DHD, they're just more of a bridge for your brain. And I do wanna talk specifics beyond creatine of what is helpful for perimenopause and A DHD brains.

Zinc, yes, helps with dopamine production, immune function, we're [00:26:00] doing usually 15 to 30 milligrams a day, usually coupling that with copper as well. Bacopa is a nootropic that supports memory and focus. SAC choline. It can help with boosting brain energy and attention. Saffron can improve mood and in some people can reduce a DHD symptoms.

Remember, supplements aren't meant to treat anything. They're meant to support and amplify what you're already doing with your nutrition and lifestyle. Omega-3 fatty acids I talked about before, they're important for brain structure, mood inflammation. We want 'em in the diet, but we also usually wanna get like 2000 milligrams in a supplement.

Magnesium glycinate, calming for the nervous system, helps improve sleep. We're hitting usually about 300 milligrams nightly. Specifically the glycinate form because it helps so much with sleep and that's crucial in [00:27:00] perimenopause and menopause. As a reminder, always check with your doctor, especially if you're on medications.

So here's the bottom line. I know this was a shorter episode, but because it's a DHD and you guys have given me feedback where you're like, I can't pay attention for an hour. We were having a quickie. That's okay. That came out wrong. I was just gonna leave it in. Okay. So here's what I wanna leave you with. Your A DHD didn't get worse because you failed at life. It shifted because your hormones changed and there is a way forward. It's not hopeless

when you understand your brain and your hormones, you can work with your body and not against it. You may also need to leverage hormone replacement therapy. Typically, we're starting with progesterone replacement therapy and oral micronized progesterone at a hundred to 200 milligrams. But because you're neurodivergent, you may need less.

[00:28:00] You may need continuous, you are different. So we usually take that at night. And then as perimenopause progresses is when we bring in topical estrogen hormone replacement therapy. It is so helpful for your brain to produce energy, for your mitochondrial health, for regulating inflammation, all the things you're already susceptible to because you have a DHD.

We'll typically bring that in topically, either using a gel, a cream, or maybe a patch and doing the lowest dose possible. So your Dr. May start with 0.025 milligram estradiol patch once a week, and then evaluate you after a month. And then consider increasing that to twice a week or maybe increasing the dose altogether.

Testosterone is one that we need to test for. So with testosterone we're gonna look at a total testosterone, a free testosterone and sex hormone binding [00:29:00] globulin. If you're having low testosterone symptoms and you have low free testosterone, then that means we need to use testosterone hormone replacement therapy, and that can be a game changer for the A DHD brain.

Estrogen gets a lot of hype, but testosterone is very important for A DHD women who are in perimenopause or menopause. and then there's also what we may use to the vulvar area. I have another episode where I talk about genital urinary syndrome of menopause and using topical estrogen, topical DHEA and these other things.

But it's super important that you meet with a prescriber who is not only well-versed in HRT, but who is neuro affirming and actually understands that the A DHD brain works differently because while nutrition and lifestyle are absolutely [00:30:00] foundational and you absolutely have to be doing those, sorry, non-negotiable, And what I ultimately want for you is to figure out what's true for you, what works best for you, and to leverage those things. Because all of this isn't about just like surviving menopause with A DHD. It's about feeling great in your body, feeling like you're getting the most out of your life. So if this episode spoke to you, please share it with a friend who needs to hear it.

 

And if you want more tools or want to explore A DHD hormone connection, dr brighton.com/sync, SY NC can help you do that. I also invite you to subscribe so you don't miss next week's episode. And until next time, please be kind to your brain because you're honestly doing so much better than you [00:31:00] think.