Is It ADHD or Your Hormones? The Thyroid & Perimenopause Connection with Dr. Jolene Brighten

So, Dr. Brighton, thank you so much for being here today. I'm excited about this conversation because it's one that I think so many women need to hear and have, but they probably— a lot of them don't even know it because no one is talking about it. So today we're digging into ADHD in women, hormones, how all these things intersect. And thanks for being here.

Yeah, well, thanks for having me. I'm excited to have this conversation.

Yeah, so it seems like there's an explosion of women getting diagnosed with ADD— ADHD rather is what I really should refer to it as. Do you think that's a real increase in incidence? Is it really happening more, or are we finally getting the picture that maybe ADHD doesn't look all like 6-year-old boys that are hyperactive in school and kind of changing our perspective and opening our eyes a little bit?

Yeah, well, if you look at the largest population who is getting diagnosed ADHD, it is adult women. And specifically women in the perimenopausal years. And so, it's very much a case of missed, misdiagnosed, and dismissed. And so, what we understand from women who are now diagnosed with ADHD is that many of them were actually diagnosed with anxiety or depression or some other condition, but anxiety and depression tend to be the top ones. What's interesting is research has shown that once someone gets the diagnosis of ADHD, The SSRIs can be stopped, the medications can be stopped, because that's not really at the root of this. And when they're given accommodations and the ADHD is addressed, it becomes life-changing for them. And I know from just talking with so many women, just getting the diagnosis is life-changing, because what they've internalized is all the messages. And, you know, everyone with ADHD has received more negative messages than the non-ADHD counterparts. And that's been a lot through Parents, teachers, peers, coworkers saying things to them like, why can't you just try harder? Why are you so lazy? Why is it you can't get it together? And so women have internalized things like, I must be lazy, I'm incompetent. And when they finally get that diagnosis, they come to recognize like, no, I actually needed accommodations, that I have been living with this disability. And when you recognize, wow, you've been living with a disability and look at where you're at, given that no one recognized that, It can be really life-changing for women.

You know, it's interesting, you probably don't know this about me because we met after this, but I ended up getting in the world of functional medicine by psychiatry. So I practiced traditional psychiatry for many, many years and then integrative functional psychiatry. And I have a couple thoughts on what's so interesting about this conversation. Number one, when women would come to us in psychiatry in our traditional sector, if they hadn't had a diagnosis as a child, they were almost immediately written off. from having ADHD. And they said, well, no, you need to go through this giant barrier of formal, full psychological testing to see if in fact you have ADHD or if you're manufacturing it because, you know, for one reason or another. So I thought that was pretty, pretty interesting. And then second, the other manifestation I would always see in these women is anxiety because they almost were just—

Mm-hmm.

Anxious about knowing they couldn't get everything done. You know what I mean? And they were anxious about the ability to execute.

Yeah, I've struggled with anxiety. And why I'm giggling right now, for the people who can see us, is because this morning, I was so anxious about getting here. So, one of my executive dysfunctions that completely debilitates me is time blindness. And so, I was waking up at 3:00 AM, at 3:30, at 4:00 AM, over and over and over being like, okay, running through my head again, how can I make What time do I have to make it there on time? What time, when can I go to the gym? What time do I have to eat by? And these things become, you know, second nature to a lot of adults, but, you know, for people who don't know what ADHD is, it's not just bouncing off the walls. Yes, there's hyperactivity. There's actually, there's hyperactivity, there's inattentive, there's combined type, and then what's really underneath all of that though is extreme executive dysfunction, and this is where people get confused because— They'll say things like, we're all a little ADHD. No, we're not all a little ADHD. We all have a little executive dysfunction. Every human on the planet struggles in some way, but with ADHD, the dysfunction is so dysfunctional that it interrupts your relationships, your work, your ability to go to school, and it is consuming. And so what is happening is that there's alterations in not just neurotransmitters, we always talk about dopamine, we can talk about others, ADHD is more than just dopamine, but in how the prefrontal cortex actually generates energy as well. And that is the CEO of executive everything. It's literally the executive suite of the brain of executive functions. And so in ADHD, there is a deficit happening there. With women that are getting diagnosed as adults, it does have to be present since childhood. It is recognized you could have a traumatic brain injury, an insult to the brain, and develop ADHD after that, but it does need to be present since childhood. And why that's important is because there is a phenomenon now of recognizing the brain changes of perimenopause, where, you know, people are saying, oh, it's late onset ADHD. No, it is not late onset ADHD, and that's very dismissive of that woman's experience. But in addition, non-ADHD brains can go into perimenopause, and the alterations in mitochondrial function, in inflammation, in hormones puts them in an ADHD-like state. but it's temporary, it's a transition. And within 2 years post-menopause, they should come back. They should be like, oh, I remember this person again, brain's working again. For the ADHD woman, the research says roughly 25% of them will have severe ADHD from post-menopause on. So this is significantly different. We also look at the research that ADHD women are entering perimenopause about a decade earlier, and they're having twice the symptom severity.

Wow. Okay, so this kind of changes the way that I want to approach my own practice, right? So obviously, you know a lot about thyroid, you know a lot about hormones, and you know a lot about ADHD in women, especially surrounding the hormonal pieces. What are some signs that, hey, look, I've looked at your thyroid, I've addressed your thyroid hormones, What would I be looking for, or what would listeners be looking for to cue them in, hey, maybe this is another layer that I need to address?

Yeah, that's a fantastic question. So within the book ADHD in Women, I created these 5 hormone profiles. They're the ADHD hormone profiles that help you understand what hormone is primarily driving your symptoms. Thyroid is not one of them. And anyone who's listening, if you're like, wait, why? Thyroid affects the brain. You are so smart because you're absolutely right, but Why it's not one of them is because anybody who has hypothyroidism can have ADHD-like symptoms. So, we see, you know, ADHD has a drop in energy production in the brain. Utilizing glucose is harder. This is why one of my tips I always give is to exercise, because that hyperactivity, that movement, that's because you will need to generate lactic acid to be the backup supply. So, if you think the mitochondria are powering the house, they're the main supply, exercise is your crank generator to get you the lactate for your brain to have more energy.

Interesting.

So, when we are hypothyroid, we're going to experience the same lack in energy that the ADHD brain has. Every neurotransmitter can be disrupted by hypothyroidism. It is not just a case of, oh, dopamine, or like, when progesterone gets low, that's about GABA. This is every neurotransmitter can be affected. So, when we take acetylcholine, which is a big issue in ADHD, that's our memory, that's our working memory. That's why we don't forget what we're saying mid-sentence. Like, I'm able to sit here, have a conversation with you, and listen to what you say, and think about what I want to say, and we take this for granted, but when you're hypothyroid, you start missing out on those things. And so, hypothyroidism absolutely needs to be ruled out, in my opinion, if somebody is presenting, and especially if they say to you, I've never really had these issues before. Usually, an ADHD woman will say, yeah, it's been a bit of a problem, but I've been able to, like, you know, use Post-its or set a reminder, or I had all these tools that worked. Certainly, when the hormones go away, things stop working. Every tactic you had starts to fall away. And so, with hypothyroidism, we have to rule that out. And if you are hypothyroid, we have to correct that first. So, in my patients, if I screen them, they're hypothyroid, they're not going for an eval for ADHD until I correct that, 'cause I want the true you.

Yeah.

I don't think you're yourself when you're hypothyroid. And so, if you get that corrected and you're still like, I cannot plan for the life of me. Put me in charge of the bake sale at school and it is not gonna happen. Or I have a really hard time organizing my schedule and understanding like, you know, what order to put things in. You have emotional dysregulation. That could certainly be hormonal, but that's a big one that almost every ADHDer has some kind of emotional dysregulation. So whether that's on the spectrum of, rejection-sensitive dysphoria. So that is not a diagnosis, but it's a phenomenon we recognize where people feel physical pain, perceived or real criticism affects them profoundly. And then we've got the other side, which is like pathological demand avoidance, where you tell them what to do and they have a visceral reaction. They will not do that. You've put them in fight or flight just saying like, you need to do that right now. And their, their nervous system is And so, if you have these persistent deficits affecting your life, even after you correct the hypothyroidism, that's when it's time to investigate. And the reality is, most women with ADHD are also going to experience some other co-occurring condition, with Hashimoto's hypothyroidism being one of those.

Wow. So, one of the things that I really admire about you is Like, I, I'm like a thyroid hormone girl. Yes, GLPs-2, but like my niche, it's narrow. But your ability to take on a subject matter and then go so deep in terms of research is inspiring. Like, it really is.

That's a neurodivergent brain, friend. That's when you have a special interest. My book has 600 citations, and people are like, you read 600 studies? I'm like, well, those are just the ones that made it in, right? And it becomes an obsession. And anybody who has like ADHD and is ever hyperfocused to where they're like, I haven't drank water, peed, moved my body in 10 hours, can totally relate to it. So I appreciate it, but it is also one of those things where it's like, it's like a superpower that also is a bit of my kryptonite kind of situation.

And did this— this was your journey too? Is this what made you get so interested into this? to really break it down for other people. Tell me a little bit about your own journey.

Yeah, so it was actually my son getting diagnosed with ADHD that I was like, okay, I've gotta understand this more. It's always been his choice if he wants to be on a medication or not. He, at 13, is still like, I don't wanna do that. For people listening, he had a condition called PANDAS, which is Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep. He's had to take tons of supplements and medications going through all of that. So that's why we were like, we need to, leave this up to him. Like, do you wanna take on this medication? And he's like, I've done so much, Mom. I'm just not interested. So I was like, well, we need to come up with accommodations. We need to look at other ways to support you then, because we're not gonna just, you know, as the kids say these days, raw dog it through ADHD. And then it was, you know, being with, so we hired a parent coach who knew ADHD really well to help us parent him. 'Cause no one gives you a manual of like, you have a neurodivergent child here. This is how you do it. So I was like, I'm gonna get a parent coach so I can do this better. And it was sitting with her where, you know, it was like I kind of argued, but it wasn't arguing against her expertise. It was more that she's like, oh, like, this kind of thing's not normal, and like, that's not something neurotypical people experience. And I'm like, wait, no, we all melt down over socks. And yes, wet hair on your back makes you want to vomit. Like, what do you mean? Like, of course. And of course, Like, I'm, you know, writing a book in my head while I'm also planning the grocery list, and I'm talking to you at the same time. And she's like, this is not normal. You and I need to have our own session. And I was like, what do you mean? And, you know, she didn't use normal in like a derogatory way. I think that's important because sometimes it can, it can feel like that. But she's just like, this is not normal behavior. How have you been living your whole life? And so that's when I ended up getting diagnosed. And this really, As much as I hate my journey and just the heartache that I've had to go through, if it wasn't for this, I wouldn't have pieced things together. So it was the ADHD diagnosis, then it was the endometriosis diagnosis, then it was an autism diagnosis. And I, at the point where I reached the endometriosis diagnosis, I started asking all my friends. I have many friends who are excision experts, and I'm like, what's the connection between ADHD and endo? And they're like, there isn't one. What are you talking about? I'm like, no. This is not a coincidence, okay? And so that's when I went into the research. And it's so funny because people all the time will say, if I Google ADHD and endo, it's you. It's you that comes up.

Really?

And I'm like, that's because I was like, there has to be a connection here. And as it turns out, those with ADHD are twice as likely to have endometriosis. What is endometriosis? A chronic inflammatory condition. It is systemic. It is raising your risk of heart disease. It potentially is raising the risk of dementia. This is where, like, this is TBD, to be determined, still in the research. And when you consider that the ADHD nervous system, the ADHD operating system, as I call it in the book, likes to throw inflammation, and that it's neurotransmitters, executive function, everything is disrupted by inflammation. When you start considering, like, the autoimmune risk, like Hashimoto's we talked about, the endometriosis, the other co-occurring conditions that happen, It's like, this is way bigger than a psychiatric condition, which is why in the book, maybe too many times, I say ADHD is a full-body experience.

Mm-hmm.

And that is the reality of many chronic conditions. And yet medicine so often is like, we're gonna put it in the bucket here, right? So thyroid, that's just a thyroid. And you're like, but what about my, like, hyperlipidemia? I have high cholesterol. And what about, like, the fact that my heels of my feet are cracking and my skin Their skin looks like dragon scales. We don't talk about all of the ways that these diseases can manifest. So, that was really my journey, but really, I should back up and say, before all of this, I started making the connection that if I had a PMOS, so polyendocrine metabolic ovarian syndrome, formerly known as PCOS, a patient, odds were high they also had ADHD. They were easier to get diagnosed because the high androgens makes them manifest as that hyperactivity and that impulsivity. But I also saw my PMDD patients over and over. So for people listening, PMDD, that is a severe, severe form of PMS where women have high risk. I mean, 25% have self-harmed, 50% think about it. It's a very, very severe psychological— meets hormonal kind of condition. And so with that, I started seeing those women higher. Like, they would say like, oh yeah, the cloud lifts, I feel better in my follicular phase. But then persistently, we still had sensory sensitivities, we had these executive dysfunctions. And so now when you look at the surveys— so they've done survey research because we haven't really funded PMDD like at all, even though it's so wildly common. But when we look at that, roughly 50% of those with ADHD report having PMDD, and over 90% of autistic individuals report having PMDD. And so that's really where all of this interest of, like, the hormone connection and what was going on. But I was like, I don't want to become an expert on, like, on ADHD and autism and all of that. Like, I'll refer. And I still refer and I partner with other people. But when it became personal, I was like, you have no choice. And that's the reality of medicine, is that I always say to doctors who are like, oh, would they Google that? I'm like, do not discount the PhD she got in her condition spending time in PubMed because medicine didn't help her.

Right, and that is how so many experts are formed, especially in these niche conversations that don't exist outside of this. I wanted to tease out a couple things from what you just said, 'Cause I mean, I could unpack this for hours, I won't, but I want you to talk about sort of this neuroimmune connection that you've sort of hinted at. Are there other conditions that are woven into this, like POTS, like histamine issues, like hypermobility or EDS?

You just named them all. Oh, I love it. Yeah, for sure. But so I actually came up with this model in the book, which is the neuroimmune Hormones, so endocrine. So for generally a person, we're talking brain-immune-hormone triad, and what sits in the middle is the mitochondria. They're really the collateral in all of this. And so what we see when the mitochondria, as awesome they are, they're kind of lame too, because once inflammation and reactive oxygen species get upregulated in the brain, the mitochondria is like, cool, that's what we're doing. I will make reactive oxygen species too. Less energy, more free radicals, more brain cells, I don't like to say brain damage 'cause it sounds scary to people, but neuroinflammation is very serious. And so, what we, you know, what we see is that in the ADHD individual, they can have this just going on on its own, but then they have co-occurring conditions. So, endometriosis, adenomyosis, as you were talking about POTS, definitely we see that. We do see Ehlers-Danlos syndrome. We see connective tissue disorders. We also see a high co-occurrence of autism. So many conditions that really are linked, because what the research believes is that we get this group of genes, like that's how it's inherited. It's a group of genes that rides together, and those same genes can be influenced by our environment, turning on and off other conditions. And then, you know, to your point with histamine, we see this very commonly. So often when someone is saying, I have the period flu or menstrual flu, so they feel like they're coming down with the flu every time before their period, that right away I'm like, I'm thinking, okay, do we have a neurodevelopmental condition? Do we have endometriosis? Endometriosis is really rich in mast cells that are fragile. They dump histamine like crazy. So I always wanna go looking deeper. And so what we see with the histamine is that anytime estrogen really goes high in the cycle, so it can be around ovulation or it can be around menstruation, and it's not that estrogen's necessarily high, it's that progesterone's dropping down. you're stressed out because you've got the ADHD operating system in a world that does not offer you accommodations. You don't make ample progesterone. And so estrogen causes the mast cells to release histamine. It also downregulates DAO enzyme, which is how we break down histamine. And then lovely little estrogen, uh, is produced from the ovaries. As long as you can make it, that histamine will cause your ovaries to make more estrogen. And so they just propagate. each other. And I think that's really important to understand because you can be having these cyclical symptoms, and maybe it's you're waking 2 to 4 AM, and usually people say, oh, well, that must be a low progesterone issue. Could actually be a histamine issue that's going on. You may be the person who's like, yeah, always before my period I take a hot shower and I start getting blotchy and itchy all over. Those are signs of histamine. Maybe you're the person who rages. Maybe you're really irritable, you're angry, you you don't understand why. And I think, you know, we often think about histamine in connection with allergies. Look at how people are when they have allergies. You know, they're tired, they're mentally feeling fatigued. Histamine should help with being alert, but every— it's just like hormones, neurotransmitters are the same. Too much of it and we start swinging in the wrong direction. So I'm really glad you brought that up because it is something that many women with ADHD struggle with, and that's at the Yeah. And I think that's the crux of really managing the condition. We can't ever make ADHD go away. It's how you were wired from birth. But there is a difference in the symptom expression, and that's what I'm always looking towards of like, how do we make it so the symptom expression of this is manageable so it doesn't feel like it's all-consuming of your life? And then understanding that life is always in flux and sometimes it will feel that way, How do we address what's going on for you and really make it so that you can feel like you're thriving in your body?

Yeah, oh my gosh. You know, as I have this conversation with you, it's like a light bulb moment. You know, I look at women so often and I think, gosh, if we could just solve this thyroid problem, they would get so much joy back. And I think over time, we're starting to address these aspects of women's health that have maybe been dismissed. Such a huge one that is not literally in the media, in conversations, in conversations between friends. It's completely under the radar. So how grateful I am as a woman for people like you, truly, because you're bringing this out into the light. And even as someone who practiced psychiatry, you know, totally unaware. So I just— super, super inspiring. Another follow-up question. So talk with me about— you mentioned times of vulnerability for this, perimenopause being one of them. Talk with me a little bit about why that happens, what's happening physiologically, and maybe what women should be attuned to, to think, hey, this is something I might want to consider.

Yeah, so in the book, I, I outlined the 5 Ps. These are the windows of vulnerability for women. So we've got When we start our period, right? So we call that in menopause menarche, but it's really puberty altogether. So a lot of people think like period, puberty, actually it's breast bud development. And what happens is that estrogen begins to rise usually 2 years before your onset of your period. And that's where we see girls start shifting. So maybe before, they may have been a little hyperactive, they may have been a little impulsive, but As they start to shift through puberty and estrogen comes online, ADHD becomes harder to diagnose because it's very internal. This is where we see internal struggle begins to spike. And because she's a girl, society's like, be pretty, smile, always be polite and accommodating, people please, do whatever you can for community. And this is where masking comes on.

Mm-hmm.

are expected to mask more than men. I always get kind of bitter at my male counterparts who are like, I just say the awkward thing and nobody cares. And I'm like, I wish that I could do that, but usually there's consequences as a woman, and we learn that very young. So the other, you know, the other 4 Ps. So postpartum, I think that's an obvious one. We lose our hormones abruptly. As you do that, you're also not sleeping, you're super fatigued. You just went through arguably like more intense experience than running a marathon. But if you ran a marathon, everyone in society would be like, rest, take care of yourself. But at childbirth, oh no, get up, do the dishes. Why is your house a mess? Like, why are you not doing your hair? Like, you know how it is postpartum, you've had kids. So there's postpartum, there's the pill. So some women it's starting the pill, some women it's stopping the pill. That, that pill formulation, depending on the one you're on, It's gonna alter neurotransmitters, 'cause that's what hormones do, and synthetic ones are no exception. Then we have perimenopause and postmenopause. Now, in perimenopause, what is happening there is a huge hormone change that is changing your brain for life. So Dr. Lisa Mosconi's, uh, work has been, I think, some of the most groundbreaking work we've seen in our lifetime in understanding women's brains. And so what happens is the mitochondria become more dysfunctional. Energy production decreases, and this is where a perimenopausal woman starts to have ADHD-like symptoms. But as I said, she will roll out of that. However, you know, from Dr. Mosconi's work, it's like post-menopause, you're gonna have about a 20% production in your energy in your brain. That's huge. Now you take someone who, as you know, the research talks about many different models for ADHD, but showing that Glucose metabolism's already altered. Neuroinflammation is often already up. Mitochondrial dysfunction already exists. And now we just took away the hormone allies. And so everyone loves to talk about estrogen. And I will say that when I started talking about this 6 years ago, I made the mistake of giving estrogen too much airtime, because now everyone's like, just give estrogen, she'll be fine. And I'm like, histamine, uh, there's other things also. COMT, which is a gene that helps process dopamine, it also processes estrogen. So you just go in with estrogen hot and heavy, and you may find that person actually doesn't feel better. I like to joke that I'm like, estrogen's not Adderall, friends.

Right.

It's not going to just increase your dopamine. So what is happening? We've got the mitochondrial changes, we've got the neuroinflammation of perimenopause, but we also got alterations in the actual neurotransmitters. So as progesterone starts to go, So does its neurosteroid metabolite, allopregnanolone. Now, I call this the progesterone sensitivity profile in the book because some women, it is low progesterone, and I help them parse that out, but other women, it's a sensitivity. It's an abnormal experience to what we would expect, so a paradoxical experience to progesterone, and they are the women who have PMDD historically. But as the progesterone starts to come up, to go. We also see BDNF alpha starts to go, so neuroplasticity is starting to drop. We also see that the emotional regulation, it's off the chain, like there's no helping it. So this is when the perimenopausal woman is raging. The ADHD woman can go from, you know, 0 to 60 in actually 15 seconds, right? Like, it's like it's immediately filling that rage. And then we've got the testosterone Which I don't feel like gets talked about enough, because with testosterone, this is the woman who, she wakes up flat, she's not motivated, she doesn't have energy, she's not able to actually start a project, but if she does, she doesn't have the gumption to follow it through. Like, she cannot follow it through. And so, what I just described are like the sex hormone changes.

Mm-hmm.

Unfortunately, sex hormones are not the only ones involved. So, as estrogen declines, insulin resistance rises. Well, the brain doesn't require insulin for energy. If you have insulin dysregulation, you have dopamine dysregulation. Then we've got the HPA axis. Now, that's the hypothalamic-pituitary-adrenal axis, and cortisol is one of these profiles, and it's a really important one because what happens is that maybe, let's say, your testosterone is on the low side, you start losing muscle mass, you become more fragile, right? So now the HPA axis has to be more hypervigilant. Oh my God, everything is danger. We have to pop off on anything because we are vulnerable. Or, you know, on the other side, what we will see is even just cyclically, so not even perimenopause itself, is that, well, progesterone always makes us feel chill and calm, right, is the story that we are given. And so everyone thinks like, oh, the HPA axis is gonna be more calm.

Mm-hmm.

It's actually more hypervigilant. So while it can be calm, it's more likely to react. So it's more likely to react, and we see the same can happen in perimenopause. And why is that? Well, during the luteal phase, I think it's because if you're possibly pregnant, you should probably, you know, be afraid of an animal attacking you. Like, you should be running away from things more often than not. And then when you get to perimenopause, It's the, my testosterone's going, my estrogen's going, my progesterone's going, the HPA axis is trying to take over for a lot of those things.

Yeah, trying to compensate. So interesting too, the parallels with thyroid, with ADHD, even the timing of the 5 Ps, right? Like, it's so fascinating. Okay, talk with me about Kind of next steps. If someone says, I think this might be a problem for me, I remember struggling at some of these key points in life. Sometimes it's probably like an increase in demand. Maybe people can go through high school okay, and then the demands of college, they can't compensate anymore, that sort of thing. And they think back, maybe this was me, and they're experiencing it perhaps in perimenopause. What would the next step be for them?

Yeah, well, in the book, I unpack a lot of areas, but one thing I would say that I think we're getting wrong in medicine is that we need to have the conversation of hormone therapy sooner than later with these women. So, if we know that peak perimenopause symptoms are going to be 35 to 39 for these women, for a non-ADHD woman, that's happening in her 40s. So, if that's when that's going to happen, we need to start these conversations in their early 30s, not because they need to start hormones in their early 30s, But I think waiting until someone's desperate and their symptoms are so bad pushes them into decisions that sometimes they regret, that they don't feel like they were in total control of. I think it's, you know, as you were talking about being in psychiatry, it's the same thing, you know, with patients where, you know, I'll say, we need to establish with a psychiatrist, or maybe, you know, endometriosis, we need to establish with a surgeon. They're like, but I don't wanna be on medication, or I don't wanna have surgery. And I'm like, I hear that, and? Mm-hmm. I want you to know who's on your team before you're desperate to have them on your team. That's how we have better decisions. And so I think that is step one when we're talking perimenopause, is that we've got to work them up. We've got to do a full history. If you have a history of PMDD, I already know oral estrogen is— or excuse me, oral progesterone is probably not going to be tolerated well for you starting you at like 200 milligrams. Maybe we could start you at 100 milligrams. Maybe you might be someone that I have to have to start at 25, and I have to hold for a period of time. And the reason is, is that there's dysfunction in the GABA receptor, and there's a lack of neuroplasticity and usually neuroinflammation taking place. So we've got to help with neuroinflammation. That's step one for sure if we want progesterone to work. But we also have to go slow and let the brain have time to be able to be— basically bring that neuroplasticity to a place where they accommodating the allopregnanolone coming in. And then we might also have to have discussions about going a different route if we're going to use estrogen. So currently in the United States, it's not recognized as acceptable to use vaginal progesterone to protect the endometrium if someone's on estrogen therapy. The British Menopause Society, however, is very much recognizing progesterone intolerance is real. Some women are rapid metabolizers. They go into allopregnanolone so fast. We can start with slow-release progesterone sometimes in those cases, but in other women, we're trying everything and it's like we just need to bring on some vaginal progesterone. And that is, you know, something that you want to know this ahead of time before going in. And then we want to look at when do we intervene with estrogen. I think waiting until you have hot flashes is usually too long. And why I say that is because for these ADHD women, they typically are going to exhibit Lack of executive functions. Those are declining even more. They're starting to feel like I have brain fog all the time. I'm losing those words mid-sentence. Like I can never know where my keys are. I'm losing my wallet every day. You know, I think society likes to make make jokes of women's experiences. Oh ha ha ha! The forgetful, flighty woman. These things are detrimental to someone's life. Losing your wallet. Having to go to the DMV every other month to get a, like, new ID. Like, we don't ever in society account for the time in women's lives, right? It's like our time is just freely given.

Endless, yeah.

Yeah, and there's none of this, like, you only have so much time on the planet, you need to spend it doing whatever you came here to do in your highest good, and you shouldn't have to be expending extra energy on all of these things. We also see sleep declines really early. Okay, so, you know, I'm talking a lot about hormones, and I have a whole chapter in the book, and I go through the different hormone therapies. I even give dosages because I'm intending that this is a book you take to your provider, and we get your provider to get on board. We start making this change we need in medicine. But, you know, before we even get to the hormone chapter, maybe this will upset some people, we're talking about gut health. So I go all into gut health, then we go into dietary practices, then we're going to talk about sleep, we're going to talk about exercise, like we're going to talk about all these core things. But, you know, why we do that first is it's absolutely foundational. But I also recognize that sometimes your best efforts, you're never going to get that sleep without hormone therapy. So, you know, roughly like 70% or more of those with ADHD have some kind of sleep disorder. They do not sleep. And there is a phenomenon known as delayed sleep phase syndrome.

Mm-hmm.

Your melatonin may rise at 9 or 10. My melatonin wants to rise at midnight, 1:00 AM. Well, not me because I've trained my body very, very well. But this was my husband when we started dating. And he's like, I do my best. He's also ADHD. This is how, like, genetically, there was no rolling the dice. It was guaranteed.

Yeah.

We had an ADHD kid. But neither of us knew we were ADHD until we were adults. But, you know, he's like, I do my best work Wow. And that is something that can feel so wild to people, and yet it's so normal for the ADHD brain because of that. But if you consider women, we need more sleep than men typically, and that sleep directly impacts our hormones, not to mention the glymphatic system of the brain. You— so that lactate that I said, exercise, you guys, it's so great for your brain energy. Like, if you want 2 to 3 hours of focus, put in 2 to 3 hours of exercise. 20 minutes of zone 2 cardio and you'll get it. But if you don't get good sleep, we don't clear that lactic acid out. That just sits in your brain and it actually starts to work against you. So, you know, that's the other reason why I'm like, started with hormones as a starting place, because I would love to tell you just sleep and exercise, because we know musculoskeletal syndrome of menopause is real. Without estrogen, you're like, every time I move my body, it's the worst pain in the world. And I have no dopamine, how am I gonna motivate you to exercise? How's that gonna happen?

I love that approach. That's kind of our approach too, is like, give people the leverage to do the other things, right? If we can move some of those cogwheels around and give them support in that, it's so freeing to be able to change your lifestyle, work on your gut, exercise, all the things. So I absolutely love that approach. I wanna ask one more question about So let's talk about the inverse situation for women that maybe have already been diagnosed with ADHD. Maybe they're on medication, maybe they're not, but they haven't addressed everything else.

Yeah.

And they're hearing this for the first time. What would your advice to them be?

I would definitely look at your dietary habits. So the research on gut health and ADHD absolutely blew my mind. There's not an ADHD gut profile at this point, and I say yet because we might get there, understanding that there's a female ADHD gut profile and then subsets within that. But what we do understand across the board, ADHD individuals tend to have much lower microbial diversity.

Mm-hmm.

As we lose estrogen, you're gonna lose microbial diversity. So we wanna intervene sooner than later on that, and that means You know, in the book, I call it microdosing your microbiome. Food aversions are very common in this community, and so instead of you thinking, okay, I have to eat like the entire chia seed pudding, which, gross, I don't like that, can you just sprinkle some chia seeds on something and give your gut a little something different to munch on? And so this is so important because when it comes to the inflammation we experience, that can be coming from the gut. We also understand that, yes, we make lots of neurotransmitters in the gut. They do not cross the blood-brain barrier, but what they do is they are interacting with the vagus nerve. So, within the book, I go through all of these practices to help you support your gut and also how to support your vagus nerve. So, fiber diversity is really important. The majority of ADHD diets, are low in fiber, high in ultra-processed foods, when you look at the research. So, someone might be listening to this and be like, not me, because I follow McCall. And then, yeah, maybe not you. Not me either, because a special interest of mine at 18 was nutrition. Like, praise everything good for that. But what's interesting is that we've got a lot of research on children, and what it shows is that children who have high polyphenols, lots of plants in their diet, high-quality proteins, lots of omega-3 fatty acids, they have less incidence of ADHD symptoms that is hijacking their life. So it doesn't tell us that like any one diet is like, oh, absolutely the best diet. What it tells us is the foundations that we find in something like the Mediterranean diet are absolutely crucial. We also understand from the research, emerging research so fascinating. ADHD people seem to have different metabolism when it comes to omega-3 fatty acids and protein, so they likely need more protein and more omega-3s. And I believe as we find more, we're going to also find that, like, these are the people who are like, no, I need way more B12, right? The RDA has never considered these people in their life, right? So it's very interesting because when you look at the research with, like, omega-3s, There's studies that are like, yes, it helps. Other studies are like, it doesn't really help. What we know is that it's not actually the DHA, and that's what so many supplements targeting ADHD people are, is they're like, brain health, DHA. It's EPA. It's bringing down the inflammation. It's usually a much higher dose. So rather than that 1,000 to 2,000 milligrams, it might be like more than like 4,000 milligrams, and it takes much longer. And why does it take much longer? Like, it's 3 months or more to see benefits. Because neuroinflammation is very, very hard to bring down. So, if someone's listening to this right now, and they're like, what should I do? I would start with, how many plants can you get in, in a day? And when I talk about plants, it's not just about like, oh, eat your leafy greens. Can you add rosemary, oregano, thyme to something? These all count. They're all giving you polyphenols. Can you get more fruits in? It's great sources of polyphenols. So, we wanna up the fiber. We want to up the protein. And then one thing that I ask people to bring in is ghee because it's rich in butyrate. So we want to get your gut bugs working for you to make that butyrate. But what we understand from the research is that butyrate not only helps with healing the intestine lining, it helps with bringing down inflammation, it actually helps with the blood-brain barrier as well. And so instead of just having butter, having ghee instead, like making that quick swap, can actually start to change your gut health and I love it.

So you've hinted at so much valuable information in your book, but I want you to share a little more about it— the name, when it comes out, and anything else that you want to kind of share with us. I honestly can't wait to get my own hands on it, so please tell listeners.

Well, firstly, I need you to know that I put a cheat sheet in the beginning that you can skip all the boring stuff if you want. So, so the book is ADHD and And the first 3 chapters, I will say, are very science-heavy, but it's because I want you to understand your operating system. So, you know, we're just setting you up in the beginning to really understand, like, what the heck is ADHD, then, like, what is going on with your hormones and how your hormones make you manifest differently with ADHD. So, like, a low testosterone woman is going to look different than a PMOS woman in terms of their presentation. Which, warning to everyone, I should say this, is that if you start— I always say this to patients, okay, we need to start testosterone therapy, I need you to hide your credit card for 2 weeks. Because impulsivity, even if it's the right dose, impulsivity goes up when we've had a deficiency in testosterone and then we replace it. Impulse— you might be more hyperactive. That's not a big deal for women. They're usually like, I'm going to the gym, I'm doing all I'm playing with my kids, like, great. But the impulsivity, as someone who started testosterone, and my husband was like, you warn women this all the time, and then I catch you going into the pet store looking at puppies being like, I think we should get a puppy. Oh, no. And he's like, well, do you wanna sleep? And I'm like, ah, it's a done deal, okay, right? Like, that's all you have to say to me. I bought 2 pairs of sequin pants instead. I don't wear them, but I have them. The impulsivity was like so, so bad. also, like, I, um, like, got really nostalgic for every video game I played as a child. So I just, like, went on Nintendo and bought, like, Mortal Kombat and, like, Tomb Raider. And my husband's like, did you literally just buy all these video games? And I'm like, I'm like a teenage boy right now.

Right.

Like, this is so ridiculous. So I do like to put that warning out there because I think a lot of people are offering testosterone therapy more to women. I love that. Um, and at the same time, I think just be warned, it doesn't mean your testosterone dose is wrong. It's just that your brain will be like, woohoo!

It's coming online.

Good times. So, uh, you know, in the book I, I offer a lot of like nuanced things like that. Um, but the, the middle section is where it gets really meaty into like the how-to. And I take you through, I basically give you a handbook to your gut health, your sleep, your exercise, and very ADHD-specific. So there's quizzes all throughout of like, why are you not feeding yourself? Like, let's figure that out. Is it executive functioning issues? Is it like icks? Like, I just have food, like, aversions. Like, and I help you really address things from, like, the ADHD perspective, including getting into supplements that are evidence-based, hormones that are evidence-based. And then I put it all together in a 14-day reset. And I know people are going to be like, oh, why isn't it just, like, fix all the things? Well, This is a lot of layers. It's a lot of layers to go through. And it's my hope that you will do the reset in the time you're looking for a provider to partner with. And I don't think that, I mean, especially if you need hormone therapy, you can't do that alone, but I don't think you should have to DIY everything in your life. And I think that's a big trip up in the, you know, entire wellness space is how often we're trying to get women to DIY everything. Women are already doing enough. So in the book, there's also a whole section of like how to use this with your provider. So get started in the 14-day reset. That's gonna lay all the foundations. And if you get to the right provider, they're gonna be grateful for the work that you've already done because they'll be able to 10x your results just by taking you the extra step.

I love that. So valuable. And when does it come out?

October 6th.

And where can people find out more about it?

Uh, if you go to drbrayton.com/adhdandwomen, There's a bunch of bonuses there too. So you can get like a PMDD workshop, you can get an ADHD hormone workshop. There's the Focus Plate Method meal plan that I've put together that I've used with patients for years of like how to actually eat to get your brain to focus. Because while your diet didn't cause your ADHD, your diet is one of the most powerful tools that you can leverage 3 times a day to help modify your experience.

Well, thank you so much for this. For your work endlessly advocating for women, because you truly, truly work overtime for us. And this is such a needed conversation and material that we need as women. So thank you so much, and thanks for being here today.

Yeah, thanks for having me.