It is not well known that female reproductive hormones play a big role in our ADHD and overall health. They can make ADHD worse some days and better on others, because our symptoms vary across our cycle and stage of life dependent on the hormone levels. For women, our ADHD is a changing state; and that’s still very new information for many. If we don’t know what happens in our brains and bodies, how are we supposed to deal with it? Learn about ways we can help ourselves to slow or stop that rollercoaster ride. There are also treatment considerations for ADHD and hormones. We need to be able to talk to our health care providers about this and be able to ask for what we need.
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Topics discussed in this episode:
The typical experience with female hormones 01:37
- as a teenager and young adult there was a lack of information about having a monthly cycle
- pregnancy meant learning a bit about fertility helped and how ADHD played a role 02:18
- Confusion, crying and even anger—did I take my meds? Yes? WTF? 03:01
The Central Role of Hormones 03:28
- Female Reproductive Hormones have an effect on our brains, bodies, physical and mental well being
- They target the brain and almost every system in our body
Estrogen impacts ADHD: 04:46
- impacts serotonin, dopamine, and norepinephrine
- impacts executive functions, attention, verbal memory, sleep, concentration and motivation
- females with combined or impulsive type ADHD are more sensitive to micro fluctuations in hormones
- there are dramatic changes of hormone levels across our lifespan:
- puberty, pregnancy, postpartum, perimenopause and menopause
- hormone studies have shown that that the experience of female ADHD symptoms do vary across time dependent on the hormones in our bodies 06:48
What can we do? 07:14
- Understand that this means there isn’t something wrong with us
- Short answer=a lot
- Longer answer= there is helpful information on this subject,
- we will have one episode a month on this topic
- I am not a doctor 07:44
- any information provided here does not replace that from your healthcare provider.
Treatment Considerations for Hormones and ADHD 07:54
- Fluctuations in the menstrual cycle do affect stimulant usefulness
- In the second half of the cycle, the stimulants may not work as effectively,
- Some women may benefit from a small increase in their stimulant (last 10 days)
- SSRIs can be a trade-off
- Many women are first diagnosed with anxiety and depression and then treated with SSRIs
- They make thinking less rigid or disinhibiting –less bothered by things
- Those of us who struggle with impulse control, need to know that this will also lower our ability to control impulses further
- Trade off in that it may be harder to inhibit your reactions but feel less anxious or depressed
- Oral contraceptives can:
- stabilize estrogen levels
- Regulate an unpredictable cycle
- Keep estrogen level so that symptoms are manageable
- Improve depression and acne
- Hormone replacement therapy:
- increases estrogen & progesterone
- Greatly improves ADHD symptoms
- Reduces menopausal bone loss
- Contraindicated for some; work with a doctor to figure that out
- Consider hormones in medication decisions
- Since there are so many ways medication can interact with hormones, and with the way symptoms are experienced as women
- For women, our ADHD is a changing state; and that’s still very new information for many; being able to have the information and talk to our health care providers is important 09:29
Build an understanding about what happens for you over the four-week Cycle: 10:22
- More in future episodes
- Starting with Caring Week (Menstrual Phase) Week 1 10:22
- Can last 3-7 days
- Estrogen begins to rebuild; energy and defenses are the lowest
- Skin is drier, easily tired, and often feeling not very social, okay to honor that
- It’s taken some time to remember and follow through but worth it to set up my digital and paper calendar with many, many reminders of what, when and why caring week is by:
- marking ahead when this week may be
- including the symptoms and tips in my digital calendar notes
- My caring week now includes:
- Reminding my family when it is caring week to:
- Help me build boundaries, self-advocacy, and modelling to my kids)
- Rest more frequently
- Plan to do less (avoid a busy week)
- Tweak physical activity to include gentle yoga, walking, and a yoga class for feeling crampy
- Try to plan not to record an episode that week, but that didn’t work this month
- Reminding my family when it is caring week to:
- Slowing down, paying attention has led to noticing: 11:27
- shifts in the week before my menses, including some food cravings, which are now understandable and expected
- being kinder to myself
- a need for flexibility–being in perimenopause means the actual arrival date of caring week can move around
- There are many cultures that have a tradition of retreating from high-energy activities and demands during menstruation.11:49
- if you know of practices that could help some of us with our own caring week routines, would you be willing to reach out and share them?
- Episode Recap 12:55
- Closing 14:27
Resources related to this episode
Quinn, Patricia, (2002) Hormonal Fluctuations and the Influence of Estrogen in the Treatment of Women with ADHD. In Gender Issues and ADHD: Research, Diagnosis and Treatment, published by Advantage Books, Washington, DC.
Solden, Sari. (2005) Women with Attention Deficit Disorder: Embrace your differences and transform your life. Ann Arbor, MI: Introspect Press.
Wechsler, Toni. (2015) Taking charge of your fertility. New York City, NY. William Morrow.
Moira Maybin 00:00
Welcome to the ADHD friendly lifestyle with Moira Maybin. Today we’re talking about how hormones can make ADHD worse some days and better on others, and what you need to know to slow or stop that rollercoaster ride. If you have ADHD, and ovaries, or know anyone who does, you’re going to want to hear this. I learned this the hard way. I don’t want that for you. For show notes and more information on this topic, visit ADHDfriendlylifestyle.com.
Moira Maybin 00:33
Hey there, welcome to the ADHD friendly lifestyle, a podcast for those of us with ADHD, who have had enough with trying harder and want to reduce frustration and overwhelm. It’s time to literally put on our own oxygen mask first, so we can finally breathe and make it possible to show up in our own lives without guilt or shame. Join me as we dive into the stories, adventures and mishaps, all while trying to make sense of the published research that could make your tomorrow a more ADHD friendly day. I’m your host, Moira Maybin, a woman mom, an educator who had no clue about my own ADHD until I was 45. I suspect many of us have asked the same questions I did over and over again. Why is life so hard? Why does it seem easier for literally everyone else? There are things that I wish I had known about my ADHD sooner. Now that I know what those things are. The knowledge allows me to make different decisions to make my life better and more ADHD friendly. I finally understand that to live well. My lifestyle is not negotiable. It has to work for me, and it has to be healthy. And Yep, it’s got to be ADHD friendly.
Moira Maybin 01:37
ADHD and hormones is like the chicken and egg story. Which one did we know about first? For me, puberty, and my period came 30 years before knowing I had ADHD. I was a child of the 70s and a teen of the 80s. When thanks to modern feminine hygiene products, I would be able to keep going as usual, while swimming in a white bathing suit and horseback riding and white pants. I fully got on board paying as little attention to my cycle as possible. I did recognize a change in my emotions and social confidence but told myself I was simply being paranoid, dealt with cramps, pimples, and refused to wear white outfits.
Moira Maybin 02:18
Anyway, 20 years went by knowing almost nothing about what goes on in my body during my cycle each month. And then I wanted to get pregnant. At this point, I’ve been dealing with my undiagnosed ADHD by trying to get everything done perfectly. I was a little driven and intense, to say the least. Put that with my passion for reading, learning, and doing things thoroughly, in an attempt to limit failure mistakes I now know, I dove deep. My ultimate guide was the book, “Taking charge of your fertility,” by Toni Wechsler. It is an incredible resource for anyone wanting to understand our hormonal cycle. Then babies came and my interest in hormones disappeared. Until flashforward, kids in school, all of us know we have ADHD…
Moira Maybin 03:01
How many of us have had an experience like this? You wake up one day, take your meds, get going on your day. Then out of the blue, you find yourself melting down crying, or in my case, maybe yelling, and wondering if you actually took your meds? If you have a way of checking, you see that, yes, you did, but it sure feels like you didn’t? What is wrong with me, again? still? Will it always be this way, not knowing how you will function and show up from day to day?
Moira Maybin 03:28
Here’s the missing piece of information, you are not losing your mind. Sometimes your meds do not work the same. Or rather, they are not able to deal with a change in your brain chemistry due to hormones. You see monthly cycles cause fluctuations in our ADHD symptoms. But if we don’t know what happens in our brains and bodies, how are we supposed to deal with it? Well, it turns out, we’re more likely to self-blame, feel compelled to fit in, and work so hard for social acceptance. These very things make it harder to get the knowledge we need and the help we deserve. When we simply can’t keep up anymore. It shows up as shame, low self-esteem, strong emotions that don’t go away or come back very quickly. exhaustion, anxiety, overwhelm, stress, depression. And in my case, you can also add in physical illness. If we try to get help with those things. We may experience temporary or limited relief. But we’re not dealing with the cause of the problems in the first place. None of which is our fault. But here’s the nugget that we need to examine more closely. How many of us feel like there’s something wrong with us that we just need to get a handle on, then the situation would be better? What if I told you that was a load of complete $#%#!
Moira Maybin 04:46
If you’re the owner of female reproductive hormones, meaning you have ovaries, you need to know that those hormones target the brain as well. Reproductive hormones are an intrinsic and essential part of almost every system in our body impacting our physical, social, and mental health. Levels of estrogen in the brain impact our serotonin, dopamine, and norepinephrine. Estrogen also has a direct impact on our executive functions, attention, verbal memory, sleep, concentration, and motivation. You know those days when you forget what you’re saying mid-sentence, or walk into a room and have no idea why you were there, or you can’t go to sleep, stay asleep, go back to sleep, or wake up, maybe all in one night, you get the idea. Our estrogen levels change dramatically across our lifespan. They start to change in early puberty. And over the teen years, the levels vary. This is when and why we start to be able to see more symptoms in girls. It can show up as emotional volatility and anxiety. It’s a prime time when they may be misdiagnosed or mismedicated. Estrogen is very high during pregnancy and then drops significantly in the postpartum period. Perimenopause starts around ages 38 to 40 and can last up to 10 years, and during this time, estrogen fluctuates greatly. We can spend up to 1/3 of our lives in menopause without any estrogen in our system, yet it still continues to play a central role in our health and our ADHD symptoms.
Moira Maybin 06:13
So how does estrogen impact ADHD? Well, symptoms vary with our hormonal fluctuations, they can vary from day to day. If you’re impulsive or combined type, you’re very sensitive to microfluctuations. Our ADHD symptoms increase as estrogen decreases, estrogen decreases after ovulation, in the middle of our cycle to when our period arrives.
Moira Maybin 06:48
The bottom line is traditionally ADHD has been seen as a condition that has symptoms that are considered stable across time. While we are all unique in how our ADHD symptoms show up in our lives and my ADHD is different than my family members, that each of our own symptoms would stay consistent. But hormone studies have shown that that is not the experience of females. Our symptoms do vary across time dependent on the hormones in our bodies.
Moira Maybin 07:14
So what can we do to help ourselves now that we know that it isn’t anything that we did or didn’t do? Well, the short answer is a lot. The longer one is that there’s so much I want to share with you on this subject, that I will be dedicating one episode a month to an aspect of how hormones and ADHD interact in our bodies and our lives. What are the first steps to slow that rollercoaster down? Here are some nuts and bolts. Please remember that I am not a doctor. And any information I’m providing here does not replace that from your healthcare provider. I will provide links in the show notes to all my resources on this subject.
Moira Maybin 07:54
The first thing was for me to learn about treatment considerations for hormones and my ADHD. So the fluctuations in our menstrual cycle do affect stimulant usefulness. In the second half of our cycle, the stimulants may not work as effectively. So some may benefit from a small increase in their stimulant medication for about the last 10 days. SSRIs can be a trade-off. Many women are first diagnosed with anxiety and depression before receiving an ADHD diagnosis and then they’re treated with SSRIs. They help, but they also make our thinking less rigid or disinhibiting, so we’re less bothered by things yet if you’re like me, and you struggle with impulse control, taking a med that lowers our ability to control impulses further–that was something that I wish I had known about, might have helped me a little bit. As I said it’s a trade-off. It may be harder to inhibit your reactions, but you’ll feel less anxious or depressed.
Moira Maybin 08:49
For some, oral contraceptives can stabilize estrogen levels, it can regulate an unpredictable cycle, keep estrogen level, so that symptoms are more manageable, and it can improve depression and acne.
Moira Maybin 09:01
Hormone Replacement Therapy (HRT) is used to increase estrogen and progesterone. That greatly improves ADHD symptoms and reduces menopausal bone loss. It is contraindicated for some, myself included, and so you’ll need to work with a doctor to figure that out.
Moira Maybin 09:17
It’s important to consider hormones in medication decisions. Since there are so many ways that medication can interact with hormones, and with the way symptoms are experienced as women, it really needs to be taken into account. For women, our ADHD is a changing state. And that’s still very new information for many. We need to be able to start to talk to our health care providers about this information and be able to ask for what we need or want to try. This isn’t always easy, but it’s my hope that this episode and the supporting materials on my website will make it possible for you to share this information with others.
Moira Maybin 10:04
The second thing I did in practical terms for myself was to start including in my calendar, what week of my cycle I am on. It’s very easy to find online information about the four phases of a menstrual cycle and in future episodes. I’m going to talk more about each one. But as it’s caring week in my house, I figured that was a good one to start with.
Moira Maybin 10:22
What we call caring week, is more commonly known as the menstrual phase. I prefer caring week as it works as a reminder to myself and my family what the ultimate goal is here. It can last three to seven days, but I always take the full week. During this week, my estrogen begins to rebuild, and my energy and defenses are at their lowest, my skin is drier, I can feel tired, and not very social. I started to rest more frequently. And I’m even marking it ahead on my calendar, to try and avoid having a busy week. Ideally, I wanted to not record an episode this week. But you know, ADHD, time management, I didn’t have that luxury this week. But I am doing a lot less than many other ways. I tweaked my physical activity to mostly gentle yoga and walking. I even tried a yoga specifically for caring week and I loved it. I talked about it with my family that it’s a time to care for myself and do less, I want to model self-care for them too. The only way I have remembered to build this habit is by having the days marked on my digital calendar, every day, and then in the notes section, to have the symptoms and actions right there too.
Moira Maybin 11:27
The process of slowing down and paying attention means that I’m now able to feel and notice shifts in the week before my menses including a desire for more sugar. I tried to honor that one. I use the time in the days before my period to slow down, pay attention and be kinder to myself. Being in perimenopause means the actual arrival date of caring week can move around. So flexibility is needed on that front too.
Moira Maybin 11:49
There are many cultures that have a tradition of retreating from high-energy activities and demands during menstruation. I wonder if you know of practices that could help some of us with our own caring week routines, would you be willing to reach out on my website and share them?
Moira Maybin 12:04
I think this is where we’re going to stop for today. An important piece we continue to talk about is the state of our health overall, our stress levels, lifestyle, and mental health all impact how our hormones function and how our ADHD in cycles function to we want to consider ourselves as a whole person, including hormonal, physical, mental, and social factors, rather than just the symptoms or challenges.
Moira Maybin 12:27
I’m a very different person now than when I was a child of the 70s, who knew very little about my body and health. That child couldn’t envision a world with white pants on a horse. And now we have moon cups, Thinx, and Knix as part of the repertoire. Who knows what the future will bring? Perhaps a better name than feminine hygiene products.
Moira Maybin 12:48
Okay, you’ve done the hard work by staying to the end, Your reward, here are the main takeaways from today’s episode.
Moira Maybin 12:55
Female reproductive hormones target the brain as well. Estrogen has a direct impact on our executive functions, verbal memory, sleep concentration, and motivation. That’s a lot. Unlike males with ADHD, our symptoms do vary across time, dependent on the fluctuation or lack of hormones in our bodies. Estrogen levels change dramatically across the lifespan. They onset in puberty. They’re high during pregnancy, low in the postpartum phase, during perimenopause, they fluctuate and cease in menopause. Those of us with impulsivity are very sensitive to micro fluctuations in our hormones.
Moira Maybin 13:30
The treatment considerations for hormones in ADHD include stimulants, SSRIs, the pill, and hormone replacement therapy. ADHD is different in each of the four phases of our cycle. During the first week or caring week, we have our lowest energy levels. weakened defense systems, easily feel tired and our skin gets dry. We can help ourselves with developing our own forms of caring week that include gentle exercises, postponing big social events, and making a date with ourselves.
Moira Maybin 13:59
It is not well known that female reproductive hormones play a big role in our ADHD and overall health. We need to be able to start to talk to our health care providers about this information and be able to ask for what we need or want to try. This isn’t always easy, but it’s my hope that this episode and the supporting materials on my website will make it possible for you to share with others this information. That’s one way to get yourself on the list. Thank you so much for listening today.
Moira Maybin 14:27
I hope you enjoy today’s show. This is the place for the late-diagnosed women, moms, professionals, those who want to understand ADHD, be heard, and know they’re not alone. An ADHD friendly lifestyle builds our ability to take care of ourselves and use our unique strengths and talents to create a lifestyle that works for us.
Moira Maybin 14:47
I’d love to know your thoughts about today’s episode. There are lots of ways to get in touch. You can check out my website, ADHDfriendlylifestyle.com, or comment below on this podcast. All questions will be anonymous, respected, and appreciated. I can’t wait to continue this conversation with you. But please remember, I am not a doctor. And the information presented in this podcast doesn’t replace the individual recommendations from your health care providers. You can help by sharing the podcast with the people in your life by taking the time to rate review and subscribe to the ADHD friendly lifestyle on iTunes, or the podcast player of your choice. I’m thrilled to be part of the ADHD rewired Podcast Network. Every week, you can find new episodes of ADHDreWired with Eric Tivers, sharing interesting interviews and stories. Will Curb has amazing tips and insights on Hacking your ADHD. Brendan Mahan hosts ADHD Essentials, focusing on families, parents, and educators. And my fellow Canadian MJ hosts ADHD Diversified, where she’s diversifying the voices and experiences of ADHD and mental health. All of these podcasts including the ADHD Friendly Lifestyle are available to everyone, everywhere, podcasts are available. You can join all of us at our live Q&A every second Tuesday of the month at 10:30 am. Pacific to ask us questions. Go to ADHDreWired.com/events to register. Thanks for listening. Stay tuned for the next episode as we work to build our ADHD friendly lifestyles together. See you later.