Latest / The XX Lab / The Hormone-ADHD Connection Women Aren’t Told About | Dr. Jolene Brighten #21

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The Hormone-ADHD Connection Women Aren’t Told About | Dr. Jolene Brighten #21 · The XX Lab

• speaker-0: Why are so many women diagnosed with ADHD only after years, sometimes decades, of struggling? Part of the answer is that ADHD doesn't always look the way we expect it to. Today's guest is Dr. Jolene Brighton, women's health expert and author of the new book ADHD and Women. In recent years, researchers have begun to recognize that ADHD often presents differently in women than it does in men. As a result, many women spend years feeling overwhelmed, distracted, anxious, or emotionally exhausted without realizing that ADHD may be playing a role. In this conversation, we talk about what ADHD looks like in women, some of the biggest misconceptions surrounding the condition, and why hormones can play such a profound role in affecting our symptoms. Dr. Brighton explains why ADHD is often first recognized or suddenly becomes much harder to manage during periods of hormonal change, such as puberty, postpartum, and peramenopause. We also discuss how to tell the difference between ADHD symptoms and hormone-related changes like PMS. The overlap exists and what women can do to better support their brain throughout different stages of life. Whether you've been diagnosed with ADHD, suspect you may have it, or simply want to understand the connection between hormones and the female brain. This episode is packed with insights that every woman should know. This is the XX Lab. I'm Dr. Sarah Hill. Let's get started. Dr. Jolene Brighton, welcome to the XX Lab. speaker-1: I am so excited to be here, and I'm so excited you started a podcast. speaker-0: Thank you. I'm excited too. I'm giving it a try to see whether or not I enjoy it. And so far, so good. It's been a lot of fun to have conversations with people like you and and other ⁓ people who are either in the clinical world or the research world and being able to kind of bring their, you know, cool insights to the rest of the world and the people who listen to me. So it's it's it's so far so good. I want to, we're gonna be talking today. You have a wonderful new book that's gonna be coming out next week called ADHD and women that I'm very excited about. But before we dive into that, I want to orient listeners to you. And I'm sure that they're familiar with their with your work. You of course wrote a really wonderful book, ⁓ Beyond the Pill, which we can see on your upper left hand corner. And ⁓ listeners, if you have not gotten this book yet, you need to get this book. I mean it came out right before my book, This Is Your Brain on Birth Control, came out. Yours had come out, it was a couple months before mine came out. Because I remember I'd already handed mine in, and then I saw that there was this other book coming out, which was really surprising to me because nobody was talking about this stuff before that point. At least not in my world. There were there weren't people talking about birth control and the potential side effects it can have. And I was so Happy to see that you essentially found the same research I did. And that we'd come to the the many of the same conclusions. And so I really appreciated that you stuck your neck out there and put that book out there. Cause I know that especially in your world, I feel like I got it a little bit easier because scientists, we can be a little bit sort of skeptical and you know, and countercultural and ask, you know, sort of the the point that goes against the status quo. And the status quo in medicine is birth control is perfect and don't ever qu ask questions about it. And so for you as a clinician to start asking some of these questions was just such a, you know, a breath of fresh air. And I just want to say one thank you for that and for the that contribution. And then just wondering like your experiences thing since then, like, like how did that go for you? Was it was that a rough road for you? speaker-1: Yeah, it was horrible, actually. No, it was like it was like a you know, double-edged sword. Like it was wonderful because so many women felt ⁓ that someone was actually listening to them, that the what they were experiencing was being validated, but clinicians pushed back so hard. And what's so interesting, you know, I endorsed your book. ⁓ so they your publisher sent me your book and I felt the same way. I was like, ⁓ like somebody else who read the same studies and was like, yeah, okay, there's something to this. What I think is so troubling is how few clinicians actually recognize that it's researchers who provide the information that shapes guidelines. And how little of them actually read research studies. So they're very quick to just say that doesn't exist because I haven't read it, which I think is just a very odd thing to say, because you could take a trip to PubMed and there it all is. But also, You've had countless, I mean thousands upon thousands of patients who've sat across from you saying, I'm experiencing these mood symptoms, I'm experiencing ⁓ you know, chronic yeast vaginitis. Like I'm having these side effects of birth control. And for years you told them that's a you problem, it's not a pill problem, and never thought to question the pill. So what's been interesting, I'll say, is that I mean, so I was really naive. I thought. Here's science, right? And I'm gonna present this science. And people, of course, are gonna be like, these are the facts. This is science. Like, we're gonna listen to this. And I didn't really I was so naive and not realizing that there is such an emotional connection that providers have. And I don't think I really realized that when I said, when you just hand a woman the pill and you dismiss her symptoms and you never work her up, like that's a disservice to her. That clinicians would take that as like, I'm doing a bad job and you're attacking me. So I will say I'm really naive. I think it is because I'm neurodivergent and I'm just like, I don't understand. Like, if someone presents you with the facts, why would you not just listen to the facts? And like, I didn't really realize how many clinicians. I mean, you know, I got bullied on social media and it was bullying because I was called names. ⁓ there have been so many articles written about me. Saying I'm part of the alt right like initiative. Like it just like everything they can do. And it's really saddened me because I've come to realize that journalism is incredibly corrupt and it's not there, it has no integrity anymore. The number of times ⁓ reporters have gotten on calls with me under false pretenses, and then they begin like a whole narrative that they're trying to shape about me. And then I just let them know, ⁓ I just want you to know I'm recording this call. They just ha hang up on me. Like they won't even talk to me at that point. I'm like, okay, so you're gonna lie about me. But what's been really interesting is now here we are in 2026. And the same gynecologist who hated on me, who said that I was making up everything, that nothing was real, they have now taken the message of beyond the pill and they've repackaged it as their own. And that's been fascinating to watch, to see them. And I'm like, you know, it would be really nice if you apologized to every woman before them. Like, I don't need your apology. But to see them actually say now, like, ⁓ yeah, we've been covering up endometriosis, we've been covering up P A C O S or PMOS now. We've been doing all of this and actually s you know, calling out their colleagues on it, but then just pretending that they never said what they said to me. speaker-0: So do you think that it's gotten easier to have conversations now about hormonal birth control and talking about it as being anything other than absolutely perfect with no side effects and stop complaining, ladies? speaker-1: Definitely not. So if you watch the news cycle, it's every couple of years a news segment comes out and they say more women are leaving the birth control pill than ever. This has been going on for everyone listening for a decade now. I've been watching the same news cycle for a decade. So they they have this headline: More women are leaving the birth control pill than ever because of influencers. And like if I say anything questioning the birth control pill now, Google. YouTube, like all the powers that be, like they've ⁓ it's very well known that the medical societies have lobbied to say, like, you no one can question what we're doing or what the guidelines are. And if you go against what the guidelines are or you question the practice, like you're gonna be down, like you're shadow banned, basically. It's well known and it's well documented, all of this. But to the news cycle, they always say this. I'll get thrown in that mix as well, where they're like, she's telling people to go off the pill. But if you actually look at the data, Women are not leaving birth control. They're actually choosing long-term birth control. So they're switching to IUDs instead of the birth control pill. So we've actually seen contraceptive use has gone up. But the news is framing it as this alt-right movement to make all women pregnant and barefoot in the kitchen. So women are so dumb, they're falling for it, and they're leaving the birth control pill. But they're leaving the birth control pill because it it does come with a lot of side effects. It is imperfect. In terms of like, you know, contraceptive protection, like it it relies on the user too much. And what does an IUD do? It skips user error and it goes right to like 99% effective. And so the other thing we're seeing is women saying like, I don't know the political climate. I need something that's a sure shot. And the pill is not a sure shot. Like an IUD, it has a much higher efficacy rate. So that's always, you know, for anyone listening, stay skeptical when you see these newslines, these headlines that come out, they're they're so manipulative. And I really hate how they treat women like they're such idiots. Like they're just falling for propaganda. But if you actually look at the data, no, more women are on contraceptives than ever. And they're choosing these forms of contraception. That have higher efficacy rates because they don't want to gamble with the birth control pill. speaker-0: Right, especially right now in the political climate in the US. I mean, with ⁓ abortion being made illegal in so many places or very difficult to come by, it's like it women need a sure shot with avoiding pregnancy. It's like it's become so high cost to have an unexpected pregnancy. And I do think that there's also like there's such, you know, just just sort of speaking to the point about treating women like they're idiots. I mean, I think that You know, with my experiences when this is your brain on birth control came out and and also just seeing what you went through ⁓ with Beyond the Pill is is this idea that you know you can't say bad things about hormonal birth control because then women are gonna go off of it and start getting pregnant. Like they have no ability to think for themselves. And like, like if you say, Well, just so you know, you know, here's what to look for, here are some of the trade-offs you're making if you use hormonal birth control. But that means that women are automatically going to start marching, you know, away from their birth control and start doing something else or or not doing anything at all because they're too, you know, too stupid to be able to figure out alternative means of regulating their fertility. I mean, it's just completely ridiculous. speaker-1: It's absolutely patriarchal. And we would never see this in men's health. It only happens in women's health. And it tends to happen with the women who claim to be like they're feminists, they're anti-patriarchy, and yet they're upholding the patriarchal systems that actually cause harm to women, which is to say that doctor knows best as if daddy knows best, the white coat is to be bowed down to and never to be questioned, and you're too stupid. To understand your body. And if we told you any of the, you know, true informed consent side effects of this, like you would just be hysterical and you would make a bad decision. Therefore, me as a doctor has to make that decision for you. And I don't, I find it absolutely ridiculous how many of these doctors are out there being like, I'm anti-patriarchy. And I'm like, you are the embodiment. Of the patriarchy in the way that you are treating women. And you know, some of these same clinicians, I remember when your book came out and I saw them criticizing your work. And I saw one very famous Obi Gains. She was like, This person clearly doesn't understand the research. And I was like, That's her study. Like she, like that study, the author is Dr. Sarah Hill. But please tell me how you, who've never done a research study in your life, understands the research so much more than this actual researcher. And so when you look at it through that lens as well, it becomes very problematic because they, you know, will twist the narrative in order to fit like what is working for them, not what is true and not what is working for the patient. speaker-0: Yeah, I've always like been very surprised by people who claim to be, you know, like these very progressive feminist, you know, pro-woman, you know, advocating for the rights of women, ⁓ telling me, don't give women this information. It's like, well, so you're trying to tell me that ⁓ that women should just be c completely beholden to what their doctor tells them and that they shouldn't have any sort of insight into actually what the trade-offs are that they're that they're making with hormonal birth control or what to look out for. Like we shouldn't even be telling like parents of teenage girls. Like, just so you know, ⁓ teenage girls are the ones who carry the burden of the mental health-related side effects. And so you should really keep an eye on your teenager. We shouldn't do that. That's non-feminist. speaker-1: I don't know if you know, though, the very first study that was ever done on birth control and ADHD women was just a couple of years ago. And they found disproportionately that they're at much higher risk of depression. So having an ADHD brain puts you at higher risk of depression as it is. So I just want people to understand that there's kind of that baseline that we've come to understand. And you know, I always say it's like, like we know a left-handed person has a lot more stress living in a right-handed world. It's the same being an ADHD brain in a neurotypical world. So we've got Cortisol dysregulation happening, you know, there's inflammation, disruption of serotonin pathway. But they did this study on the birth control pill and they found five times increased risk of depression. The other thing that I found really interesting is a new study came out. And women who identify as ADHD, so they didn't necessarily all have the diagnosis, but if they identified as ADHD by taking a screening exam, they were 41% more likely to experience PMDD. Whereas the general population was less than 10%. So when I start piecing all of this together, like I have in my new book, I'm like, cause the the thing that has bothered me forever, like since I started this endeavor like 10 years ago, looking at birth control pill is who is most vulnerable? How do we counsel better? We have to identify who is most vulnerable so that we know to keep tabs on them and their health. And as it turns out, neurodivergent women. Tend to be very vulnerable. Now we've only had one study. We need to repeat, ⁓ you know, and have more studies and ask more questions, especially as we're seeing more autistic women. We know neurodivergence is an umbrella. There's many neurodivergent conditions out there. So we need to just be asking: like, who is at risk and how high is that risk? And how do we mitigate that risk? Because the other thing about being a teenager. If you have the, you know, form of ADHD that lends itself to impulsivity, you're at much higher risk of getting pregnant. And so we we have to have something available for you. And but to do fertility awareness method, like that may work, but that means somebody with executive dysfunction has to actually be tracking things. And so we have to ask, like, i is this the best, you know, thing for them? And so I think this is a Complex intersection within medicine that we have never answered and we don't have enough research on. And I think the lack of research and the flippant prescribing of things without ever questioning, well, could this woman respond differently? has absolutely done harm. speaker-0: I think that this is like a really great pivot point to start talking about neurodivergence and in particular talking about ADHD. As I mentioned at the outset, ⁓ you do have a new book coming out, ADHD and women. And it argues that ⁓ ADHD in women, rather than being something that's sort of fixed and you know, is sort of like easy to pin down, that it tends to change in response to hormonal changes. And I want to unpack those ideas a little bit, but before we do that, I'm just really curious about what led you to this path. Like what was it clinically or what was it personally that led you to want to begin to explore ADHD in women? speaker-1: Well, it really started with observations of my PMDD patients and my PMOS, formerly PCOS patients. So, you know, I noticed that my so at the time this is PCOS, but now we call it polyendocrine metabolic ovarian syndrome, a much more accurate name. We'll see if it actually changes clinical practice, though. What I noticed with them is a lot more of them had a diagnosis of ADHD. Okay, that's interesting. The research says time and again that it is these. PCUSPMOS women who get ADHD at a higher rate. I challenge that. I don't think that's the case. I think what it is is that high androgen levels make them express in a way that clinicians recognize it because it's more of that like male archetype of ADHD, the impulsivity, the can't sit still, the fidgeting on the outside. But it was my PMDD patients who would say, like, okay. Things are really bad. Dark cloud moves in, and that is happening cyclically for me. However, things like while the mood might change, things don't get easier for me just because I'm now in my follicular phase. Like I still struggle with, you know, and then you name the executive function, and they're struggling with these aspects. And I'm like, that's so. Interesting, you know, I always look for things like thyroid and making sure like we're correcting anything that could be contributing to these symptoms, but I would send them out and say, like, let's get you evaluated. And sure enough, they'd come back. ADHD autism. These are the two things I kept seeing. So fast forward, I'm in my 40s. I have an ADHD child. I'm sitting on the porch with our psychologist who acts as a parent coach, who's like helping me be a better parent to this neurodivergent child. And I started arguing with her, but like not arguing because I she's wrong, but arguing because I'm like, no, that's normal. Like I did that as a kid. Like I've done these things. And she's like, we need to have our old session. And I'm like, what do you mean? And she's like, none of this is actually normal. And I'm like, I don't understand. So get diagnosed with ADHD. That was like a a very that's like a very easy one, I think. ⁓ comparatively speaking to the later autism diagnosis I got. Where they put you through a gauntilage of things. And ⁓ just so people know, like when because people always be like, You can't be autistic. And I'm like, I you don't see me at home. So no, you wouldn't think that. But when you go through that, you also have to have family members. Like my husband had to write like a narrative about me. And then, you know, they were like, Do you like, do you want to let her read that? And I read through and I'm like, This is how everyone sees me that like knows me in real life. Like, ⁓ my God, I thought I was like, I was thought I was masking harder and like more put together. But what was interesting, sandwiched in that time, is that I was going through infertility and I also got the diagnosis of endometriosis, which I immediately, my brain is like, this is no coincidence. One does not have, like, you know, like, and how am I in my 40s? It's such a weird thing to be like, okay, 29 years of menstruating, they finally catch endometriosis, but also like I also have ADHD and I'm also autistic. And like I start going through all that, and I found sure enough, research studies that like. ADHD women, autistic women, they're more likely to have endometriosis. So I actually write about this extensively in my book because endometriosis is contributing to further neuroinflammation in the brain that then makes the ADHD and autism so much worse. So while this started as a like clinical journey, observations in patients, it became very personal, very quick. And I also think I'm not alone in being in my 40s, being late diagnosed, and being like, okay, firstly, I can look back and forgive myself for a lot of things and be like, well, you know, you thought you were weird all the time. ⁓ it turns out you were different. But at the same time, I'm like, it is weird to be in your 40s and be like, okay, now I'm having like this existential midlife crisis of like, who am I and how am I not myself? Because now I've come to realize that like, I actually have a different operating system. So that's what I call it in the book. I talk about the neurotypical operating system, it's more like the iOS, like it's integrated with everything. It's super intuitive. Like everybody understands it. And like I got the Android, which is not a worse operating system. Some people will argue it's a better operating system, but it is not compatible with my, you know, earbuds and my Mac and like all these things. And it doesn't just like integrate seamlessly. Like there's a whole learning curve to it. speaker-0: And it's gonna turn the chat green. speaker-1: Yes, yes. And people are gonna know that you're different and don't have the iPhone. That that should have went in my book. I still I'm actually an iPhone user and I didn't know. I I didn't know this about Androids. But yeah, it's gonna tell on itself. speaker-0: It does. Yeah, it turns the chat green. I wanna put a pin in something really quick and then you can ⁓ and then I'd I would love to have you continue. But you had mentioned because at this ⁓ stuck in my brain and I'm sure other listeners are gonna have the same experience, where you were talking about the fact that you were ⁓ talking with this therapist that you're working with to help you and navigate the relationship with your child, your neurodivergent child, and and you're realizing that some of these things that you did that you thought were normal. Would you mind sharing with us like what are some of those things? Like speaker-1: Well, it was like it started with sensory sensitivity. So like I can vividly remember my childhood having meltdowns over the seams in my socks. Like, why did anyone think seams and socks were a good idea? I don't know. Gagging. No, I have very long hair, but I will gag if my hair is wet and stuck to my back and I can't get it off. You know, whenever people are like, ⁓ it isn't an ADHD or superpower, and I'm like, I can get down with that so long as you can recognize my kryptonite. And one of my kryptonites is if I If I touch raw silk in a store, like you'll see me be like, like just like so, so a lot of sensory sensitivities that I'm like, or hearing electricity. So I thought, like, yeah, like is it's so annoying when you can hear the lights, right? And my my my son psychologist was like, people don't hear lights. Like this is not this is not a thing. So a lot of these sensory sensitivities, but also the social dynamics of like not understanding. What people mean in conversation. So I often will have to touch base with like my husband. It's really funny because people will try to passive aggressively insult me online, but because I don't get it, I like don't get that like they're insulting me. But I'll have to ask my husband and he'll be like, and sometimes I think like someone's my friend, but then they say stuff to me and he's like, That person is not your friend. You're not understanding this social communication. I know people don't love AI, but AI has been such a game changer, I think, for the neurodivergent community. Cause I can put things in there and be like, why did someone say this and what does it mean? The other thing is that, you know, the phrases that people use. So for example, like saying clickbait. speaker-0: Like ⁓ like ⁓ yeah or like an idiom or something like that. speaker-1: Yeah, yeah. So ⁓ just the other day, somebody wrote this like dedication to their book. And I was like, peak clickbait. And then she's really upset because she's like, no, clickbait means that it's deceptive and this is real, and I'm not being deceptive. And I was like, I thought clickbait meant it was so tantalizing, you couldn't resist it. It was the bait, and I took it and I clicked it. And she's like, this person was like, Okay, that's okay then. And my husband's like, ⁓ my God, you should just ask me what things mean because. It's like you're always like getting these things wrong, or like, you know, I can't, I can't read between the lines. So that's the other thing is that ⁓ people will often think I'm aggressive or argumentative because I will ask clarifying questions. I just don't understand. I just don't understand if you're not talking to me directly, like what is happening between the lines. And then, you know, I've had in my history, so figuring out a I like, okay, like I'm neurodivergent. People would say, like, ⁓ she's a gossip. Like, so someone would be like, she's gossiping about people, or like, tell me they don't like gossip. And I didn't understand. And what was actually happening is I was asking them about someone and I was asking about this interaction. And I like didn't understand the interaction. And they thought in me asking about that, that I was trying to talk bad about the person, but I I was not the intention. The intention was like, I just am like, This person kept saying this to me and like they said it three times. So I think maybe I didn't like respond right or something. Like, why would they say that? Why is that significant? And then people are like, you know, why are you talking about this other person? And I'm like, because I don't. I'm like, help me out. You know this person better than me. And I actually don't like this. This happened where someone like kept telling me about their husband's job title. And I just did not get it. And like then she was kind of mad. Afterwards, I just did not understand what happened. And my husband's like, So that's a really prestigious job title. And your reaction was like, ⁓ that's cool. And it was should have been like, wow, that's really like great and stuff. But you just like kept on moving like it was nothing. And I was like, I didn't know. I didn't understand. And so it's things like that where, like, you know, I just don't always understand in a conversation how I'm supposed to respond. And I'm, you know, being neurodivergent is completely exhausting. Also, because you're constantly scanning at the environment, everyone trying to figure out like. And the other thing is like rehearsing conversations ahead of time. I didn't know that wasn't something that other people did. And so I would be like, ⁓ I'm gonna go talk to like so with you today. Like we're gonna probably talk about this. And so if she says this, then I'll say this and like doing all of that ahead of time. speaker-0: Well that's so interesting. Like and I think that so many listeners, for those of you who are not fam as familiar with ⁓ Dr. Brighton as I am, you're very socially facile. Like, like to me, I wouldn't have ever expected that you had any sort of effort that went into your ability to ⁓ communicate with other people because you do seem like such a genuine like an extrovert, really. speaker-1: Everybody's always like, You're such an extrovert and I'm like, Really? Because when I speak at a conference, I then spend six hours in my hotel room buried under my pillows and blankets. speaker-0: Yeah, well I and it just is I I think it's just a really a reminder to all of us that that we really don't know. You know, it's like everybody always seems like everything seems so easy for everybody else, and that it's that and that we're the only person who's struggling with something or the only person who has something about us that makes us unique, like being neurodivergent, for example. And ⁓ and seeing that somebody like you and obviously you've been very successful in the world and you do a really nice job of connecting with people, even if it is difficult for you. ⁓ I that it k it like that's pretty inspiring for for all the rest of us. speaker-1: Well, it's a a very high masking state. And I will say it's when your hormones change in perimenopause that just about every woman who's been getting by high masking is no longer able to mask. And this is why we're seeing such an explosion of the number of midlife women being diagnosed ADHD and autistic. And there was just a study that came out showing The ADHD women actually enter perimenopause about a decade earlier with twice the symptom severity. And so, you know, people are like, ⁓ like, why are we seeing this explosion in the numbers? And it must be like all these things in the environment. And I'm like, there's been generations of gifted women who now just cannot keep up the mask anymore. Like it just is so energetically demanding. And with that loss of estrogen, you know, it leads to mitochondrial dysfunction. We don't have the capacity to constantly keep up masking. And I think that's when, you know, it becomes really important for women to start looking at how they've been living their life, the people pleasing they've been doing, like how, you know, everything's been organized and start giving themselves permission to step back on things. But also, you know, as I detail in the book, there's ways that you can take care of your brain that like we're not talking about. That medicine's not talking about. They're treating everyone in perimenopause as if if we're exactly the same. We're all exactly the same. We all have to do exactly the same things. And what I'll say is that I feel very much like the neurotypical woman gets a lot more leadway in her exercise, whereas the neurodivergent woman needs to be exercising daily. And so, you know, one of the things I talk about in the book is the production of lactic acid. So the thing that makes us sore, the reason why ADHD years fidget. Is because it produces lactic acid and that gives you brain energy. And so the brain, the ADHD brain is actually really poor at using glucose compared to like the neurotypical brain. So energy utilization is just compromised. There's mitochondrial dysfunction, there's increased reactive oxygen species. Estrogen goes. Now energy is compromised even more. And this is where you say if the mitochondria are the powerhouse of the cell, right? So they're powering the entire house. Your crank generator is exercise and it literally needs to be cranked. And if you can just give yourself 20 minutes, we know that that can extend your attention and focus for two to three hours following that. And so much of that is the lactic acid. But the other side of that is that if you don't get quality sleep, the lymphatic system doesn't clear the lactic acid. And now it actually has worked against you. And so while we talk about these things, like every woman struggles, right? We got to exercise, we need to sleep better. If you are neurodivergent, like it is like, It is like the you know, I'm so careful because like pathological demand avoidance is very common in this group where they're like, if you tell me what to do, I won't do it. But it's imperative. And it's I think we're gonna find out in the future that conditions like ADHD, autism, perhaps yeah, endometriosis even, are increasing the risk of dementia in women. And so that's the other reason why I'm like, we have to be doing these things to mitigate it. We know that. 70% of those with ADHD experience delayed sleep phase onset. That means their melatonin doesn't rise until like midnight, 1 a.m. And then society's like, you have to get up at 6 a.m. You have to do, you have to do your work. And so we have to start looking at the unique needs and really addressing those. Cause just telling you, go to bed at 10 PM, take your progesterone, which progesterone might make you feel absolutely horrid, that's very real, or make it so you can't sleep for these women. You know, we have to actually be asking like what is driving this and then work it backwards so that we can help them meet those goals. speaker-0: Yeah, so you've mentioned a few times this idea of masking. Can you explain to us like what that is? speaker-1: Yeah, so masking actually fits under the umbrella broadly of camouflaging. And so, and this all sounds very like devious. And it's and it the people all the time are like, ⁓ you're faking who you are. You're not faking who you are. So I think what's really important for people to understand is that the evolutionary perspective, without community, we would die. We would die. We now understand that being socially isolated is the equivalent of 15 cigarettes a day. Like that is how detrimental it is to your health. So In camouflaging, you are attempting to appear neurotypical at all times. So you're not saying the weird thing. You're, you know, for the ADHD ears, like you're not interrupting people mid sentence. You're not, you know, something that neurotypicals hate is when they're talking about themselves and then you talk about yourself to like to relate to them, to be like same, same. And neurotypicals are like, you're just trying to put the focus on yourself. And really, what it is is that under that umbrella of camouflaging, You're trying to say I relate to you, and here is how we're similar. So it can look a lot like so rehearsing what you're gonna say ahead of time, looking around like in an office meeting and seeing like who gets praised, why do they get praised? I need to emulate this behavior more, even looking at how people dress, making sure that you fit into how people dress. So It's a lot of energy at looking at how do I show up in a way that makes me seem that I'm not other because we know on a biological level, if I'm seen as other and I'm outed from the tribe, right? Because tribally speaking, other could carry a disease. That's very threatening. Like, how do I stay within community? And how do I seem like I'm fitting in, that I'm neurotypical? So that's the idea. Of camouflaging, of masking. And it takes a tremendous amount of brain energy, as I was saying. And this is why when we when we go into perimenopause, the changes in our hormones change the way the mitochondria function, our ability to produce energy, and it starts shifting all the neurotransmitters as well. So with ADHD, everyone wants to talk about dopamine. And yes, dopamine is important, but like. Nobody ever died because ⁓ you know, you you were bored, right? I mean, maybe if you're distracted in a car. But if you think about acetylcholine going as well and you're forgetting things, like you're losing things, like, you know, heaven forbid, we've all seen those videos of the person being like, Where did I put my baby? And they're wearing their baby, but they're checking the stroller, they're checking everything. So, you know, there's lots of neurotransmitters that are changing during this time. But I think the most concerning thing is that the mitochondria. They're so cool until they're not. They're actually pretty lame in like the fact that as soon as reactive oxygen species get upregulated, the mitochondria are like, cool, that's what we're doing. I'm gonna make some too. Like, let's do that. And so now the brain is struggling with free radical damage, with a lack of energy. And on top of that, there tends to be neuroinflammation that gets upregulated as well. And so that kind of breaks the system where women are like, I can no longer like keep up with like the appearance. Or, you know, we'll see in like earlier perimenopause, they'll be like, I just lock myself down the week before my period because like I just can't trust myself not to interrupt people, not to just say something that gets me outed out of the social group. And so it's a very, I think a very concerning thing we're not talking about of like these women are starting to change. Their social behavior, they're starting to change their interactions because of how the hormones are changing and they're not really understanding themselves. And I mean, it's only been in like the last five years. We started getting all this research on ADHD showing that, like, yes, in the menstrual cycle, so before your period, we expect you to be more impulsive. We expect that, like, if you have ADHD, that your executive functions are going to struggle so much more. If you're someone who's progesterone sensitive, you may be having issues with PMDD, but at the same time, you may have issues with GABA not stopping you from saying the things you really shouldn't have said. speaker-0: Exactly. And it seems like you've touched on a few of them. And then I want to talk about why it is that the hormonal changes that happen during perimenopause and that happen in the luteal phase of the menstrual cycle tend to exacerbate these symptoms. But like what exactly is happening that I mean, so one experientially, what does it feel like to have ADHD? ⁓ and I know that there's kind of different variants, so it'd be interesting to, you know, it'd be great to get your sort of a description of maybe some of the different flavors. of ADHD that exist and then trying to understand like what the mechanisms are. And you talked a little bit about neuroinflammation and and the role of different ⁓ neurotransmitters. But I I'm sure I think that it'd be great to get a little bit of a deeper understanding of of what those mechanisms are because I think there's a lot of confusion around. speaker-1: Yeah. So when it comes to ADHD, you know, it gets put into these silos of like hyperactivity, inattentive. Many women, they resonate with the inattentive type. So, you know, that is something that is much harder to see as a clinician, which is one of the reasons women get delayed diagnosis. And then there is, you know, the combined type of ADHD. And what everybody always thinks is that so the name I say in my book, it's not a great name. It's a bad name, actually, because GABA, you know, the all of these neurotransmitters are being impacted. And so what we come to understand with women who have ADHD is that when they enter puberty. So I talk about these five Ps in my book, and puberty is one of them. These are the periods that get exacerbated with ADHD. And as girls go through puberty, what they start to do is internalize the struggle. So society has said to them smile, be polite, sit still, act ladylike. You know, all of these messages that we've all received. And so they start to internalize the struggle that manifests more as anxiety. So we understand that an ADHD woman is more likely to be diagnosed with anxiety and depression, which are co-occurring conditions with ADHD, but they're gonna get those diagnoses before they ever get the diagnosis of ADHD. So the hyperactivity. Is often internal for women. So they still have hyperactivity, even though they're being classified as inattentive. And their hyperactivity may look like when I'm trying to fall asleep at night, I replay everything I said in the day and I just hate on myself for the TMI. So TMI is very common in ADHD, saying too much because you're impulsive. You put the ideas out. This is also why you're like such an asset in the boardroom or so many places, anywhere that needs creative thinking and like. Lots of idea generation. ADHD brain is great for that. But on the other side, it might say too much. So you might be falling asleep at night and your brain is racing. You can't turn it off. And we start to identify those things as like rumination, or you know, perhaps this is a psychiatric condition. And what it is is the hyperactivity of the ADHD brain. There's also a lot of people pleasing. ADHD women learn from a very young age that mistakes are not just unacceptable, they're dangerous. They will get you cut out of people's lives. You will be kicked out of clubs. You, you know, you will not get the promotion. There's a lot of consequences to you not fitting the script. And so that's something else we'll see is women constantly people pleasing. And what is wild about the ADHD woman is often she can have an entire household that's running. And she knows her children's schedule, her husband's schedule, like she's taking care of everyone else that she cannot take care of herself. She forgets to feed herself, forgets to drink water. Me in my luteal phase, I don't know how many times I'm gonna forget to put on mascara, but I just put on primer, my kid's first day of school, and I show up with white eyelashes. Like that's some trend out of the 90s. Like it's so embarrassing. And my husband's like, You don't look that different. I'm like, ⁓ no, you're wrong. I'm like, so. speaker-0: Is that a comment? speaker-1: Yeah, no, he's I don't I think he's trying. I don't know. But I'm like, no, I definitely look different. We have white eyelashes. That's weird. And you're like 45 showing up at the school with white eyelashes. But there's just things like that. And I think like a lot of times ADHD and women gets characterized as this like quirkiness. It's something I've been fighting about with book covers because they're like, ⁓ you know, like we're gonna mismatch the letters and do different colors and all this stuff. And I'm like, I'm so Sick of us treating ADHD women like children and then conveying that like you're the girl who mismatches your socks. Like maybe you are, but I was like, with my book cover, I want to convey like tranquility and the the like hope and the promise that like you can feel good in your body embracing yourself, but also like working with your brain. But you know, I think for everybody listening, if I was to put ADHD in one definition, Dr. Anne-Louise Lockhart said it to me so beautifully, which is that it is extreme executive dysfunction that interferes with your life. So everyone will say everyone's just a little ADHD. No, in fact, not everybody's a little bit ADHD. Everybody has some degree executive function. Like, and depending on how you split them up, there's like 10, 12, maybe 15 executive functions. Like if you think of things like your ability to plan. To coordinate things, your ability to work with time. That's like my nemesis. You know, so these kinds of things, all of us have some level of executive dysfunction. For the ADHD person, there has been a level of dysfunction their entire life that has disrupted relationships, school, their work, and they may be putting a great deal of energy to appear put together on the outside while they feel like they're flailing on the inside. And what happens in perimenopause, so we can go deeper on like ADHD hormones, what happens to the brain? But it is very common for women to experience ADHD-like symptoms in perimenopause. They don't truly have ADHD. And what's really great, if this is you, is the research says about two years after menopause, like your brain's gonna come back. You're gonna be okay, you're gonna be fine. The bad news is if you have ADHD and no, we don't intervene, 25% will go on postmenopause to have severe ADHD symptoms for the rest of their life. I think this is a public health crisis because these are people who miss doctors of visits, miss screening exams, but these are also people who miss mortgage payments. Like this is very, very significant to where I'm like, we need to be intervening because 25% is far too high to see women having that degree of executive dysfunction for the rest of their life. speaker-0: So you said that that ⁓ you can experience during perimenopause an unmasking of ADHD, but you can also experience symptoms that ⁓ that seem like ADHD but are not. Right. How do you tell the difference between the two? Like clinically. speaker-1: Yes, this is such a great question. And one of the key things is that it needed to be present since childhood. Now you can acquire it. Like if you have a head injury, if you end up with a brain infection, like things can can flip switches and then you can be classified as acquired ADHD. But you go back through someone's childhood. So this is why like I started the top of this talking about like they had to ask people who knew me as a child. So my husband, he actually met me when I was 19. We like knew each other for a very long time before we ever even dated. So he was actually a really great historian to have involved in this because just of the the quantity of time that he knew me. And then we also had to ask like my siblings, which my siblings were like, Yeah, she was weird. I was like, Thanks, guys. Thanks. ⁓ But you know, like the there, like, you know, some of the things that also came up was like, you know, she always seemed super argumentative, but in reality, they came to understand that, like, no, she just didn't understand. So she kept asking you questions, which seemed like an argument. But she just more was like, What do you mean when you say that? And also, why do you say this if that's not what you mean? Like, why like say what you mean? Like, I don't understand. So, anyhow, I digress. So it's that presence since childhood. And so when you ask women about this, you're not asking about like, ⁓ could you not sit still in class? Like the DSM has a whole criteria, but it's not just that it with ADHD. It's like, did you ever get like classified as having severe anxiety? Do you ever feel like you were monitoring yourself? How much did you obsess about your back to school clothes because you didn't want to seem like you were, you know, you didn't fit in? I do have to share. I just got my colors done. I was gonna have this photo shoot and I was like obsessive and I was freaking out. And like my audience, I kept just like putting up photos, help me get dressed. I don't know how to dress. Like somehow I like don't know how to dress myself anymore. Cause as it turns out, when you move from Portland, Oregon, where you never see the sun and your hair is inky black and your face is like pale, like Morticia Adams, and then you end up living somewhere in the sun and everything changes. Like, yeah, like you don't know how to dress yourself anymore. But I finally came to the understanding of like, why was I obsessing over that? Because I know how important it is that I look a certain way, that I fit the certain part. And that like if I don't have the appearance right away, like judgments will be made about me. And we tend to be a lot more sensitive to that. So everything has to be present since childhood. And when you dig in, they're like, people will be like, no, one of the things I'll be like, Were you gifted? Were you ever put in the gifted program? And people are like, yeah. Like, and so they think like I couldn't be neurodivergent. And then you start going through that with like autism, for example, like tell me about your routine. And that there are autistic people are very literal and they are love their routines. Like, I'm a fan of a routine. I am like someone who always has to have a plan. And if we deviate from the plan, I have like massive anxiety about the plan. And like, I gotta like, I'm very bad at the transitions. So it's those kinds of things. Like you had this since you were a child. Tell me about the ways that you compensated for it. And so you start hearing about like, you know, I nature that I like thought through the conversations I was gonna have. Before I go to a party, I think about like, you know, what are the things I'm gonna need to say? What, what's the thing that everyone's gonna want to hear? Before I go to a restaurant, I study the menu first. I make sure I know where I'm gonna sit and I understand the ambiance. Neurotypical people are not doing these kinds of things. So what happens in perimenopause is that. Executive dysfunctions rise because the brain no longer has the energy that it needs to be able to run those. And so this is where women will start to struggle, where they're like, I can't remember what I'm saying mid-sentence. Okay, check, that's probably acetylcholine. Estrogen just pulls on everybody. And let me just say, like, when I started talking about this like six years ago, I made a huge mistake in talking about just estrogen as a starting point. Because now everyone's like, just give estrogen and it fixes things. And I'm like, Unless she has histamine problems and now you're gonna make her rage and she's not gonna sleep and she's gonna be up from two to four a.m. Like, let's not forget progesterone, which I have to say is like why I love your new book. Cause I was like, Yes, praise progesterone. I feel like I'm like constantly defending progesterone in the book because I'm like, it's true, like PMDD can be made worse with progesterone. You know, you can have progesterone sensitivity. You, you know, there can be progesterone, is also why like your executive. ⁓ functions get worse when you are in your luteal phase. But at the same time, without progesterone, you're not getting your BDNF alpha. You're not protecting the myelin sheath of your brain. You're not regulating histamine. You're not regulating neuroinflammation. Like you have to have it, but like we have to figure out how to get that like in balance for you. So you know, just as summaries for women, yes, you can go into perimenopause, not have ADHD, but start resonating as if you do have ADHD. And that's where I'm like, My book comes in to support you and get you through that period of time because this idea of like it's temporary, it'll come back after menopause. So just deal with it. And I'd reject that. You still have a full life to live. You only have so many years on this planet and we ain't got time to waste. speaker-0: Right. So the you your book then can be useful to women who have ADHD, right? And and as you noted, this is something that you will have manifested symptoms of it throughout your lifetime, which is why you do these interviews with yourself and with other people who've known you for a long time to help construct a picture of are you somebody who's neuroatypical or are you somebody who's more neurotypical? And and so that's how we can help distinguish between somebody who's like true ADHD or just somebody who's in. Peramenopause and no longer can give a f speaker-1: Yeah. That's true. That happens. speaker-0: Just fresh out of just fresh out of speaker-1: I I'm always like the tree has runneth barreth, like it's barren. I'm so sorry. But I also think like a lot of women will say, like, no, like you shouldn't blame these things on women's hormones. And like maybe it's just, you know, when women start to have relationship troubles, they're like women are very quick to just be like, it's the man, he's a problem. I'm like, yes, and okay. So yeah, sometimes they are problems. ⁓ a lot ⁓ it's very funny because the research is like. So there was older studies. It's since been refuted where they're like, men grow out of ADHD. When men get older, things get better for them. I'm like, they married. They married into executive function. That's what they did. They married into executive function. And a lot of times what happens is that ADHDers find each other. So my husband and I are both ADHD. And so it's definitely something where, like, you know, me being my mid 40s now, I'm like, I cannot carry the mental load for this. I cannot. But, you know, women are so quick to be like, Don't blame it on our hormones. And I'm like, we we have to talk about hormones because your brain is full of receptors for your hormones. But I feel like that's like old school feminism, where they're like, don't say that women's hormones influence their brain and their behavior because it'll be weaponized against us. And so, like in my book, I'm just like, women's hormones influence their brain the same way men's hormones influence their brain. Hormones influence brains because they're also acting as neurotransmitters and they're affecting neurotransmitters. speaker-0: Yeah, I had to spend ⁓ a lot of time in both of my books talking about this idea of getting over the queasiness that a lot of people get when you start talking about hormones influencing the brain, ⁓ especially with women, and understanding that everybody's hormones affect their brains and that's like what they're supposed to do, and that we are so much better for it, and that it helps to ⁓ helps us to adjust our behaviors and our emotional responses and our executive function. ⁓ to match the environment and our hormones are really a really important part of that picture. And yeah, no, I I appreciate the difficulty of ⁓ having to lay all of that out because people do get a little bit uncomfortable about that possibility. But it's true and And so what you have discussed is that the fact that ⁓ and and what you discuss in your book is that you get this paramenopause, you know, sort of unmasking, and you can have these experiences either that are magnification of ADHD or just, you know, the us you're you're having the symptom set for a couple of years during perimenopause, but then it will resolve postmenopause. ⁓ and then you'd also mentioned, I just want to ⁓ put a pin in it really quick. ⁓ the the idea that we experience these moments of vulnerability that you can have worsening. And you'd mentioned I think it was the five Ps, and I'm assuming it's like puberty, ⁓ postpartum. speaker-1: Pre period. speaker-0: I'm like I'm like, what is the other period? Yeah, pre period. So yeah. So anytime that you have rapid hormonal changes, should we buckle up if we're neurodivergent and expect that we're going to get worsening? speaker-1: y we should expect that we're getting worsening symptoms and we should plan for that. That's what I would say is that instead of just accepting the inevitable, we should actually make plans for that. So if you, you know, we don't have research on this, but you know, I have seen this time and again, if you are neurodivergent and you're already, you know, vulnerable to depression, then we would expect postpartum depression. So rather than just saying, six weeks and then we'll see you when we see ya. We should probably be following up on this woman, but we should also do things to help her, to help mitigate this. I mean, we can use hormone therapy, and I do think we should. I'm a big advocate for hormone therapy in postpartum women who especially are over the age 40. More and more women are having babies after age 40, and they're basically doing postpartum to peribenopause. And that's rough. And I think it's very rough on the brain. And we're not talking about it. And I say this as someone who had a baby at 40. So I'm not judging anybody for that. I've I've lived it. You know, what I talk about in the book is this model that I put together, which is the brain, hormone, immune triad. And what sits in the middle is the mitochondria that really is like either supported or collateral damage in the midst of all of these changes. And this is what really can impact anyone. And I think we have to understand. So as I talk about the triad, the brain is what orchestrates your hormones. The brain is the starting point. We always, you know, talk about the ovaries or the testes or, you know, you know, talking about the adrenal glands, but nobody is really paying attention, you know, enough in the conversation to like the brain orchestrates all of this. And it can be impacted by inflammation in how it operates, or the hormonal changes can shift the immune system. Then that impacts the brain. We know that, you know, chronic. Stress is, you know, it's a very interesting thing about ⁓ ADHD is that everybody's like procrastinating and being told, like, you're lazy and why can't you just get it together? They're leveraging cortisol. So cortisol makes dopamine work better. So acute cortisol, this is why every ADHD is like the night before my papers do in college. That's when I'm doing it, because they do their best work. Yes, because they are leveraging cortisol. But when we have that chronic Cortisol exposure is when dopamine receptors stop working. So even if you do make it and you don't clear it, it's still not gonna dock on the receptors, right? And when I talk about cortisol, I think it's important for people to understand it's just it's not just psychological stress. It's also like, do you have endometriosis, adenomiosis, PMOS? Do you have gut dysbiosis? Like there's all of these underlying reasons women can have. For inflammation. Cortisol is the most anti-inflammatory hormone we have. And so of course the body's going to say, let's do more cortisol in the face of this inflammation. And then we end up with shifts throughout the body, you know, but also shifts that are happening in the brain as well. speaker-0: Have us return to those when we start talking about some of the ways that women can help support themselves with their ADHD. But before that, I want to talk to you about this idea of sex differences in the diagnosis of ADHD. And there was ⁓ some headlines that came out, I don't know, like five or six years ago, and they were talking about the fact that, you know, women may be being underdiagnosed with ADHD because it presents differently. In women than in men. And I remember when I first heard that, at first I was like, well, good. Now we're gonna, you know, have some research that's finally done on women and we can actually, you know, understand how this, you know, condition manifests in women, ⁓ using women as research participants to like actually understand how their brains work. But then about five minutes after I had that, like, this is a great moment for women, I thought, wait a minute, is this just the drug companies trying to find a greater number of users? Like, are we changing the diagnosis just so that way that we can ⁓ give more women drugs? Do you think that there actually are differences in the way that ADHD manifests in men versus women? Or do you think that there's anything to my paranoia about changing the diagnostic criteria to create more customers? speaker-1: Yeah. Okay. So I think anyone who just was like, this has become a conspiracy theory podcast needs to know the history of PMDD. So PMDD, premenstrual dysphoric disorder, which I struggle with, not to be cool or anything, but before it was a diagnosis, I was dealing with it. I like to say things like that. I also have adenomiosis, and I'm like, not to brag, my uterus is twice the size of yours. Like these things are not cool, everybody. Just so you know. So here's the thing: PMDD. It was the pharmaceutical company, Eli Lilly, that put together the entire conglomerate that pushed it through the FDA to become a diagnosis. And why did they do it? Because then they had the patent for Seraphim, which was basically just an SSRI. It's Prozac rebranded in purple and pink because that's what little ladies love, right? And so yeah, it's absolutely a conspiracy. It's why some doctors say PMDD is not real. PMDD is absolutely real. It is absolutely a hundred percent real. And, you know, why did they give up their patent of seraphim? Well, as it turns out, like only like half of women actually respond to the SSRI. So it wasn't that good of a treatment. Then comes like, you know, ⁓ Yaz and Drosperinone, and they're like, ⁓ we're the next best thing, right? So PMDD absolutely was and I Give receipts in the book. You can Google this. It is well known that it was pharma influenced, it was pharma driven. The entire diagnosis exists because pharma pushed it through so that they could have the patent. They made all the money. By the way, seraphim, hell of a lot more expensive than Prozac. And Prozac, they were like, We're gonna, we're gonna be losing our patent on this. So we need to do something new. Okay, so like skepticism is real. This is not a conspiracy. They do do this stuff in women's health. It's been well documented. And I do think we should be skeptical of like, are we gonna just push women onto stimulant medications when we haven't studied stimulant medications in women? That's problematic. That to me, when women are suffering twice the adverse drug side effects as men because they were never studied. And I need every woman to know that neuroscience is probably the most guilty. Of not being inclusive of women. And you know, you pointed out this in your book as well of like when they do include us, it's not truly including us. It's like, when are your hormones most like men? Okay, check. That's when we're gonna look at you. But as it turns out, many women report stimulant medications do not work in their luteal phase. So why is that? It's because those medications are reliant on dopamine. When we're in the luteal phase, it's not that people are always like, ⁓ your estrogen's gone. So dopamine's gone. Your estrogen's still there. Okay, she always there. Okay, except for when the ovaries retire. It's that progesterone rises so exponentially high and it's GABA's turn to shine. And so, you know, this is where I'm like, stop patholog like pathologizing the luteal phase, right? Like everyone who's out there being like, This is how you can like hack it like a boss girl and make sure you're productive in your luteal phase. I'm like, I don't think we're supposed to be. I don't think You know, I say in my book, like, you know, La Luna, she shines, she gives you the full moon, and nobody bitches at her when she decides to dip out for the new moon. We're following the same cycle. Why can't we just have a couple of days off? Because capitalism, okay, we're going back to more conspiracy theories. So the thing with these stimulant drugs that I will say is we finally first had our first animal study that described to us how they're working. Now, this is what's really interesting about Ritalin methylphenidate. If you truly have ADHD or They induce neuroinflammation in the brain. And you take this drug, your reactive oxygen species and your inflammation go down and your mitochondria work better. But I hate to break it to all the tech bros who are riddling on the weekend being like, I'm gonna get things done. They found the opposite. So if you do not have neuroinflammation, you do not have ADHD, it actually increases inflammation, reactive oxygen species, it causes more mitochondrial dysfunction. So we better be damn right that we are dealing. with ADHD and when we give this medication. And also, this is the tricky thing. We have no great way to measure neuroinflammation. There's like vibrant wellness has like one lab out there. It's not cheap. It's not accessible to everyone, but it's and it's like, you know, is this all we have really? We can't quantify ⁓ neuroinflammation. Yeah. speaker-0: Like d do you know how they do they just like measure that u ⁓ using peripheral blood and then just like make guesses about what's happening in the 'cause it's it's hard to measure, you know, anything in the central nervous system. speaker-1: Totally. And what are we gonna do? Like, I mean, I I at first the first draft of my book had like a full cytokine panel in there and was like, we're seeing these cytokines. We these cytokines bump up against the blood brain barrier. They can cause permeability, that you know, will cause the microglial cells. It's all inferences that we make. Then I was like, dude, who can afford this panel? Like, who can do all of this? Like, this is just not like accessible. And so, like, we can make inferences based on like Are you having brain fog? Are you having cognitive struggles? This is also why we've seen ⁓ the studies on vivants in perimenopausal women who are like the ADHD medication works for me in perimenopause. Why? Neuroinflammation. When estrogen goes, we can see an upregulated ⁓ upregulation of neuroinflammation. So the other thing, the other little pearl I'll give to people, and most of the research we have in ADHD is on children, not in women, spoiler, but I think this is compelling enough. And I actually leverage this is saffron. Particularly a form called Afron, which has clinical studies on it. I would not just buy Amazon saffron. I I can guarantee you paying five, ten, fifteen dollars for a bottle of saffron, that is not saffron. That is counterfeit stuff. And I just wouldn't mess with it. But there's been research. Yeah, it's expensive. I mean, buy the spice alone, right? For your kitchen and you're like, that's not cheap. So there's been studies to show in children that when on methylphenidate at Ritalin. And they take saffron, it actually works better and they don't have to up the dose. And I think that's really compelling, especially when we consider the research on saffron and PMDD, saffron ⁓ and ADHD. So alone it can help with these things. But the cool thing about saffron is there's also been clinical trials using it alongside an SSRI to help mitigate the side effects of anorgasmia and lack of libido. And then using it alongside Ritalin to show that like it can make it work better. And so, you know, that's one little pearl that I would give to people is that you can leverage that. Saffron is going to be better 28 to 30 milligrams. It's really tight range in all the clinical research. It's better taken daily. You know, people will say, ⁓ I just take it in my luteal phase. But I'm like, you want the compounding effects because it also has anti-inflammatory effects. And it seems to be harmonizing neurotransmitters is the best that we can put it, because we're not opening up skulls and being able to see like exactly what is saffron doing. We're getting more clinical trials of like how do people feel when they're on it? You know, but back to your point, I think that there is a difference between male and female ADHD, and it comes down to hormones. So, you know, I'm an ADHD, raising two ADHDers and they're boys, and one of them is 13. And ⁓ my God, have I like, whenever people are like, ⁓ don't say women's hormones affect their brains, I'm like, Have you never been around a teenage boy? Like the emotions, my goodness, the emotions. The other thing that I'll ⁓ so you know there's the testosterone piece. And when testosterone's up, this is when we see more impulsivity, we see more hyperactivity that's externalized. You know, we see the ⁓ you know, I think about Simone Biles, a gymnast, right? ⁓ just very physically active. We see people figure out that they can channel this into a talent and they become very hyper-focused on that talent, which is, you know, one of the the things that are benefits but also harmful about ADHD. And then we see like when when girls go through puberty, that's when we start to see ADHD changes for them. So if they didn't get clocked early on as like, ⁓ like they're a little more hyperactive. Also, you might just be talkative. So your hyperactivity may not be physical, standing up, moving around. It may be you just don't stop talking. Like I was like, how did nobody know? Mm-hmm. How many report cards I had? This is she talks too much. That is a sign. Now people pay me to talk. So yay, eat that first grade teacher. So, you know, when we all when we put women on hormone therapy, we can also see the changes in how their ADHD expresses. So I have shared with my audience, I had. Emergency knee surgery last year, I started losing muscle mass. And ⁓ we were doing everything to try. Like, we were just like restricting blood flow, doing like STEM, like, you know, all this stuff. I could not put on muscle mass. And finally, I'm like, I need to check my hormones. And I was very proud at 45. My estrogen and progesterone look amazing, but my testosterone was like so garbage. It was so low. I wasn't making it. ⁓ and my sex hormonbinding globulin fine. And so I had to like ask myself a question. Like, I went through surgery. That's a stressor, right? I should be able to bring my testosterone back in theory, but I also don't have two years to work on that. I can't be losing muscle mass at 45. So I went on testosterone and we, my husband laughs at me because he's like, You always tell your patients who you know have ADHD, like, okay, we're gonna start testosterone hydrocredit card for two weeks because your impulsivity is gonna be really bad. Even if we have the dose right, your brain is gonna get flooded and then you're gonna be really impulsive. Well, I almost bought a puppy. Instead bought two pairs of sequenced pants instead. The impulsivity was so bad. And it was like the archetype of what you would think of ADHD and the way the research has classified it. And then like two weeks later, like things evened out and everything was fine. And I'm like on this tiny dose of testosterone. And I'm like, woo. That was that was wild. And so the hormones definitely influence how our ADHD shows up. And that's why at the top of this, I said the PMOS women. The research says that they have ADHD at a higher rate. They also have about a 40% chance of birthing a child with ADHD, which you know begs the question during the testosterone wash that happens early in utero. Like, how much testosterone do we have? But also, these women have insulin dysregulation and inflammation through their pregnancy. And that we know can lead to a neurodivergent child. This is not to blame mom. This is actually to say clinicians. You should be doing something about this sooner and you should be monitoring her more tightly. Like I would say, insurance should cover a continuous glucose monitor in somebody that has a condition that we know can lead to insulin dysregulation. Because waiting until like you drink a sugary beverage and then things are so bad, that's too long. That's too long in the neurodevelopmental window. speaker-0: Do you know, and this is a totally off topic question, but it just popped into my brain and now I want to know the answer. Do you know whether ⁓ girls ⁓ from boy girl twin sets are they more likely to have things like ⁓ PMOS and and maybe some of these sort of male typical expressions of ADHD? speaker-1: I don't know. I don't know that we've done that research. I would be really curious to see that. I mean, we know ADHD is one of the highest inherited psychiatric conditions that we have. So, you know, that's why I'm always just like, if you're a mom and you're neurodivergent, like this is whenever people say like we need to find the root cause of neurodivergence. I'm like, you're looking at her, or you're looking at the sperm, right? You're looking at the man as well. So we know these are inherited, but at the same time. You know, it's not just the inheritance. So, what I argue in the book is not that we can make neurodivergence go away. It's that we can help with the expression of neurodivergence. And so this extreme expression of dysfunction, like we know when ⁓ so when we look at the studies of children and their diets, the more ultra-processed food they have, the higher incidence of the diagnosis of ADHD. Food didn't cause ADHD. It exacerbated ADHD. And when we look at when they're eating more plants, more fiber, they have more variety of foods coming in. They have lower incidence of ADHD. These children still have ADHD. It's just that it doesn't present so extreme that you catch it. But in terms of the twin studies with that, I'm like, I'm very curious about that. I haven't actually seen any twin studies. Now I'm like, I gotta go look. speaker-0: I was in particular curious about whether the prenatal exposure to testosterone that little girls get if they have a a male twin, because they there's gonna be more uterine exposure to ⁓ testosterone. And there's been a few things where they've done like looked at ⁓ 2D40. Are you familiar with that? Like the digit but like your your ring finger and your pointer finger, ring finger, pointer finger, in the ratio and like the more masculinized your ratios, like the girls that have a a male twin. have more masculinized 2D, 4D, where they've they've got that you can tell that they had more exposure to prenatal testosterone. I was just curious about like with PMOS, the condition formerly known as PCOS, whether or not you get more of that or, you know, some of these other things that are related to excess androgens in the case of having a male twin. speaker-1: So I do cite this study in my book about ⁓ hersutism. So your mom not actually having PMOS diagnosis, but just by way of having herutism, then you're it you are increased risk for having ADHD. So just seeing a higher androgen state. I would argue, you know, that prop that person probably did have PMOS. It's so common and it's the most common cause of hyperandrogenism in women. But you know, it, you know, things have things. Pregnancy can be weird, right? Like things can happen in pregnancy that we didn't expect. But I thought that was really interesting. Is just the just signs of higher androgens meant that you were more likely to be diagnosed with ADHD. So there's definitely this testosterone connection. Yeah. And it's something that I always get asked. People are like, ⁓ so you do have PMOS. I do not, in fact, have PMOS. ⁓ I'm a very regular menstruator. So, but so that's, you know, not what happened. in my situation, but it is very much the hormonal influence, not and not just androgens or looking at estrogen. It's also looking at insulin and looking at inflammation. So presumably cortisol changes are happening in utero that we know can influence the outcome. And so the child is more likely to be diagnosed with ADHD or autism, which I question does that mean The symptom expression is so much more severe that they catch it earlier. ⁓ because, you know, like I said, you're not changing, like you're not not ADHD just because you eat more plants. But we see this in the research time and again. We also understand that those who are neurodivergent, they have less microbial diversity. So their gut, they have more propensity towards intestinal hyperpermeability and less. beneficial bacteria. And we don't have an ADHD type in terms of the microbiome. But you know, the question is, what did you get from your mom? And then what did you get in your childhood for the way you were eating? And then also were you restricting? Like the, you know, having food adversions is really, really common. And so I think it's a difficult thing because it's like, we know we inherit mitochondria from our mother, the DNA, and we know we inherit the microbiome from our mother. And then we come out and then it we're shaped by our environment further. speaker-0: Is ADHD on the rise? Because it seems like, and I don't know whether it's just that ⁓ people are more likely to be diagnosed now than they used to be. Is it rising? And is that because of environmental changes? Like you'd noted that ⁓ people who eat a ultra-processed food-based diet, for example, that they tend to manifest symptoms to a greater extent than people who eat a healthier diet. And so they, you know, they would still, you know, have ADHD, but maybe they'd be less likely to get diagnosed because the symptoms aren't presenting as, you know, sort of robustly as they would be in the case of ultra processed foods. Like are is are there environmental changes that we've created that are have produced an increase in ⁓ ADHD diagnoses? speaker-1: I think we are definitely looking at, you know, an intersection with the environment. So the first thing we'll say is that the group of women that are getting at the highest rate of being diagnosed are middle-aged women. Okay. So that's not new. And it's not that ADHD is on the rise because it's new. It's that this entire population who's been missed is now actually getting diagnosed. And we're and you know, it's crazy because when you look at the research. And they ask clinicians, like, how confident that you can diagnose female ADHD or adult ADHD? And then they're like, I'm not. It's like six percent. They're like, I'm not confident. And then you ask them, like, and what do you know? What do you do about it? And they're like, I have no idea what to do about it. I don't only know how to treat this in children because we've been focused in children, because we've been focused on getting them to behave in school. And so I think like we have to then look at, well, what is going on in the school environment? So I just want to be really clear to people. ADHD can be acquired, but it's not through diet. It's through like a brain injury. Otherwise you're born with it. This is genetic. But we know that genetics are not everything. speaker-0: Does the environment interact though? I mean, because the environment interacts with genes at all levels, right? Like the expression of any gene is influenced by what's happening with the rest of the genetic environment and what's happening in the social environment and what's happening in the food environment and, you know, and whatever and whatever. So I mean you can have the genes, right? But they're not necessarily, I mean, you don't you don't think that the environment influences the expression of the the genes? speaker-1: ⁓ absolutely. No, so that's what I'm saying is that you have the genes. So let's look at the school environment. Let's look at what's going on. So maybe a mom is able to like feed her child really well, right? And her child's playing outside, getting lots of sunlight, vitamin D, super important for regulating the immune system. What happens then when we take this child and we say, sit, sit for six hours, right? Like when I was a kid, we had so much recess, like so much recess, so much PE. Now, like my son gets But both of my sons, they get PE twice a week. What? Like twice a week? You go outside and you move your body. What did I tell you the ADHD brain? It has to have movement to make enough energy. The ADHD brain, what's interesting, the research, can literally become so bored that it falls asleep. Like it just becomes so bored that your dopamine goes down and your GABA comes up and it just says, Go to go to bed. This is so boring. So, like this can happen in a classroom environment. But then let's look at what's been happening to school lunches over the years, right? So like I mean, school is definitely feeding me like tater tots and a hamburger, but at least I got half an apple and some carrot sticks. Like school lunches have degraded significantly. Corporations like Pepsi have lobbied to be on campuses. Now children are getting more sugar exposure. And I know there's people out there being like, don't vilify sugar. Kids shouldn't be getting over 16 grams of added sugar. Adults should not be getting over 25 grams of added sugar. I'm not talking about fruit. Go off on your fruit. I'm talking about the added sugar that you're getting. We know that negatively impacts the microbiome. Now, the microbiome of the gut is helping produce neurotransmitters. We currently understand that those are not crossing the blood-brain barrier. They're interacting with the vagus nerve. And the vagus nerve is saying to the environment, it's bad. It's it's bad, right? It's saying, hey, brain, it is bad out here. And so that's gonna, that's gonna change things. We also see the use of antibiotics, right? So the use of antibiotics shaping the microbiome, leading to intestinal hyperpermeability. Now we've got more inflammation. Inflammation in the gut is going to travel the vagus nerve. Like there is that communication happening. So I think you know, when we start talking about the environment, like the studies on nutrition and ADHD, they're really irrefutable. It's shown time and again that the more ultra processed food, the higher the expression of ADHD, the more plants is really specific. So polyphenols. And getting lots of fiber and diversity of fiber, less symptom expression of ADHD, as quantified by the rates of ADHD that we see. Now, that doesn't mean that your diet caused your ADHD or that your diet caused your child's ADHD. It tells us that this is a condition, much like PMOS, that is very, very much influenced by the environment and the environmental inputs. And so there's things that we can do about that. We know that any brain struggles. If it's not getting adequate sleep. Okay, well, let's look at the school system that we're doing to children. So these children, as they enter puberty, here comes delayed sleep phase onset. Their melatonin doesn't spike until like around midnight. And school's saying, I need to get you to get here at 6, 7 a.m. I look back at high school and how I was like in leadership, going to classes at six o'clock in the morning and living on four hours of sleep. Like, of course, like any human brain would have dysfunction, but you're talking about a brain that has a vulnerability. And I think that's how we have to start shaping these conversations is that the neurodivergent brain has extra vulnerabilities. The genes you inherited that made you neurodivergent, they come in clusters. So they come in clusters of things like you may have issues with like COMT. So you can't process estrogen as well. Then you're also clearing maybe dopamine too fast. You could have, you know, MTHFR changes, which I know is like a really big buzzword. I don't think it's as ⁓ As amazing as everybody wants to make it out to be, but it does mean that like your detox capacity could be in ⁓ inhibited. And spoiler, the best thing you can do is eat your leafy greens. Like we're right back to that place again. So you might also have inherited genes that make you more susceptible to autoimmune disease. So we see that autoimmune disease tends to travel in the cluster. So ADHD, Aylers Downloss syndrome, autoimmune diseases, ⁓ endometriosis, a domiosis, ⁓ depression, anxiety, like There's all these clusters of conditions that come together that we absolutely understand from the research benefit from a nutrient dense diet and regular exercise. And what did we do in school? We we compromised the nutrient dense diet, we took away exercise, and then we were boring as all hell, being like, just sit here and pay attention. What's wrong with you? You have to actually change up the learning environment for this person to be able to learn. And instead of looking at like, how do we support this person? The child gets the diagnosis, they get the medication so that the teacher can handle the classroom that is now 36 children instead of like the 20-something children that they used to have. So I think systemically we have set up the ADHD person to fail. And then we've blamed them for the failure when it really wasn't them. It was that everything was like conspiring. It was conspiring against them. speaker-0: Do you think that our smartphones are also conspiring? I mean, I would think that that would also like sort of exacerbate ⁓ ADHD symptoms. speaker-1: So the smartphone, I think the problem with that is that we all get a dopamine fix from it and they are designed to be addictive. There's a reason why all these tech CEOs that have kids are like, I don't let my kids on this. My thirteen year old like, Do you know I'm the only kid in school? Who's not allowed to be on TikTok and Instagram and all this stuff. And I'm like, do you know your mama's on there and she knows what people are like? And absolutely not. Like it's a it's like some of the worst people in the world that aren't even real people. They're just bot farms, like they're gonna attack your mental health. Like, we're not here for that. So I think like there's a there's a lot of problems. I think there's ⁓ Dr. Ben Rain had a great book on why brains need friends and talking about like the phone and the that doesn't, it doesn't do it for the brain. And I think that we have not touched on the community aspect of the so the, you know, everyone thinks smartphones and they just think, ⁓ you're scrolling and dopamine addiction. Yes. And I'm very concerned about the time people spend on their phone rather than connecting with other humans and how that's actually starting to change our brain. We know that just being in community with people, it shifts our it not just shifts our neurotransmitters, it shifts our immune system. So I think there's a big question there. And then Arguably, you know, doom scrolling. So one of the bonuses in my book, I I took it out and you're gonna get it as a book bonus is like how to help your teen sleep because they were like, You're the book's 500 pages, like calm down. You can't have that in there. But you know, one of the big problems is teens having access to these this blue light at night. They're already susceptible to melatonin rising later. Well, if melatonin tries to rise and they're looking at these screens, it's gonna break down their melatonin. They're constantly sending this daylight signal. And I think that's problematic. And if you can't, ⁓ maybe if you have a teen girl, this might work, but there's also research that like these devices are aging our faces. They're aging us like more quickly. I tried that on my son. He was just like, I don't care. I was like, dang it. I thought maybe if I was like, ⁓ like this is actually aging you, he's like, I'm not, I'm not hearing it. But I think, you know, there's a lot of aspects of the phones that we're not looking at. And I think just reducing it to their addictive capacity. We're missing the the entire social conversation and how that's impacting our entire system. We're not meant to do this. speaker-0: Yeah, I know, yeah, I know, I know. This is it's so artificial. It it does not have, it doesn't have, it doesn't pluck all the same strings as the actual face-to-face interaction does. So it sounds like, you know, from everything that you said, if you come into the world with a predisposition toward ADHD, right? Let's say both mom and dad have it or w whatever it is, there are things that we can do to minimize the ⁓ expression of symptoms and and prevent them from being disruptive to our lives. And that it doesn't necessarily mean that we have to take pharmaceutical interventions. I would be really curious just to get your hot take on the different pharmaceutical interventions that are out there and what your thoughts are about the extent to which they're helpful, not helpful, and also especially for younger people. I always wonder about that with young developing brains. ⁓ but then also talking about some of the things that research finds to be helpful for managing symptoms that is non-pharmaceutical. speaker-1: We know as you bring up development developing brain, something that's interesting is if you have a true ADHD child, and and why I say this is because it's always important that you actually get worked up. I know that it's r like healthcare is so tricky. And I do think self-diagnosis is valid, but I think we have to say these have limitations. And you might be missing hypothyroidism, you might be missing bipolar disorder, like you might be missing something significant. And so I am always like cautious about that. If you have a true ADHD child, pharmaceutical intervention before age 12 actually helps with their gray matter. And it's show it's shown to imp have ⁓ improvements on their brain overall. And so it's very interesting when they look at it from that perspective. Now, these are being done in males. So we don't actually know, right? Like it could be different in females because the female brain maturation is very different to male brain ⁓ maturation. They're not being flooded with estrogen, right? And I think. What's important for women to understand if you have a daughter, everyone thinks puberty equals period. Well, actually, her estrogen is rising two years before, well, you know, before she gets her period. So that's about when we see breast bud development. That's the onset of estrogen. And so it's just important to understand that like she might have in those changes ahead of time, she might also start having lots of rage, irritability if she's also having IBS like symptoms and really serious stomach pain. That's when I'm like, check. Endometriosis, this could very well be an endometriosis case, and endometriosis being rich in histamine, is making her neurotransmitters way, way worse. So, you know, when it comes to the pharmaceuticals, we do know that they can help with brain development. The, the, the thing, so we're talking about stimulants here and non-stimulant medications that work on the dopamine pathways. The thing that I really question. Is the use of SSRIs in young people. I'm, you know, that's something that I'm like, I think we can argue that SSRIs and ADHD medications can absolutely be life-saving. So we know from the research that when an ADHD receives a stimulant medication or non-stimulant medication, they have less accidents. They are the less risk-taking behavior, less ⁓ drug addiction and drug seeking. And they're not seeking drugs because they're bad people. They're trying to regulate. ⁓ you know, people who start drinking mass amounts of alcohol, I joke Rose All Day was invented by neurodivergent women because they're trying to get their GABA. And like it works, right? And so they're just following biology, but it works against them. So it's not great for that. When we start looking at Audi HD, so the combination of autism and ADHD, I don't see these stimulant medications work so well. In fact, a lot of my patients and women will report they're buzzing. They're off the wall, like they don't feel right. They feel dis disconnected from their body. There's there, I think that this is something different. I think this co-occurrence like sets the brain up for something different. I personally don't use stimulant medications because I'm the person that literally every medication I use, I experience the side effect. I use this medication, my fertility journey called Nupajin, and it's like supposed to regulate the immune system and be super great. And they're like this. Really, really small percentage of people might actually have like a jump in their ⁓ white blood cells and might develop a rash. It was me. I had a full body rash. It was like everything. So that I just want people to understand is because my genetics, I'm like, I'm like allergic to amoxicillin and sulfur drugs, and like literally my body is just ⁓ you know, it's just not having it. So, you know, I leverage saffron instead. I also leverage creatine. So, creatine, we need research for ADHD women. We're starting to get it in perimenopausal women, but we're understanding that it can help with energy production in the brain. If I tell you that the research is said time and again, ADHD, one of the biggest issues, is it just can't produce enough energy. And why wouldn't we do something to help produce energy? But Copa is another herb that's been studied in ADHD. It's anti-inflammatory in the brain as well. There's a particular form of choline I like called cytokoline. And that has been shown to help. I mean, it's actually the clinical studies are in people with like severe memory issues, and it's been shown to help with memory. Memory is something that, especially short-term working memory, that ADHDers struggle with. The other thing is Nacetylcysteine. N-acetylcysteine has been shown to be helpful for PMDD, endometriosis, and ADHD. This is a precursor to glutathione. So those are like ⁓ some of the supplements. I go through like all the supplements. I give you all the research ⁓ on them. And then I also talk about supplements for particular hormone profiles to try. But the other thing is that we also have to come back to the basics of how to feed yourself, how to exercise, how to get good sleep. And what I do differently in my book is instead of being like, hey, you need to exercise, we actually go through this, what the research says about exercise, how it helps your brain. And let's have you. Take a quiz and figure out why you're not exercising. Because you might not be exercising because of sensory sensitivities. And I tell you, ⁓ you need to get on a bike and you just need to exercise is good for your brain. That's not gonna work. I need to give you ideas like, let's change the clothes. If you've if the icky, sweaty clothes on you is the problem, let's change the clothes. Maybe it's more loose fitting. Maybe we get you like a different bra. Maybe we get you noise-canceling headphones if you're going to go to the gym. Like, so getting different strategies in place. So that you can actually exercise, you can actually sleep, because it's not as simple as just telling someone take melatonin. Just spoiler alert for everyone, higher doses of melatonin tend to work against the ADHD brain. And so, you know, I see parents that are like, I'll just give my kid melatonin, they'll sleep on the plane. And I'm like, that Bobby, low dose, friend, because if it's not, they might be awake. But you know, we have to actually look at like what's at the crux of the sleep issues and work on that. One of the problems that ADHD brains have. Is that their default mode network that can just be really upregulated? So some of the things you can do is like think about filing things away. So you can get in your head and you can start worrying about things that in reality are never going to happen. So you can actually make little file folders in your brain and say, okay, that's going in the never gonna happen. That's gonna go, let's think about that tomorrow. Like that. That network is not working against you, but it can be working over time as it tries to consolidate everything you took in. And because you're neurodivergent, you may not have the level of synaptic pruning that the neurotypical brain went through. So you have way more connections. You took in way more information in your day. And so your brain has more work to do at night. And then when it comes to like the eating aspect, undeniably, we need more plants in the diet, more omega-3 fatty acids. People with ADHD were just starting to get research showing. They actually don't metabolize omega-3 fatty acids in the same way. They probably need higher levels. So this is why the research so often, when you look at the research with omegas, it's pretty meh. But when you get people on omegas, they're like, no, but like individually, I feel great. Well, there's two problems there. One is sometimes they're not using a high enough dose, but the other is everybody thinks DHA brain. So let's give high DHA. What the ADHD brain needs is actually high EPA because it needs to overcome that neuroinflammation. And so, you know. Omega 3s wasn't in my initial list. I definitely recommend it, but I think getting it from food first. So I put a full ⁓ 14 day meal plan. I make a case that tacos might cure ADHD. Just kidding. But I do think I'm funny in the book. But ⁓ I mean, eating spicy food, like I tell people this book was written. Sometimes I was writing on my bike or at a treadmill desk is like almost always how I write books, but I'm like, it was fueled by exercise and salsa. Because capsaicin, the thing that burns your tongue, it spikes dopamine and it spikes serotonin in the brain. And it's actually beneficial for the microbiome. And it's been shown to help with gut health. You would not think something spicy actually can help heal your gut. And yet it can. So I do also want people to know like, I'm not gonna come in and be like, change your whole diet and like you're eating bad. I'm gonna be like, let's make food fun, desirable, and also let's let's overcome some of the executive dysfunctions. So there's also a quiz on like why. Why don't you eat? Like, what is it? Because food's boring, because you're over it, because you ate the same thing every day for like 10 days and now you can't ever look at it again. Like these are the common things that people struggle with. And so I put lots of quizzes about like what's unique to you so that you can figure that out. And then of course, you know, the thing I haven't even talked about is hormone replacement therapy. And I put an entire chapter, and my editors were even like, Do you need to put all the dosages in here? And I'm like, I do. Because I clinicians read my book and I want clinicians to have, like I want more women to find clinicians that can help them because I think we just are like too often people are like telling women to DIY everything. And I'm like, you shouldn't have to do everything yourself. Like you should get support. And at the same time, I want women to know like what they should be looking for, what they should be expecting, what could happen if they start estrogen and they're not given progesterone because they don't have a uterus and like how to advocate for yourself through all that. Cause I do think. Hormone therapy when you're in perimenopause, or even possibly, you know, you're PMOS and you're in your 20s and you're not making progesterone, you may very well need some progesterone during that time. So for everybody who's like, why didn't you call it menopause hormone therapy? Because we're not just talking about menopause. And I feel feel like that's not inclusive enough. Like, and also I've been doing this for like 15 years. I'm really old. Okay. It's the hormone therapy, is the name. I changed it to PMOS. Like, I'm an old dog. speaker-0: We're doing a study right now where we're we're gonna be looking at supplementing women who are using hormonal birth control with micronized progesterone. So that way you can get some of those really great neurotransmitter effects and and the anti-inflammatory effects that naturally cycling women get. Because essentially what we need to be doing with women who are on hormonal birth control is treating them like menopausal women because they're not producing any hormones. And obviously you can't give them too much estrogen or else that's gonna lead to, you know, stimulation of the ovaries and then you're gonna get ovulation and that's gonna sort of make it all, you know, kind of destroy the whole point of it in the first place. But we can at least do things with testosterone and ⁓ and progesterone. And so we're trying to see whether or not we can mitigate some of the unpleasant side effects that women get using hormonal birth control with that. So you guys can stay tuned for that. I'm I'm really excited about that project. speaker-1: You know that's really common in the endometriosis community, but it's like always on the hush, is that giving an IUD, because they also have adenomiosis and then supplementing with progesterone. And then if you're I talk about this in the book, if you're given a progesterone IUD, or excuse me, a progestin IUD, and you're not getting any progesterone if you stop ovulating. And on top of that, you may not be getting any estrogen. And so this is like one of the reasons why women get a progestin IUD. And then later down the road, they're like, Why is my brain no matter no no longer working? And their doctors are like, it doesn't go systemic, it stays in your uterus as if this is like Vegas and it doesn't go anywhere, right? ⁓ the uterus is not Las Vegas. I hate to break it to you. What happens there doesn't stay there. And so, you know, if that's you, like, and you stop ovulating, well, you're not cycling. Now you don't have estrogen, you don't have progesterone, that's gonna affect your neurotransmitters, but it's It's very common in the endometriosis community be to be doing this kind of adback therapy. Because one, ⁓ endometriosis people have a lot of psychiatric conditions, you know, not having your pain believed for like your entire life, like that'll do a number to you. But also because like these hormone therapies, so sometimes GNRH agonists are coming in, and ⁓ I just think that's criminal to do to a young girl who's supposed to be laying down bone mass and not using some estrogen adback therapy because we know it's like. Such a low dose of estrogen just to protect her bones, like and make sure she doesn't lose it. But you know, you can do like a little bit more to try to support her. But so for people listening, GNRH agonists, they put their chemical menopause, they put you into chemical menopause. And while doctors say, ⁓ but you, your hormones will return, actually, there was an entire lawsuit because the pharmaceutical company knew that too many women did not actually have their hormones return. And we're talking about 20-something-year-old girls. Ending up with hormone levels that we aim for in menopause hormone therapy. These are not girls who can lay down bone. These are girls who are just gonna maintain where they're at, we hope, cross our fingers. And so that's why we see like a lot of adback therapy happening in that community. But it is really interesting, too, of like, you know, the if they give ⁓ endometriosis woman progesterone, they may also give her progesterone. There's a center I work with in Tijuana that I consult a lot on their patients and I will consult on a lot of these cases. And sometimes I have people coming to me and they're like, My doctor's like, okay, I need to use topical progesterone. I need to do something different because you're having all these symptoms. I'm like, you're having low estrogen symptoms. So they over they should they overshot the moon. Okay. They were like, let's give progesterone and progesterone. And now you're like, my skin is dry, my dress are my breasts are drooping. Like, I feel like I'm aging so much faster. I have all of this brain fog. I have joint pain and inflammation. And I'm like, that's your estrogen. And I think it's just silly. Like that's a that's a whole nother conversation for another day. But like I just think it's silly to be like withholding estrogen from endometriosis patients as if they have no brain, as if they have no bones, as if they have no heart, and just being like, you're just this like endometriosis uterus, and you're like, bro, it's not even in the uterus, it's like outside the uterus. And then you're like, just take away all of her hormones because like who cares about dementia? Like, who cares? Like she this takes care of endometriosis. And spoiler. It doesn't cause those lesions make their own hormones because they're so tricky. I was are you a Game of Thrones fan? No. ⁓ my gosh. Because we were talking about Game of Thrones villains, and I was telling my husband last night that like there's these two villains, ⁓ Joffrey and Ramsay, and Ramsey's the worst. And I was like, you know, people sometimes complain about their Joffrey kind conditions. And I'm like, I see your Joffrey and I raise you Ramsey because like literally my endometriosis is like, let's make histamine, let's make prostaglandins, let's make cytokines, let's make heparin so that yeah, you just keep bleeding, like just like the lamest little lesions. speaker-0: ⁓ my gosh. So ⁓ so I want to know now, like knowing everything that you know now, right? Because you're late diagnosed ADHD, right? And and now you have you spent the last however many years researching this and understanding the way that it's influenced by hormones, like knowing everything that you know now about yourself and about the condition and about its relationship with hormones and everything else, like what would you have done differently in your own life, if anything? speaker-1: ⁓ this is gonna piss some people off. So I have always said, like, I'm a first-generation college student, like the first girl in my family to like, I mean, the first person to go to college. And I look at the birth control pill and I'm like, it definitely helps me in that journey. But now knowing what I know, knowing my PMDD struggle, knowing how like everything I went through, how I masked my endometriosis, like, I just look at like. That pill did so much harm in my life. Like it did so much harm now. And I think like there was a part of me that was so resistant to like, I didn't ever want to say that because I didn't want to influence anyone else to like not take the pill. I didn't want to say I made this 10-year mistake of my life. Like, you know, I just think there's like ego wrapped up in that. That like also, like, I just think there's also the indoctrination of like the birth control pill is what helped you be successful. And yet I look back. And I really question starting the pill at 17. What did that do to my brain? It didn't have time to mature, it didn't have time to develop under its own hormones. How who am I? Like, how could I be a different person? Would I be a different person? Like, and you know, and I think it's easy to say, like, I like who I am. And like, but there's always that like question mark. But, you know, for me, the pill masked the endometriosis and then. I came off of it. Everything was horrible. I was just told I must have, you know, PCOS because like my periods went missing. And then they came back like a floodgate. And then it was just like horrible cramps, down for the count again. And I was able to get out of pain with like nutrition and lifestyle things, which then led everybody to be like, you don't have endometriosis because you have to have pain. Spoiler, a huge portion of us don't have pain. It's actually fatigue, it's like the number one symptom we're all struggling with. But so when I just look back at all of that and I And I look at your research and I look at what we know now in the science. And I think that's also like something where I have to be gentle with myself is like you can't judge your past self based on the f the information you now had that you didn't have then. But I do question like knowing that my brain, I had this different operating system, knowing that I require these hormones, I'm so much more hormonally sensitive. Like, what did that actually do to me? And I I know like just saying that is like gonna get me some hate, but I can't. Help but question the way that, like, you know, like I just think about like it just hindered me. It just like hindered me in so many ways. And also, like, I wouldn't, I had this secondary infertility and this really painful ⁓ journey and like losing babies, like you know, being pregnant nine times is no joke of like what it does to your body. And so I just look at all the struggles I had to go through. And I'm like, and it comes back to like just being handed the pill, being told just to take it. Being told your extreme TMDD, which persisted on the pill, the repeat endometriomas on my ovaries, which continued to rupture while I was on the pill. So don't tell me the pill is a treatment for endometriosis, because I'm like, it can be helpful with symptoms. It may help shrink endometriomas in some people, but every time those ruptured, it seeded more endometriosis into my pelvic cavity, which is why my organs were all tethered together. So, you know, that's like a really Big thing, like medically wise, that I really have to sit with of like you, you're you didn't even have a fully formed brain and you made a really big decision. Like that's a really big decision that you made on your brain. ⁓ and then outside of that, I think it's just like I would have been so much more gentle with myself and less like beating myself up. I don't know. Like, you know, I was a kid of the 80s and 90s, like, I don't think anyone would have been any nicer to me to be like, ⁓ you have ADHD like any, it's a different time. Like the kids these days can't even handle the words that people used on the daily back then. And I'm just like, this is a very different time. But I do think like that was one of the biggest things of like getting diagnosed and looking back and being like, ⁓ my God, all those times you judged yourself, like honestly, like people you needed accommodations. You needed help. Like, and instead you were met with criticism. And like you and so many women internalize the criticism they've heard their entire life. And you know, there's ⁓ Evidence that people who have ADHD receive more criticism, like as children, than others do. And I think when you get diagnosed, it's a real opportunity to look back and be like, Wow, these are the stories I was told about myself. That's not the story I have to keep telling myself. speaker-0: Yeah, which is brings me to my next question. And that is ⁓ what in writing ADHD in women, like what did that teach you about yourself? speaker-1: They was such an eye-opening book as I got into everything. So, you know, this is why whenever people are like, she's anti-birth control and she doesn't care about teen pregnancies. I'm like, I'm a product of a teen pregnancy. I was the first woman in my family to not get pregnant as a teenager. Yeah, I come from this huge Hispanic family. So I'm just like, no, friend. I like take that like, you know, it's you being in charge of your fertility like very, very seriously. So, like, that's one of the big aha things that I looked at is like. My mom at 16 couldn't have had the nutrient density. She wasn't prepared for a pregnancy. So, like, she likely had inflammation going on. She had all these other things that influenced her. And then looking at like as a kid, I like was addicted to fish. Like, and I just like am so grateful that like I love to eat vegetables and fish as a kid. Like that was like my thing. And I am like to see the research of like, wow, you actually don't metabolize protein. And ⁓ nutrients, so like B vitamins, you don't metabolize omega-3 fatty acids in that way, and just seeing like how I gravitated to those things. I think one of the most exciting things though is like being a Mexican American and coming across all the capsaicin research research and actually how they've been trying to study capsaicin and put it in a capsule because of the potential benefits for preventing dementia and how beneficial it is for the brain. And as it turns out, no, you have to eat it daily in food. Like that's that's we can't put it in a capsule. It can't be a supplement. I think that was like incredibly, incredibly fascinating to learn all of that. The other thing I would say is the PMDD. I think ⁓ so there's an entire chapter on PMDD and talking about it from the neurodivergent perspective. And you know, for a long time in medicine, we thought you need progesterone. That's the PMDD problem. Then we're like, ⁓ snap. It's a progesterone problem, right? It's allopregnenolone and And as it turns out, looking at that research, that like there's there's something wrong with the neuroplasticity in the brain where the GABA receptors are not adapting, which I know you know, you wrote all about that. But the research study, I don't know if you read this one, where they actually took away women's hormones and then they added back hormones to see what are your PMDD symptoms? And they add back estrogen and they're like more physical symptoms with estrogen. It's not just a progesterone story. We give you back progesterone, more mental emotional. Okay, we would expect that. We give you nothing and 30% of you still have PMDD. That's what led me into the like, I think this is an inflammatory issue. And I think why ADHD women are at such a higher risk of PMDD is because of the propensity towards neuroinflammation. And you know, we see the I am still waiting on the research. If you want to do this, it would be great. But the histamine PMDD connection as someone who's actually leveraged the pepsid and ⁓ claritin, not the Allegra, but the Claritin, ⁓ before for PMDD, like it is incredibly helpful if it's histamine driven. But I don't think PMDD is is, I'm not even sure it's one thing. speaker-0: Do you know Tor Tori Eisenlaw Mall? So she she is ⁓ PMD, she's like the PMDD research researcher. She's UIC. Yeah, she's ⁓ she's ⁓ I just had this conversation with her the other day because I was like, I don't think PMDD is one thing. Like I think there's multiple PMDDs. And she's like, yes, no, this is ⁓ 100% ⁓ the case. And when you look at speaker-1: No Okay. speaker-0: d risk factors, the the etiology, the progression, the treatment. They there's a lot of sort of buckets that it seems to fall in. And some of it definitely I think is very much linked to inflammation. And in and we see this with, you know, there's comorbidity with autoimmune disease and PMDD. There's comorbidity with experiences of trauma, which oftentimes is leads to dysregulated inflammation. With PMDD. So I think there's that bucket. And then as you noted, the the histamine bucket. There's probably a progesterone sensitivity bucket. There's a lot of different buckets. And ⁓ yeah, I'm recalling it all one thing. I'm sure the same is true with ADHD, don't you think? speaker-1: I think ADHD, we're gonna have to come up with subtypes of it. You know, it's also something too, like in the autism community, people are like, it's a spectrum, and you know, and people also conflate things. So people will be so I think autism is like a perfect example here because they'll say, like, there's you know, this severe form of autism, but what they're actually talking is like co-occurring in l intellectual disability. And I think that's also the problem that we see with PMDD and ADHD. Is that ⁓ I've seen clinicians who will say, no, no, the female archetype of ADHD is they have these extreme luteal phases, this like, you know, mood symptoms, physical symptoms. I'm like, no, that's PMDD, it's co-occurring. And I think we have to like start piecing these things out. But you know, the in the research, there's an inflammatory biotype that's been proposed for ADHD. And I think like it's gonna come back again. This is not to blame mom. Like, and listen, I'm a mom who's neurodivergent, who had neurodivergent children. So I'm like not blaming anybody. And I certainly, you know, I like whenever people are like, well, maybe I I have colleagues, they'll say things to me, like, maybe if you had done something right, like, you know, better, then it wouldn't have happened. I'm like, I was growing my own food and eating out of my own garden and like all of this stuff during my pregnancy, and like I'm I hate to break it to you. Like These things just happen sometimes. Like it's just the reality of things. And I don't think that we should be blaming moms, but I do think having the data of what happened in utero would be incredibly insightful into what shaped people and what actually happened. Because you know, the PMDD brain, you know, whether it's neuroinflammation, whether it's allopregnenolone ⁓ sensitivity, the GABA receptor. The neuroplasticity of the brain is being affected. It's not adapting the way that it should be. And I think, like, anytime, so anytime someone is like, cause this whole ⁓ anti-histamine PMDD thing, even though it's like viral now, it's been going on for like a decade. Okay. Women have been talking about this for like a long time. And anytime a woman comes to me and she's like, ⁓ yeah, I have these like really severe moods, but hey, I tried this like antihistamine protocol and it worked for me. And then I start asking questions like how painful are your periods? Do you ever have pain with sex? Like, how bendy are you? Can you bend your finger backwards? Do you roll your ankle often? What why am I asking these questions? Because if you have a woman who has histamine problems, you probably have a woman who also has connective tissue disorder. And you also have probably have a woman who has endometriosis. I don't think. Endometriosis is as rare as we're making it out to be. And I will also say to the women listening, when you have an inflammatory condition like PMOS, endometriosis, which is a systemic inflammatory condition, that is going to affect your brain. It's going to affect how your brain functions in like, and it's always the question of like, who are you actually if we removed this? Who are you actually if we put out this fire? But I think like it all, you know, comes down to like we've got these clusters of genes. And what are the environmental inputs that are turning things on and off? So, you know, as as you said before, and I'm really glad you clarified my position because yes, we inherit things. Like I inherited all the freaking like endometriosis and like all of this stuff. But as you heard from my story, like I was able to get out of pain. I was able to control symptoms. I was able to have two children conceived naturally. Like, and so what does that speak to? Not miracles or work harder. It speaks to environmental inputs. Matter greatly. And the body was designed, especially the female body, to be receptive to the inputs of what the environment is giving. speaker-0: I love it. I think that you've given us so many things to be hopeful about when it comes to having ADHD as a woman, just in terms of being able to recognize our symptoms and then being able to manage our symptoms, either using medication or using non-medication-based treatments. ⁓ and sometimes using both. ⁓ as you noted with the saffron therapy, I think that's really exciting that there's research being done, seeing whether or not it sort of potentiates. The actions of the treatment leading to better treatment outcomes. So very like so much great information. And I'm so appreciative of you and so excited about your book, ADHD and women. And ⁓ before we go, I want to know what is it as you look forward, because you've been in the world of women's health for a long time now, like in terms of like the things happening in the world, what are you most excited about in terms of The progress in women's health. speaker-1: Seeing women actually pushing for better care. So, you know, I talk about like Beyond the Pill came out and medicine is actually changing. It's improving. We're now seeing doctors concede that, like, yes, just passing women a pill for generations was not the move to do. That didn't happen because this book came out and like they weren't gonna hear it from me, but they would hear it from their patients. And that I think is so exciting in how. I mean, 2015 was the year of the period, right? They deemed it the year of the period. Women have taught to take to social media to talk about everything they're experiencing. They're being very candid. They're not hiding things like previous generations did because they felt ashamed. And then they're pushing for and they're demanding better care. ACOG would have never updated their guidelines in 2025 to say, well, we should actually give pain management for an IUD. By the way, like So many other countries in the world think that's absolutely barbaric. My colleagues in Mexico are like, who would do that? Who would place an IUD in a woman and tell her take like you know, acetaminophyll? Yeah. Like who would do that? And I'm like, America. ⁓ they're doing that. But why did ACOG change their guidelines and say, yeah, that's not maybe we should actually study this practice? And yeah, that's not working for women, and yeah, we should actually give adequate pain management because of women. Because of women, not because of researchers, not because of doctors, not because of anyone else, but women banning together and demanding better research. And what I'm also really excited about is how many women are opting into research studies, which are, you know, mostly surveys, but they're saying, I am willing to tell my story and put my data out there so we can collect more data. I have a colleague right now, Dr. Anna Sierra, that we're working on a research study right now on better outcomes for endometriosis patients, because there's no study that tells us. Why do 30% of women experience pain post surgery? And why do these others don't? Okay, let's ask women. Let's ask them what happened. Let's ask them what they did differently. And seeing women actually stand up and say, Yeah, I'm gonna participate in this. I'm gonna make that change. Like as we see funding get cut, as we see like, you know, scientists getting like, you know, basically muzzled, like when we see all of this. And then to see so many women just say, bet it's on. Like we'll do this, like we'll make this happen is Just so exciting. speaker-0: Is so exciting. I'm so thankful for all of women putting their essentially putting their foot down and saying, like, we deserve better care. I know for myself, when my first book came out, I got my I got flooded with emails from women who because they read in in there, I have a chapter about how you know science has ignored women and how little research has been done. And as you noted, in neuroscience is absolutely the worst, right? It's male animals. Male subjects. If it's ⁓ female animals, they'll overrectomize them. say, look, we're studying females and so many women reaching out and saying, What can I do? Can I be in a study? Can I help you in some way? Can I help move the research forward? And anyway, women are the VIPs of women's health. I completely agree with that. Where can listeners ⁓ find your books and learn more about you? speaker-1: Yeah, you can find me at drbrighton.com, dr-b-r-i-g-h t e n dot com. That's my main hub. I'm all over social media at DRJolene Brighton. And then the book is anywhere that you find books. I would encourage you to call your library and ask them to carry it so that everyone who can have access to that as a girl who didn't grow up, having access to buy books and just having access to a library, it means a lot to me. And then also support your local bookstores. speaker-0: I love that. Yeah. And go to your local bookstore, get to know the people who work there, have a chat with the person behind the counter. Because as you noted, these types of interactions where we're just dealing with each other digitally, don't press all those same buttons, and you get so many amazing benefits from conversations with live humans. So thank you so much for joining us, Dr. Brighton. speaker-1: Absolutely. Thank you so much for having me.