ADHD in Women: Navigating the Hormonal Tides with Jaclyn Potts

Hello and welcome to the art woman podcast. This is an exploration of woman kind. Here we discuss what it is to be a woman in the modern world while utilizing ancient and modern modalities in tandem to create a bounty of health for the body, mind and spirit. Hello, welcome to the podcast and welcome Jacqueline, how are you today? I'm well thank you Sarah. Thank you so much for inviting me today. Thanks for having me. Thank you for being here. Honestly, this is a much awaited podcast and like I you know researches me search basically like I was diagnosed with ADHD kind of mid this year and I'm 29 and so and then I did a deep dive because I was like sometimes my symptoms are worse and sometimes they're better like what is up with this and so then kind of fielding that to the community I have and then finding out that there are a bunch of women who have the same questions that I did so yeah thank you so much for being here. Oh it's my pleasure I'm very excited. I'm excited too. Let's get into it. I'm just to start off and do some introductory questions. Can you please tell us about your background and what inspired you into your journey of psychology? I'm a psychologist by background and um from as early as I can remember I would be sitting on park benches at the beach on holidays and I'd have people come up and sit next to me and I'd be very curious about their lives and I think that curiosity has really been the thing that's inspired me to find out about the inner workings of people and I'm very curious about that so I think that's probably what motivated me and maintained the hyper focus of psychology for as long as you need to in terms of the study that we have to do um because that's definitely not in line with my usual attentional um span and focuses so yeah that's probably in in a nutshell why I am a psych and why I'm here today really. And so going on from that what motivated you to focus on ADHD you did just say before you're like my own attention span like do you have ADHD or experiences of ADHD? Yeah yeah I um I have experienced ADHD hyperactivity my entire life with a formal diagnosis after my first pub um postpartum so um that I particularly loved working with clients um of neurodivergence especially women before my formal diagnosis um but I feel like in many ways where kin in the in the experiences we've had and I feel that lived experiences so vital for the work that we do therapeutically with our clients I think that until you've lived this you don't quite understand it um and I feel that's where we can add the most value to our clients that we have lived experience where they're with you in the trenches and experiencing both the benefits of ADHD but also the challenges that we encounter as well. So you were just talking about some of your lived experiences of ADHD but like before we even get started for people in the lay audience who might not even understand what that is could you please define ADHD and highlight a few of its key characteristics you did just say a few of them then but maybe just give us a really solid definition to form that foundation before we get into the new degree intricate parts of it. Yeah okay the one the one thing that I really work hard on in the work that I do with clients therapeutically is the psycho education around it so I love this piece this is my jam um but really what we want to understand is is that ADHD is a neurodevelopmental condition and it affects how we process information regulate our attention and control our impulses so it doesn't mean we don't have the ability to attend to things it just means it it's impacted and um the regulation of our our attention is is impacted so it's not just about like being in attentive or distracted or hyperactive it's much more kind of complex than that so it's about differences in our brain function and our behaviour and I especially in the work that I do we see it that ADHD exists on a spectrum and it can very really significantly intro individually but also between individuals as well and I think that's where it's really important fast on our each individual experience even throughout the the lifespan of one individual as well so it is chronic and that's something that's really important and they manifest as we have certain experiences and life changes and hormones but we have different presentations of that throughout our our lives does that clarify it or do we need more detail if you could give me like some concrete this is what I see in most women who have ADHD like symptoms or like give me an example like doom piles or everywhere it's one of the ones that I know yeah um if only you could see my desk right now then I could affirm for you the the concept of doom piles um but really when when we look at it from a clinical perspective there are three potential diagnoses so there's ADHD with inattentive presentation hyperactive presentation or combined so when we look at that from a clinical perspective we're looking at inattentive symptoms would be like difficulty sustaining attention really with tasks that require sustained mental effort so reading following instructions listening to directions frequent forgetting forgetfulness losing items that are really necessary for tasks that we need to do functionally on a day-to-day basis so keys while it's paperwork etc. appearing distracted or a bit spaced out even when we are trying to focus is another really key symptom of inattentive ADHD and struggling with time management and organization then we have the hyperactive impulsive presentations so that's feeling like you're being driven by a moda even if you're feeling exhausted that's a really really common symptom I see in women and restlessness constant feeling of needing to be on the go then perhaps interrupting conversations blurting our answers struggling to wait for your turn or at times interrupting conversations or someone else's train of thought at times acting without considering long-term consequences that can often be described as impulsive and fidgeting tapping excessively and that physical restlessness but the one thing that I find particularly interesting in women that present with ADHD is that a lot of their hyperactive impulsive symptoms are internalized so it's very much around room andatory thoughts intrusive thoughts that they can't control and very very active internal thoughts and dialogue and then we look at our combined presentation and that's a mix of both of them. Thank you for that and I realize as you were saying interrupting I've already interrupted you twice and I was like I remember mentally taking a note of that being like don't do that. It's also the story of my life so it's probably going to be a lovely dynamic between us today. And it's interesting when you do it people think you're really rude and it's like oh no I'm just really excited to talk to you and I want to connect and that's all it is yeah yeah it's the passion it's that it's that beautiful kind of connection and depth that I feel like neurodivergent individuals especially women bring and that's why I mentioned it's it's a strength there is a lot that we can leverage if we manage the shadow aspects of it too. Beautiful I love how you said that. Thank you so much for just kind of playing out three of the main things that you see and attributing like characteristics and behaviors to it I think that's so helpful. Could you please extend on that and tell us what symptoms and characteristics and behaviors that women exhibit that maybe you don't see in men like is there a difference between how it's presented between the sexes? Absolutely and just when we consider the differences in presentations it's really important to remember that the DSM the criteria that we actually refer to when we're looking at at diagnostics around this it's typically if you look at the references on there and who contributed to it it's typically white Anglo-Saxon males so really being aware of that and where the data is yielded from in order to actually create the criteria is really a useful to explore and I could talk about that all day but I know specifically it wasn't the question but I think that's a really important thing to remember that the DSM criteria really reflects that of your Anglo-Saxon white male and it's more about when we're talking about the presentation of symptoms in men which I'll touch on just briefly is really around the externalised symptoms so hyperactivity and impulsivity that real physical restlessness disruptive behaviour in the workplace or at school depending on the age of the individual and we often see that outward behaviors draw a lot more attention in earlier years so that's why you generally see the diagnosis I'll. younger boys because they're externalised and they draw a lot of attention from teachers, parents, peers in those earlier years than with females. So if we touch on the symptoms of females, a lot of those are more internalised, like I spoke about before. So we're more likely to exhibit in attentiveness, emotional dysregulation, perhaps, and feelings of overwhelm, and a general sense of just not being able to get on top of things, rather than the physical hyperactivity. And it may be that we appear more daydreamy or scattered rather than disruptive. Then there's the emotional sensitivity. So clients often report the heightened emotional sensitivity, including the frequent mood swings and trouble managing frustration and feelings of inadequacy, which is that that real imposter syndrome that we also experience or the rejection sensitivity dysphoria, really kind of playing havoc with our actual experience of the reality of our situations. Then we've got masking behaviours, which is something that is predominantly what I see in many of my presentations with clients as well. They often are better at masking out their symptoms as women, using compensatory strategies, and you know, it makes them appear organised and focus, and that can really delay the diagnosis as well. That was kind of going into my next question, because everything you're saying just then, and when I was kind of loosely diagnosed by my psychiatrist, she was like, "Yes, you show symptoms, but the DSM-5 is based off of white, Anglo-sex, and men. So technically I can't diagnose you, but you show all of the symptoms that we would see in a woman, but the DSM-5 hasn't caught up yet." So then my next thinking was, "Okay, so many women must be getting diagnosed late, and then being misdiagnosed, probably with anxiety and depression, is that correct?" Yeah, yeah. If I were to look at the data of the work that I do with my clients, many of them are in their late 30s, early 40s, coming to me with a historical psychiatric history of anxiety and depression. And then one of the really wonderful things that I have recently been created as a questionnaire for masking. And that allows us to look at the typical Anglo-sex and white male presentation in the criteria, but also identify where are we out with masking? And how much of that is influencing the actual outcomes on our general diagnostic assessments of 80 HDN women as well. So that creates a very profound experience for women when they do get that diagnosis, and I'm doing everything in my power to educate women about exploring it earlier. So perhaps they don't have those misdiagnoses because they often come to me and say, "It just never hit the spot. I just never felt heard. I didn't. I felt like there was something more going on. The sense of overwhelm I feel every day just isn't my anxiety and depression. There's something else going on." Yeah, thank you for that. And that kind of leads in me into my next question because we will talk about this how dopamine is attached to estrogen in some ways, and that can impact how we present. So, do life stages like pregnancy or metapause intensify, or even reveal 80 HD symptoms? Because you said that you were diagnosed after your first bulb, which is when you don't have as much estrogen around. And I've heard of psychologists being like, "I'm getting an influx of women who have just had their first child who are all of the sudden exhibiting ADHD symptoms that they didn't have before and same thing with post-menopausal women as well. So is this something that you see, and is this something that we also see reflected in the data? Yeah, it's something that we're seeing and I wish that we had more longitudinal studies to give us the data. But anecdotally, I'm seeing it and hearing it almost daily. Every time I practice, I'm hearing it. So if we consider, like, there's a whole lot of societal and cultural expectations, there's the previous misdiagnoses and treatment that are almost cloud what's going on, the women, and perhaps lead them down different paths. And that's what we find. We find that they've been navigating what feels like quite an overgrown path of confusion in terms of their psychiatric health, and then kind of going, "Oh, well, I've been diagnosed with ADHD now and I understand," and the light kind of comes at the end of this journey and they go, "Oh, all of this really makes sense." And when we look at the key factors presenting the symptom presentation, it's quite a few factors at play and it's quite dynamic. But if we have a look at the presentation of early adulthood and the adjustments and adaptions that are required, if we have a look about the symptoms that might be happening in early adulthood, for example, that transition brings on increased responsibilities and it highlights ADHD related difficulties. And the way that many people in that kind of early adulthood group present our time management problems, emotional burnout, lots of imposter syndrome and memory issues during that time. And if we then progress into motherhood, that can magnify the ADHD symptoms. So you've got all of these hormonal impacts, which is so profound, but you also have an extraordinary amount of extra mental load, which is creating overwhelmed, a sense of overwhelming disorganisation, forgetfulness, emotional sensitivity, task paralysis, especially if you're in an attentive presentation. And if we actually kind of even capture what societal expectations are on mothers and that they are organised and nurturing, that can really exacerbate feelings of inadequacy at that time. And sleep deprivation and stress, if I were to say what the biggest impact on ADHD symptoms were outside of the hormonal aspects and our cycle, it would be sleep. So that it's almost like a breeding ground for ADHD symptoms at that time. And then if we looking to menopause in midlife, then we're looking at the estrogen levels declining during perimenopause. And then in menopause and that can make ADHD symptoms more pronounced. So we see worsening inattention, difficulty with emotional regulation, energy fluctuations and really significant identity shifts, which are quite profound also in the motherhood space too. So I hope that kind of captures what as a woman, we're navigating through our journey of life and then the ongoing demands associated with all of the experiences we have. And then the adaptions we have to make whilst also experiencing these symptoms, which are actually exacerbated by our biology and our life experiences and stresses at the time as well. The only constant with a woman's body is change. And so that's a thing, even when you're in your cycling years, I feel like I'm four different women throughout the month. And I feel like it's such a beautiful thing. And when you tune into it, it's such a gift, but I feel like women already, if they don't have ADHD, they're at odds with that because we're taught to be static. And then we go through motherhood and then you have, you know, don't have any sleep. You have this perfect environment that is a breeding ground for ADHD. And then you're like, what the hell is going on? I should be so in love with my baby, why don't you feel so disconnected? Why am I not sleeping? And you know, it just kind of creates this snowball effect and then you get anxiety, depression, all of these other things that kind of latch on to that ADHD experience as well. It's so sad. And then women are lost and they left alone to figure this out on their own. So yeah, hopefully if anyone's listening to this and they've just given birth and they're like, I have ADHD or the sudden, like, you're not crazy. It's just the experience you're going through and it's completely okay. Yeah. And it's, I just really want to kind of reach out to those women, whether it's, you know, you don't necessarily have to be a mother to have an emergency symptoms. And this can come up in any stage of life. And it's likely that you've had ADHD the entire time as a woman, but you have employed and you are the most ingenuity of individual to have employed so many strategies to mask and to compensate. And that's something that I really try and honor with my clients because I don't, I don't know anyone else on the planet that could actually create this degree of buffering around them that allows them to function in that static nature, that static way. And then we see the burnout. We see the burnout in shoe. And it's about educating women around almost like a wave is coming and going and going with that instead of fighting against it and educating them about the dynamic around that and it's quite interesting because I supervise a lot of early career psychologists and many of them are neurodivergent and many of them are really impacted by their cycle and we have really linked the discussions in supervision about how we can work with that cycle and setting up their calendar around that and managing client work around that as well but I know that's not the topic. I just thought I'd slip in here and have a quick rendezvous and talk about a few of the questions that were fielded to me from the poll that we just didn't get time to touch on in this podcast. So the first one is how do estrogen and progesterone affect ADHD medications? Do women need to adjust dosages throughout the cycle? So as we were learning about just before with Jacqueline, estrogen and progesterone they have significant impacts on ADHD symptoms and therefore it does have an impact on ADHD medications and women have found both in studies and even through anecdotal you know stories I've heard from other women saying that they've found that they needed to adjust their dosages throughout their hormonal cycle because of the fluctuations between estrogen and progesterone. So let's get into that. Estrogen first off tends to increase the effectiveness of ADHD medications particularly stimulant medications like Ritalin and Adderall. So estrogen enhances dopamine activity in the brain and by its ability to bind dopamine at its receptor site and it tends to up-regulate its production. So estrogen equals more dopamine, right? Which means we have this increased focus and attention when we have estrogen around which is in that follicular and ovulatory phase. So this tends to make ADHD medications far more effective during the follicular and ovulatory phases when estrogen is around. On the other hand, progesterone dampens the effectiveness of the medications so progesterone has a calming sedative effect and it reduces dopamine receptor activity and it up-regulates the production and binding of GABA to newer receptors in the brain which has the opposite effect of dopamine. So this can make ADHD medications less effective during the luteal phase when progesterone levels peak and put particularly even the menstrual phase like the first half of your menstrual phase. And so what we found in the literature for dosage adjustments is when we're in that follicular and ovulatory phases, ADHD medications work far more effectively and no dosage change may be needed. But when women are in their luteal phase or even their early part of that menstrual phase, women may experience reduced medication effectiveness. So adjusting that dose and maybe increasing it may be effective. So lower doses are less effective during this phase while higher doses could compensate for progesterone's impact on dopamine. I have to say this though, it's really essential. If you have ADHD, if you're on medication, you have to work closely with a healthcare provider to monitor your symptoms and make adjustments. Don't just listen to this and say this health provider on a podcast said this, I'm going to do this. This is just informational. I'm a nutritionist and I've specialised in women's health, but I'm not your nutritionist. I'm not your women's health specialist. Jacqueline is an amazing psychologist, but she is not your psychologist. So again, just remembering that aspect of this podcast and this is just what informational just so you know that oh, I have noticed that my ADHD medication isn't as effective. Now I have this information I can go to my healthcare provider, have a conversation and we can adjust the dosages. Another really interesting question I had was do women on the autism spectrum or ADHD tend to start their periods earlier than others. And the research suggests that yes, women who are on the spectrum, the autism spectrum, so ASD, all have ADHD tend to start their periods a little bit earlier than others. One study found that girls with ASD had a higher likelihood of early puberty, though the exact mechanisms are not fully understood. And just in the science we have today, we still don't fully understand why some people get their periods earlier than others. It has a lot to do with the anti-muleurian hormone in the body and another hormone that regulates estrogen and progesterone as well and it kind of dampens their effects and stops FSH and LH and even gonadotropin releasing hormone from activating in upper hypothalamus. For some reason with women who have ASD or ADHD, we tend to get that early activation of the hypothalamus to produce FSH, LH and therefore estrogen and progesterone and therefore get your periods a little bit early, which kind of makes sense because ASD and ADHD occur in the brain. And when we get our first menarchy, that's activated in the brain as well. So it may be related to hormonal differences or how the brain processes sensory and physiological signals related to puberty. It might also have something to do with trauma as well, which we will be talking about in this podcast. So we've also seen this with ADHD and so similar patterns have been observed with women with ADHD and girls with ADHD, with a tend to experience menarch earlier and research that is actually now suggesting that hormone imbalances and differences in brain development in seen ADHD women may contribute to that early onset of puberty. So we see some studies as well that propose hyperactivity and impulsivity are also associated with ADHD may influence how the body responds to puberty hormones, which I think is really interesting. Another question that I got over and over and over again is, okay, we hear a lot about this gut brain axis. Is there a connection between gut health and ADHD, especially in women and the answer to that is a absolute resounding yes. So there is a grounding, so there is a growing body of research that highlights the connection between gut health and ADHD, particularly in women. We do see in men, but we see it more so in women. And the gut brain axis refers to that bi-directional communication between the gut and the brain, where signals are sent back and forth via the nervous system, hormones and the immune system. So let's go into that a little bit more. So the gut microbiome includes trillions of bacteria and other microorganisms like even viruses, fungi and yeast to a certain degree. We need them around because they influence brain function by promoting and producing neurotransmitters like serotonin and dopamine, like I was saying before. They're really, really crucial for mood, focus and attention. When we have an imbalance in the microbiome, which we would usually call dysbiosis, it disrupts this process of creating these serotonin and dopamine and all these other neurotransmitters and therefore impacts our mental health and perhaps the exacerbation or the appearance of symptoms, right? Also inflammation. So both ADHD and gut health are linked to inflammation. Chronic inflammation in the gut can lead to systemic inflammation. So chronic inflammation means low level inflammation that occurs over a long period of time and systemic inflammation means it's going up towards other aspects of the body. It's not just in the gut anymore, it's going up to other parts of the body, which may impact the brain and worsen ADHD symptoms. So in women with ADHD, especially those who have colon morbid conditions like anxiety or depression or even PMDD, you're going to be a lot more sensitive to inflammation, basically. And when we're talking about inflammation, inflammation is a tool used by our immune system and 80% around immune system lives in the gut. So if we're talking about inflammation, you have to focus on gut health and then there's an aspect between that estrogen and gut health as well. So in women, hormonal fluctuations, especially fluctuations in estrogen can influence gut microbiome, composition and gut motility. There is this part of the microbiome called the estero bloom and it talks about how estrogen influences our gut and the gut microbiome community there. Estrogen promotes a healthy microbiome, but when it fluctuates, like when we expect those during the hormonal cycle, pregnancy or menopause, it can impact gut function and in turn, it will influence ADHD symptoms as well. Also, leaky gut, also known as, you know, that leaky gut is what we use in lay terms. If you said that in a doctor's office, you know, they might turn up their nose at you. The official word is intestinal hyperpermeability. So basically, it's where we have tiny little holes or gaps in the tight junctions of our epithelial cells. So we're supposed to have all of these cells kind of like brick and mortar, right? They're creating this beautiful barrier between us and the microbiome, so we can absorb food and then we can excrete waste. And we only take in what we need and let go of what we don't. But if we have inflammation, we're going to have some leaky gut, which means the tight junctions between these cells are loose and other things can get through. So this means that women with ADHD, if you're experiencing gastrointestinal issues like bloating, intergestion or food sensitivities, it can be a sign of this because this condition allows undigested food particles, toxins and microbes to enter the bloodstream. And this is going to trigger an inflammatory response. And then that's going to exacerbate ADHD symptoms because of that gut brain axis. And then also talking about dysbiosis and leaky gut and neurotransmitter imbalances. So imbalances in the gut to lead to altered production of neurotransmitters like serotonin and dopamine, which we both need in balanced amount, especially if we have ADHD. So since women are more likely to experience certain neurotransmitter imbalances like lower dopamine, specifically in ADHD, dysbiosis is going to further compound and worsen the symptoms of ADHD. So what can you do? Number one is gut healing, right? So focus on eating foods like prebiotics, which are rich in fiber and probiotics. So probiotics are the bugs, so the healthy microbiome bugs, prebiotics are the things that feed it. So there are some fibers and foods that we don't actually access or benefit from. It's on only there to benefit the microbiome, which is prebiotics. So making sure you're eating high fiber foods, you need to be eating about 30 to 40 grams of fiber every single day. Some people say 20 to 30, I like especially if you have ADHD to increase that because that's really going to make sure your gut microbiome is super robust, so making sure you're eating lots of avocados, beans, rice, you know, high fiber foods like apples, dates, sweet potatoes, especially in that progesterogenic phase because we need to be supporting serotonin and dopamine production. Lots of B vitamins also helps too, but we want to be eating fermented foods. So kombucha, kefir, kebwata kefir is really yummy, coconut kefir is really yummy, dairy kefir is really yummy as well. I'm not so about integrating like kind of high yeasty foods like kombucha or sour dough in this time, especially of ADHD because I feel like the esterobloom can get a little bit out of work, especially with ADHD, but that's just kind of what I see in my clinic. Take with that what you will. And then the next thing is addressing food in sensitivities or sensitivities. So many women with ADHD have sensitivities to certain foods, and I see there's a lot. So gluten and dairy and even eggs to a certain degree and beans, so beans that have been properly made. So you need to be soaking them for a long period of time and cooking them properly and putting them with cumin, so you can actually digest them and take away that phytic acid that's attached to the protein that can exacerbate symptoms of food sensitivities in leaky gut. So making sure that you're identifying and eliminating the triggers and then slowly incorporating them once you've bound up your gut lining with things like zinc and even L-glutera thion. These things are really great. Omega-3s are really great for this as well because they decrease the inflammation in the gut. You can't really heal any type of leaky gut or intestinal hyperpermeability unless you've addressed what's inflaming this area, taking away what's inflammatory, adding things in that are anti-inflammatory and then giving your body the ingredients like zinc to reform those intestinal tight junctions, so you don't have leaky gut anymore, basically. As I was saying before, omega-3s, so you can take 2 to 3 grams a day, which is 2,000 to 3,000 milligrams, and so fish or your supplements are going to be great. Also have a high level of EPA and DHA, which are also really positive for ADHD because it's been shown to improve focus attention and impulsivity. I did say also zinc. Zinc is really important for the development and synthesis of dopamine in the gut, right? So that first phase of creating dopamine and you need to be having at least 30 milligrams a day. So supplementing with 15 to 25 is really great. Like citrate or zinc picolinate is also great, magnesium, you know, I've said this a lot in every single part of my content I talk about magnesium. Really important for regulating neurotransmitter activity, so managing stress, hyperactivity. So magnesium glycinate, that's the one that's most well absorbed. It's gentle on the stomach and it's also going to help with any type of leaky gut or food insensitivity and you can take 200 to 400 micrograms a day or milligrams a day. It is iron, so we need iron because it supports dopamine production and low iron has been linked to worsened ADHD symptoms, particularly anxiety symptoms because we do see an overlap between anxiety and low iron, which, you know, I talk about in my hormone or birth control podcast. So if you're interested in that, go listen to that podcast, but I don't recommend supplementing. I'm really anti-ion supplementation unless you absolutely need it. I have a few women in my clinic who are like, I just get mouth ulcers or I have other things happen when I don't take my iron, okay, that's fine. If you were going to supplement with iron, iron by glycinate is okay. I'm just saying because iron is used by pathenergins in the gut and if you already have leaky gut, it can worsen it. So before you supplement, please just try and get it from Whole Foods. Cubes, red meat, even seafood like oysters going to be really, really great if you wanted to incorporate things like beef liver and beef liver supplements, that's awesome. If you did really want to supplement with an iron supplement, you know, never go over 18 to 20 milligrams a day. So the next one is vitamin D. So vitamin D is really, really helpful for women with ADHD. So vitamin D receptors in the brain are involved with dopamine regulation and neurodevelopment. And when we have deficiencies, we have poor focus, mood instability and cognitive challenges. And then if you wanted to mix it together, D3 with K2 is really amazing. K2 is really important for brain function too. And you can take up to 5,000 eye use of vitamin D a day. That goes up and beyond what the RDA, at least in Australia is, but I've done a bunch of research. Dr. Ronda Patrick is really great to look into this when she talks about vitamin D. She's done lots of research. I've done this and found that there's not really an upper level for vitamin D. It's really well utilized in the body. There's not really any dangerous side effects associated with huge amounts of vitamin D anyway. You'd have to have so much vitamin D to start getting upper limit negative aspects associated with it. So don't go past 5,000 eye use, try and get it from whole foods, of course, but supplementing with that and K2 is great. Be vitamins too. So I was just talking about be vitamins before, really, really important for brain function and neurotransmitter production in the gut. So B6, super important for dopamine and serotonin, B12 and folate is really important for mood and cognitive function. So if you take a B complex supplement that includes B6, B12, B2 and folate in their methylated forms, that would be great. I really like the ethical nutrients brand, the super B. I think it's called super B or mega B. It's always super or mega with them. So you can follow the dosage on any label though, but you want to have, you know, 50 to 100 milligrams per day of B6 and B12. Next is L-theanine and so this is an amino acid that you can find in green tea. It promotes relaxation and focus and it boosts alpha brain waves and it helps to calm down hyperactivity and improve attention without sedating you and you can take this in a supplement. So 100 to 200 milligrams a day and next is NAC. So NAC helps to balance glutamate and dopamine in the brain and that's been shown to improve mood, reduce impulsivity and enhance cognitive function in ADHD. So you can take 600 to 1200 milligrams a day of that and I'll also add on here as well L-tyrosine. So L-tyrosine is an amino acid that is the backbone of dopamine and I've been supplementing with this I of ADHD and I've found it incredibly helpful. I take 500 milligrams in my follicular inobulatory and then I take 1000 to 1500 in my luteal and menstrual. I haven't been going up to that 1500, I've just been trying to state that 1000 and I found it so, so, so helpful. This cycle I haven't noticed that I've like lost my keys or my phone which is kind of a telltale sign that I'm going to get my bleed soon and my dopamine is low. It's actually been a lot better in my partner even said that the other day and I was like, okay, it must be the L-tyrosine. So hopefully this answered a few of your questions and gave you some really concrete feedback on like what supplements you can take and what you should do, how you should eat for ADHD as well. So let's get back into the episode. Oh no, you're speaking my language, I'm always saying that to women especially if they work for themselves. I'm like if you can plan out your month especially if you have ADHD to go, okay, this is where I have the best communication skills. This is where I know I'm going to hit burnout and I need to integrate a little bit more rest and recovery and reflection. And so maybe let's talk about that ebb and flow. Like could you please explain maybe that connection between estrogen and dopamine and how that impacts on ADHD and its symptoms, characteristics and behaviors? Yeah, yeah, absolutely. So when we understand the dynamic between these hormones we know that estrogen plays a role in dopamine regulation. So dopamine and ADHD are crucial at controlling attention and in pulse regulation. And these are domains that are typically impaired in individuals with ADHD. And low dopamine levels can exacerbate ADHD symptoms and those are generally the symptoms that we see in difficulty focusing, impulsivity, in attention, those types of things. So as a woman engaging with a natural cycle, estrogen levels fluctuate throughout a menstrual cycle and we know that it peaks around ovulation and then drops before menstruation. So when estrogen levels are higher during that follicular stage, many women with ADHD notice improved concentration, mood, motivation, due to that increased dopamine activity. I would even go as far to say that I see women anecdotally reporting to me that they may experience more hyperactivity during that time, more hyperfocus during that time also. And less rejection sensitivity and less kind of sensitivity or emotional dysregulation during that time as well. So if we were looking at it, that would be the time to be more engaged in social activities or in more dynamic extroverted type of activities as well. And then conversely during that luteal phase, when estrogen levels fall, dopamine regulation decreases. So that may make your ADHD symptoms worse, leading to increased difficulty with that focus in emotional regulation. Sorry, like in that little tube. phase, we're talking about quiet work, detail-oriented things, organizing deep cleaning, creating more internal-based activities, which seem to work best in that in that stage. Yeah, it does. And it speaks to like a few of the behaviors that you might see, because I know as soon as I'm getting my period in two, three days, if I can't find my keys every single day, if I leave my house and I'm like, oh, where are my keys? Where's my phone? Where's my wallet? I'm like, okay, I'm getting my bleed in like two or three days because my ADHD symptoms are like kind of playing up and it has been really interesting to kind kind of play around with that as well. And also, could you please talk about maybe ADHD and its connection to PMDD because we know that PMDD only really appears in that ludicor phase when we have that huge drop-off of estrogen, we're not binding serotonin and dopamine in the brain, all the sudden we have all this GABA, and I think for women with PMDD that switchover is really intense and it can give you mood swings and a lot of women just say it's hell-weak. And I've seen a direct overlap, the women who have ADHD also have PMDD most of the time. Yeah, yeah. I wonder if it's the chicken or the egg here, because if I see a presentation of PMDD, I will screen for ADHD immediately. And so when I started noticing this in the early days, before it became kind of really apparent and common knowledge, there was a study in 21 that was released that basically indicated that, you know, over 45 percent I think it was of people reporting ADHD who had a diagnosis of ADHD symptoms, 45 percent of them were reporting PMDD symptoms and were formally diagnosed with PMDD as well, which I think is quite extraordinary. When you think in contrast PMDD affects approximately 2 to 8 percent of the general female population. So to me that was like so profound. And speaks to the other life changes that also occur when we have our babies, when we birth, when we go through petty, perimenopause and menopause as well. So in terms of my research and I've deep dive pretty extensively around this from the psych perspective, the prevalence is not fully understood. But it's indicated that when we have a look at the hormone fluctuations and the neurobiological aspects of ADHD, we see almost a heightened receptivity to pre-menstrual mood changes. And ADHD related symptoms like, like, also exacerbate the PMDD symptoms as well. So when I see these types of symptoms, I feel so much compassion for my clients because the impact of these two conditions that are interacting comorbidly have such profound impact on their quality of life. And it's really crucial if you're listening to this and you're experiencing severe pre-menstrual symptoms to really speak with healthcare practitioners. And those around you as well, because I've seen women's lives change when it's appropriately supported in this space. And you do not have to experience those symptoms to the severity and degree that you do that it's really impacting your function. There is a lot of help out there and tailor treatment plans and things we can do to support. Before we move on and I just even forgot to ask you, can you please define PMDD and also tell us what are the characteristics and behaviors that we see associated with this? Yeah, it's typically the dysregulatory emotions and the emotional sensitivity. I don't even like referring to it as sensitivity. It's almost receptivity to what's going on around you because it's real and it's valid. So if we take out all the DSM criteria and not speak so clinically, I think it's really, imagine a line drawn in the sand. And that line is I can generally function in the two weeks to one week before my menstruation occurs. And if you are noticing impaired function in your social occupational home life, daily activities and activities of daily living, then no matter what I think you need to speak with a health practitioner about that, because it doesn't need to be so severe and it doesn't need to be impacting you to the degree that it is. So the symptoms, emotional dysregulation and typically that's the majority of what presents during that time, increased tierfulness, hopelessness is a really significant presentation to the point where at times we do see increased suicide ideations and increased thoughts about self-harm, we really need to be aware of those things. And if that is very different to how you would normally get a sense of yourself and a sense of how you feel in the other two weeks, perhaps of the month, then that is something we do need to treat as an urgent health condition that needs support. Absolutely. I think I hear there's a lot in my clinic as well. How are your cycles? And very often when we say, yeah, it's fine. Like my periods are fine. I don't experience any pain. I don't have any acne. You know, my boobs don't get sore. And I'm like, okay, do you feel like you want to die after you ovulate? And they're like, oh my god, yes, I'm like, okay, so something isn't right here. Like you have to keep in mind that your mental health and any PMS or PMDD symptoms and ADHD symptoms are also a biomarker. And it's your body is communicating something to you and like that's something you need to pay attention to. And place at the same level of importance as you do your physical and physical and psychological symptoms as well. Yeah, absolutely. I speak with a lot of women and they're bleeding outside of their cycle. And there's all of these markers going on. And where we're going, you've got those markers and your seeking treatment for those physical markers. But the suicidal ideation and the intense, intrusive thoughts that almost you feel compelled by, you're not, you're not seeing as another symptom. And those are debilitating and very extraordinarily distressing. And and we always hear about them secondary. Hey, yeah, yeah, yeah. As we're going on that tangent, can we please talk about how ADHD and trauma are connected and can trauma mimic ADHD symptoms because there seems to be a little bit of an overlap between these two? Yeah, it's, it's really interesting around the impact. I'm an EMDR practitioner, which means I practice in trauma quite often. And I, given I work predominantly in the perinatal space, I work with a little birth trauma and experiences women have had in their early years as well. And I have anecdotally seen that simply by being neurodivergent and the experiences that we have through schooling, through societal expectations, through the masking that we've had to engage in, there are exposures to traumas simply through that. But when we look at the connection between ADHD and trauma, it is quite complex and multifaceted. And the information still out on whether trauma mimics neuro diversity and neurodivergent symptoms, or is it that we have the two existing comorbidly? What? So there's still a lot of information that we need to get around that. And I'm pleased to say there's studies emerging. But with both ADHD and trauma, they can independently affect emotional regulation, attention, executive functioning. But when they co-occur, they can exacerbate each other. So that leads to even heightened, more heightened challenges, especially that's really relevant for women as both conditions are often under diagnosed or misdiagnosed as well, especially with some of the, the misinformation about borderline personality disorder and experiences with trauma, we know that if someone has an experience of a diagnosis around a borderline personality disorder, that it really should be termed multiple complex trauma syndrome. And the stigma attached with those things. So I think there's not only the under diagnosis and misdiagnosis, but also a popular culture and how certain diagnoses are viewed as well. Yeah. Going on from that, like, do you, what are some therapeutic approaches to address both trauma and ADHD that don't overwhelm the nervous system? Because I've heard of a lot of somatic practices out here and I've seen them and I've heard stories from women who either have trauma are ADHD or both and they're like that completely obviously stimulated me, maybe even retraumatized me, maybe even made my symptoms worse. So what are some practices that you'd recommend or even just some behaviors that you would say? Like exercise, get enough sleep, I guess, are probably two of the most important ones. Can you extend on that? Yeah, absolutely. You're totally right. And I have come across a lot of clients that have used cognitive behaviour therapy through all their misdiagnosed anxiety and depression. And one of the things that just never quite, I'd never quite understood is if we have trouble regulating our executive functioning system and our and cognitive behaviour therapy is about executive function, then CBT just doesn't cut the cookie. And we see a lot of people that are engaged in CBT for their anxiety and depression. And then we engage in therapeutic modalities like EMDR, which has, if not, better therapeutic outcomes than CBT in the treatment of trauma. And we see that EMDR helps processing that unresolved trauma. It reduces the emotional intensity, intensity, it desensitises individuals, and it alleviates symptoms that do mimic and exacerbate ADHD and the trauma-based symptoms as well. But above all else, it really is about the trauma-informed care that women who have ADHD and trauma or and/or trauma care, you know, it's so important that the people that you encounter that are there to support and care for you are trauma-informed in their approach. And we know that therapeutic alliances, the biggest predictor for therapeutic outcomes, no matter what psychotherapy is utilized. So I think feeling hurt, understood, cared for, validated are some of the most profound things that you can experience as a human, as a woman, and as the woman with ADHD more than anything that we would do at a more kind of complex level like EMDR. Yeah, and as someone who's done EMDR, it's groundbreaking. I cannot believe how effective it is and how simple it is. It's just such a wonderful practice. It blew me away when I first did it. Yeah, and I think it's really important, like EMDR and the processes around it are not widely known. But if we consider and let everyone know that you actually don't have to relive the trauma like you might perhaps do if you were doing cognitive behavior therapy or exposure therapy, you do not have to relive it. There are different protocols to utilize an EMDR where you don't even have to speak about your trauma out loud if you choose not to. So that's really important to honor. And I think that's the most trauma-informed approach that we could utilize. And I think it's just quite profound. And that teamed up with a good therapist that's trauma-informed and as you feel feeling hurt and validated, that can be pretty life-changing. First of all, coming on from that, how can women make sure that they find a therapist or a psychologist and psychiatrist? I'm trying to remember all the words. Who's trauma-informed and specialises in ADHD because yes, someone can go and get a bachelor and do your masters in psychology. But how do you know that they've actually specialised in these things? And if they're actually going to be a good fit for you? Yeah, it's a really good question. I think the term 'specialised' in any industry needs to be considered with caution. And I think that there's not a lot of formal professional development out there for the subjective ADHD. You'll see lots of little training programmes pop up. It's nothing as formalised as what you would do with EMDR training or as regulated with EMDR training. I think that the most important things to consider is that if finding a psychologist, I can this may sound, this may sound, and make some people laugh, but it's like finding a soulmate, honestly, because it, and it's about giving it some time, you certainly don't expect to date and find your soulmate in the first instance. And so understanding, doing your due diligence, of course, and exploring where their skill set is. If they say they do, you know, they treat 20 different presentations. It's probably someone you don't want to work with simply because you want someone that has seen clients and worked with clients in this space often. And it's really just about like when you go, if you were to get a surgical procedure done, you'd want the surgical procedure done by someone who's done the procedure over and over and over and over again, the same thing goes with a psychologist. So when we consider that, it's about making sure that above all else, you have a good therapeutic alliance. And that sometimes takes three to five sessions to really get a vibe with and giving yourself that time. And giving that feedback, you know, if a psychologist isn't there asking for feedback informed treatment from you, then there's, you really want to be looking elsewhere because feedback informed treatment is so important. How did you feel heard today? How did you feel understood? What can I do differently is such an important question to be asking therapeutically. We are not the masters of you. We do not know you as you know yourself. And so we want to be guided by you and what works best for you as clients. And I think if you have ticked all the boxes in terms of your research and exploring that they have experience with ADHD, understanding how many client presentations they may have seen and many admins that generally in practices will be able to answer those questions for you. Or perhaps you could ask for an initial session with the psychologist just to get a feel. For their work with you and how you feel, you connect with them as well. Yeah, I think that's a very far and thing for women because we're so used to going into the doctor's office and being like, I have this hormonal issue and they'll let just take the pill. And so it must be very weird, I think for women who have these issues with ADHD and going, oh, I can ask my therapist to do something differently. Oh, that's so interesting. And I can say that this isn't working for me and I can go to someone else. So that's really beautiful. Thank you. Just stepping back again and just talking about the diagnoses of women with ADHD, we have seen an increase in women being diagnosed officially with ADHD. Why do you think this is increasing and specifically in women? I think that there are lots of factors are play there. If we consider the general popular culture right now, there's a lot of chatter about it. You know, you pop on tiktok or Instagram and you see that there's a lot of discussions around those things. But I really, I really love that and adore that and honor that because when we're seeing an increase in diagnoses, we're seeing the breaking down of misinformation, misdiagnosis, we're seeing that people are starting to really identify and understand what is impacting them and how they can reach out for support. So when I consider those things, it's like when you, the left-handedness, you know, the left-handedness of individuals hasn't actually increased. But when it became more acceptable within schooling systems to right with your left hand, more people came out as lefties. You know, it's not that it didn't exist. It's not that it wasn't prevalent during that time. It's that we are exploring that and more accepting of that. And to me, it's a great thing. To me, it's not that we're seeing it pop up everywhere and it's it's being overdiagnosed. I don't think that that's at all the case. Okay, cool. So that that was my next question. Was do you believe ADHD is more prevalent or we're just diagnosing it better? And you just think we're just diagnosing it better. And that's why we've seen an upregulation in diagnoses, especially in women. Yeah, yeah. Like we've we've got improved like diagnostic tools and resources. Absolutely. When we talk about some of the the best practice tools that we utilize to assess this now, we've got some really good robust psychometrics that support that. We've got some great tools that help us identify any masking as well. There's a better awareness and understanding the reduction of stigma. And there's more research on adults and women as well. So when we there's also the diagnostic bias correlation, like the historically, there's been biases in medicine and psychology. And it was often that women were overlooked. And I try attributing their struggles to the anxiety and the depression or personality traits, like such as borderline personality disorder, rather than considering it as a neurodevelopmental condition. So the shift towards addressing that biases definitely has led to more women being accurately diagnosed, which to me is something that should be absolutely celebrated. Yeah. Fucking hallelujah. Like women are getting the answers. Finally. Yeah. Finally. So what would you recommend? What are the next steps that women should take if they are suspecting a misdiagnosis of anxiety and depression? If they want to, if they've listened to this and are like, you know what? Yeah. I agree with a few of these traits. I don't think I have anxiety or depression. I think I have anxiety or I think I have ADHD. How do I go forward and try and find a diagnosis? Yeah. I think the best place to look really is reflecting on your experiences. And really reflecting on your symptoms and understanding how ADHD manifests in women. And starting to note some of those down, journal, reflect on it, understand when it might be that the symptoms are amplified and is that linked to your cycle? And then I would definitely explore gathering information, you know, understanding the symptoms, what those types look like. There are self-assessment tools that can be utilized. For example, things like the adult ADHD self-report scale and ADHD related scales for women that are quite easily accessible. And I would strongly suggest keeping a symptom diary. So documenting situations where you struggle with focus, organization, impulsivity, like noting those patterns, like I'd mentioned, any triggers or impacts on your daily life, that will be extraordinarily helpful when you go to speak with any practitioners about exploring a diagnosis, having all that information available. And if you're one of the 46% that may have for co-morbored PMDD condition, that we get onto it ASAP, especially with symptom diaries. And then consulting the correct specialist. So start with your GP, explain why you suspect ADHD and provide examples from your symptom diary, and be honest about your struggles, like this is where we remove the mask, right? And this is where we really speak honestly and truthfully about the challenges we're having. And request a referral, ask for a referral to a psychologist or a psychiatrist that specializes in ADHD. In my experience, the GPs are so saturated right now that they might not be aware of who that is. So perhaps going in armed and advocating for yourself would be really helpful. Or if you feel like you don't have the capacity because you're so burnt out, then perhaps bringing along a support person to help advocate for you and talking about a bit of an action plan before you go in with the GP. And then finding that health ADHD literate professional, so seeking out those clinicians. And they're, it may be useful whether I provide you with some resources around how to access ADHD practitioners, and you could include that in any of the resources you share. But really being aware of what it entails, I think you going in with your eyes wide open and making informed choices is really important. So you GP can refer you to the psychiatrist or a psychologist generally in order to access any of the psychotropic medication that is required as part of ADHD symptom management. If you choose to go down that route, generally unless it's very specific circumstances, psychiatrists can only prescribe that medication. So generally you would need a psychiatrist to complete the assessment and diagnose you with ADHD in order to access the medication if that's something that you're wanting to explore. Generally what we see with psychologists is that we will support you with ADHD symptom management and the strategies around that. We can absolutely work hand in hand with a psychiatrist in GP that generally in my experience, the psychiatrist will want to at least do an informal diagnosis if not have the psychologist do the formal diagnosis, provide that information through to the psychiatrist. But to be honest, Sarah, in my experience, I would say only 10% of women want to actually pursue the medication and I'm really happy to do preliminary discussions around an ADHD diagnosis and then work on the behavioural aspects of it. That might be because I work in the perinatal space and women who are trying to conceive or still breastfeeding, opting not to utilize stimulants as a treatment management strategy for ADHD at that time in their lives. And I have heard that as well that even women who haven't given birth yet and who are even postmenopausal seem ambivalent around medication and I would just say here like ADHD medication, anti-anxiety and also anti-depressants of life-saving medication and I don't really have any type of quam around the use of those medications, maybe over using them long term probably doesn't have good health outcomes for brain health. But you were just talking about a few of the different ways that you can help manage ADHD symptoms. How can you, what would you recommend to women with ADHD to help them manage their daily life, especially when the dopamine levels are fluctuating? I think you touched on it earlier before when you were like, "Plan out your month." No, when it's, your dopamine is going to be high, when it's going to be low and active accordingly. But what are some other daily things that you'd recommend? Yeah, it's such a good question because we're really looking for tangible ways to actually improve our experiences. So it's such a valid question. I think that the best place to start is building a dopamine-friendly routine. We know that making sure you're hydrated, making sure that you're getting enough sleep and exercising all of those aspects, but really trying to leverage some of the things that drive us as unique individuals. So building that dopamine-friendly routine is something I speak about regularly with clients. It's about incorporating rewards. So creating small, immediate rewards for completing tasks, dopamine is then released. So that's when we get that sense of achievement and pleasure. So even something small, like a fun activity after finishing a chalk and help, or doing something you enjoy at the same time. So perhaps listening to a podcast, while you're cleaning, or doing something that you don't particularly like, if you're into gaming and exploring those types of activities, then gamifying tasks, using absolute systems that make tasks feel like a game. So there's like to do apps with streak features and things like that, that breaking tasks up into smaller steps and checking them off provide a dopamine boost. So at the beginning of every day, I do a run-through sheet through chat GPT with tick boxes. And after every minute task that I do, I tick it off and I get a little dopamine hit. And then that actually keeps me engaged and motivated in my task and really helps me manage in attentive symptoms. So whether or not we can leverage some of those things. The other aspect, especially for those who have that general sense of overwhelm, is simplifying and structuring your environment. So the decluttering and organizing piece, the using external cues, because object permanence is a bit of a challenge that we have as an ADHD symptom. So visual reminders like sticky notes, alarms, whiteboard calendars can really help you stay on track. And prepping the night before, so laying close out, meal prepping where you have the opportunity, organizing work items in advance, can reduce that decision fatigue. And then really, I think the final piece is around creating sustainable routines. Because oftentimes we'll say, we'll do this, this, this, and this. And it's way too extensive and unlandtainable. So tying new habits to existing routines, that anchoring habit piece, time blocking, so having specific blocks of time, and starting small, before our unrelentine standards kick in, perhaps, you know, really starting with one or two of the habits and building gradually, instead of overhauling your entire routine. Those are some really kind of practical strategies we utilize in the work that I do. And then also, it might be worth touching on working within your energy levels. That might be a really valuable place to start as well, identifying your peaks, noticing when you're most alert and productive, and then taking breaks, using movements, stretching mindfulness activities to recharge when you have that energy dip. And really trying to refrain from the negative self-talk and the dialogue that may ensue if you don't meet your own personal expectations. Well, I think that's something a lot of women suffer from because they're like what is happening? I was so amazing last week and now this week I suck. I'm forgetting everything. I'm dropping stuff. I haven't been able to focus and it can kind of breathe this really nasty internal dialogue. That's just so corrosive. And I just think having that mindfulness around your cycle just as a normal woman that doesn't even have our ADHD that you can't be in a perpetual bloom babe that like things are going to change especially if you have ADHD and just kind of going okay here is when I'm going to be social here is when I'm going to focus here is when I'm going to reflect and here is when I'm going to rest and even throughout the day in recognizing when it's high and then when it's low and just you know you supporting yourself through everything you've just said basically. And I think it's really interesting that I think everyone has that little thing where they if they have a list of things to do if they've done something that isn't on their list you draw a little box and you tick it because because you want that don't for me yeah yeah how can you refrain from not I do it every single time and I'm like I just want to the plant it wasn't on my list I'm going to tick it off and write it down a little treat for my friend yeah absolutely absolutely and I think just like if if there's no other key message um today it's just really about honoring yourself and we know that women who try and perform in a way that their intuition and body is telling them that they don't currently have the capacity to do that we see extraordinary boom bus cycles and extraordinary burnout and especially as we navigate through life's responsibilities and demands um the the burnout can ensure you are a lot quicker than it may have when we might not have had kids or when our capacity wasn't taking up by other mental demands or physical demands so if if we were to just honor ourselves and where we were at in our cycle in our symptoms and not push through those things I think we would be seeing a lot more well women is there anything else you wanted to add to before we close up today no no I think the you know honor yourself is probably the most important message we can have to these so these extraordinary women out there that are functioning in a neurotypical society with just the most unique extraordinary brains honor it accept yourself and love yourself for who you are I know that you are normal and loveable oh absolutely yeah and I think that's an important thing to remember like you are a daughter you are loved to remember that no matter what your brain says to you beautiful thank you so much Jacqueline and before we close up where can people find you you can find me um through my website at www.lume-psychology.com.au so that's b-l-om-psychology I'm not on socials currently it's on my I don't know how to do this they haven't yet gotten the little dopamine reward from taking off but um you will be able to find me and my team there and if you are looking for any support in the ADHD space even if you'd like to just click through an email and explore what you should be looking for you are always welcome to reach out to me um any person that I can support in this space please reach out I'd be more than happy to help beautiful thank you so much for being on the pod and yeah hopefully everyone else has a beautiful day yes thank you so much for your time Sarah thank you thanks for being on