ADHD & Estrogen 101

In this short episode I outlined how estrogen (and its fluctuations during our monthly cycle) can impact our ADHD symptom presentation. I also went into cyclical dosing - what it is and how it can help those of us with a cycle.

In the second half of the episode I elaborated on perimenopause and the difference between a neurotypical in perimenopause and someone who has made it to perimenopause without knowing they are ADHD.

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Transcript

 This week. I really wanted to jump in and talk more about hormones and especially estrogen and how that impacts our ADHD. 

In intention, my group coaching program, we went really in depth about this earlier this month. So I've pulled some clips from that.  As well as adding some additional context to things. 

I guess the disclaimers to start off, like, obviously, I'm not a doctor. I'm not a healthcare professional. I'm just someone who has, like, I've done loads of research, and I'm now distilling that down and passing that on to you and as I say, because what we're mainly talking about today is, female sex hormones, so it's in reference, to people that are, cisgender female and have been assigned female at birth.

And if that's not how you,  now identify, we're now just talking more about like the physiological sense  I do want to put that little caveat that even though I have tried to give you a good comprehensive  explanation of what they do.

Of course, I had to condense things, things were left out for brevity, the body is really, really complex.  We've done such a disservice, not we, the medical community has done such a disservice by Gendering hormones  because it leaves out the fact that both men and women  have estrogen and testosterone within them.

Estrogen also really plays a role in our dopamine synthesis, which is just essentially how your dopamine is processed and used by your body. It also plays a role in the reuptake. So that means how much of it is getting used when it doesn't need to be used? Think of it that way, kind of. Which does factor in again for everybody, but especially when we have ADHD, we already struggle to use dopamine in the most efficient ways.

So dopamine is a neuromodulator,  sometimes also called a neurotransmitter. They're not technically interchangeable, but let's just Call them interchangeable for now. It's involved in a lot of brain functions, but especially those of us with ADHD, no. It's involved in intention, motivation, our reward process, so when you're doing something, you get that like, bing bing bing bing bing from accomplishing the thing, even if it's not the thing that you're meant to be accomplishing.

, and executive function, and executive function encompasses a lot of things, right?  Task initiation, task prioritization, planning, et cetera.  These are all areas, of course, that we know are common struggles for people with ADHD.

And it is thought that one of the markers of ADHD is that we have a difference in dopamine modulation, which plays a role in how our symptoms present, right?  

The  estrogen fluctuations that we have during our monthly cycle do impact our ADHD. So when estrogen is at its lowest at the start of our new cycle, or when we start our period, and then it begins to gradually increase as we lead up to ovulation, when the egg is released from your ovaries, after ovulation, the estrogen  plummets.

That's the word I use all the time because that's what happens. It plummets.  There is like a very slight uptick say around day kind of 2021. That's like in a typical 28 day cycle, but around that day 21. But overall it's quite low until we then start a new cycle and then it begins to rise again.

Estrogen impacts our ADHD symptom presentation as it goes through these peaks and troughs through our cycle because of the way it interacts with dopamine as well as other neuromodulators,  norepinephrine, , sometimes called adrenaline, and serotonin. There are some theories that with the different ADHD subtypes you can experience increased or decreased symptom presentation depending on where the estrogen is.

So say someone who is a much more of a hyperactive subtype, yes, they might be feeling physically really good. They might have less brain fog and more cognitive, , success and less executive function struggle as ovulation. But that increase in estrogen and testosterone may also mean that they have more impulsiveness.

They might have a harder time controlling their hyperactivity, when we look also then say it's someone that is slightly more inattentive presenting when we have these low levels of estrogen, which is in our late luteal. And then as we start a new cycle during administration, those can contribute. 

Even more so we then those times often already have brain fog, , less cognitive flexibility, more irritability and mood issues. But for those of us that are more inattentive, it can also kind of make that even worse and present as things like increased anxiety, increased racing thoughts, inability to control your thoughts, which is, of course, we know already we struggle with.

But essentially think of it like this. Your hormones are quite low, like baseline low at the the beginning of your cycle. So when you start to bleed,  They gradually over that kind of, let's say in a, in a 28 day cycle. Over the next 13, 14 days, it is going to increase your estrogen. What did we just say? 

Estrogen is involved in dopamine synthesis, which means our ADHD symptoms might be better controlled. Also if you're on ADHD medication, especially if it's stimulant medication. It will be working better. The higher your estrogen is on the flip side of that. The lower your estrogen is it is going to not work as well, which is when we look at cyclical dosing, we're going to talk about that in a second.  But dais. One to let's call it 13, that estrogen is having this kind of slide uptick curving upwards it peaks as you go into oscillation. 

And then as we said, it plummets, it drops down.  Does have that slight uptick around DEI. 2021.

As we've just said, and then it drops down again to that quite low level where it remains until we start our next bleed. So what does this look like in a 28 day cycle? And I'm just saying 28, because that's fairly, um, Typical average, some people, your regular is going to be shorter. Some it's going to be longer, but 28 set kind of average point. That means that. 

Everyone's a bit different, but let's say day six today, 13. You're probably gonna feel pretty good. You're probably gonna have better cognitive function, better cognitive flexibility, perhaps better emotional regulation. Better in general, executive functioning and your stimulant medication may feel like it's actually doing its job. 

It's actually working the way we want it to. We hit that day 13, 14 ovulation drop drop drop, drop drop. 

You're feeling like, oh, okay. Everything's maybe not starting to go so well.  Maybe that little uptake around day 21. It's like, oh, okay. I maybe I'm all right. Maybe drops down again.  . remains low. 

For the remainder of the cycle today, 28. And then we just continue. 

If we look at cyclical dosing. So what this means is. 

You have.

Kind of backup. Stimulant medication to help you at those times when your estrogen is low. 

So actually empowered by information, , from letter life from Dr. Lotta Borg Skoglund. And then obviously through my own deep dive research, I have recently. Approached my psychiatrist and requested cyclical dosing. What that means is for me, everyone's going to look a little bit different, but, This is kind of the protocols that we're trying, that seems to work best for that cyclical dosing option. I am on an extended release that I take every day.  For me, that's five aunts. And then on the days where I feel like I need a little bit more, which coincides with the estrogen being low, right. Those days I have the option of a immediate release or sometimes called a short acting.  To help me. Out. 



That's up to my discrepancy. 

I don't have to do it. There are two separate medications. I'm committing to take the Vyvanse every day.  And then the immediate release is just an option. Some doctors, for some reason, won't do this. Some doctors for some reason, don't understand how. Uh, females, hormones interact with our ADHD, which kind of just seems bonkers to me. 

Like if you are. Uh, doctor a psychiatrist. Et cetera. Treating. Females that have ADHD you need need, it is imperative that you understand this hormonal element and the complexity that it can bring to our ADHD because unlike our male counterparts,  And again, I'm talking from  a,  

Physiological hormone standpoint, if you no longer identify that way. 

Forgive, if I'm.  Not using terminology that suits you. 

But for our male counterparts there.  Hormone cycle is 24 hours one day. One day, they get the same thing every day. Rinse, repeat cycle. Continue.  Females look, we've talked about, once you start menstruating kind of, as you go into your reproductive years, they're called. We have again on average, a 28 day cycle one month. And I'm ParaMed, I suppose. Pause throws everything off the rails. 

And we'll talk about that later. But. Doctors need to understand this hormone aspect and how it impacts our ADHD.  

If you're not on cyclical dosing. If you feel like this is something that could be beneficial. I urge you to do research, email me, message me. I will send you information if you would like.  But I urge you to do research and be your own advocate because we should be in partnership with our doctors. They should not just be dictating to us. 

Our only options we should be going to them and saying, How can we collaborate and find a medication or a treatment protocol that actually works for me.  And for my life.

And this can become even more imperative. If you are dealing with something like PMDD, where we are. Really much more sensitive to those hormonal fluctuations that happen  throughout our. cycle.

So when we have added complexities like PMDD or, just extreme PMS. Maybe it doesn't go the full two weeks that PMDD does, but it's maybe you have four or five days of PMS that's just like really hellacious. .

If you do have those extra circumstances going on, and then as we kind of come into looking at perimenopause and menopause,  still talking about from the, the estrogen standpoint, right? So perimenopause is that transition into menopause. What happens here is, All of our hormones, but especially estrogen, becomes less predictable, which means our cycles become less predictable.

They become more  erratic and sporadic and it can mean that you go from, say you've always had it, 28 day cycle and you had a five day bleed and you know the cycle continues.  It might mean that you go suddenly to having one month a 24 day cycle and one month a 32 day cycle and your bleed might go from two days to 10 days to six days to all of it becomes  less predictable not just when you're going to get. 

You know, the period  the whole thing when you ovulate becomes less predictable, also keep that in mind. If you're someone who like  uses natural cycle type contraception, because when we're in perimenopause, our cycles are not predictable. Not the same. And so we, we, um, ovulate when we don't expect that we're ovulating, but for some women,  when we look at ADHD, so tying in estrogen, perimenopause and ADHD,  I did a video a while ago.

, but where I used my daughter's blocks to show how our increased responsibilities add up to make it so that we can no longer cope with undiagnosed ADHD. We, we kind of get through life. We think. Yes, in early kind of childhood, hormones are not so much a factor because they haven't begun to rise yet, so totally fine.

Then we add on puberty, okay, a little less stable. Then we add on, you know, late teenagehood, early twenties. If you do go through motherhood, that adds on another block or a few. And then We come up to perimenopause, and if you can imagine a block tower growing, growing, growing, growing, growing, each of those blocks is being stacked on, each thing is something else that's making it harder for us to balance and to  stay stable  until eventually something comes, one too many blocks, and the tower falls over.  For some of us, that was university. For some of us, that was like, quote unquote adult life and having to manage, you know, bills and rent and work and all the rest of it. For some of us, that was motherhood.

And I'm not saying you didn't already struggle with those things beforehand, but you were like  somehow keeping your head Above water, and whenever this, whatever the block is that has made you tip over,  that's when you no longer can keep your head above water. That's when you are well, and truly, you know, drowning as we continue with that analogy.

So for some women, they have gotten through all of these blocks. Yes, struggling, but figuring out coping mechanisms for them. You know, working it out  until that perimenopause piece comes, and then the tower comes crumbling down. And what we know is, as our estrogen declines, as I said, we do have increased brain fog.

We have,  more irritability and mood instability, which means our moods become erratic and less predictable. We have these, what are often seen as typical ADHD symptoms.  But the difference is, for the woman who is in perimenopause and is drowning in ADHD symptoms, we'll say,  she can look back on her whole life and say, Oh yeah, I can see how these things have always been an issue for me, but I've just been able to figure it out.

I've just been able to, like, be the duck with my feet paddling, and people think that I'm, like, Somehow managing to do okay and perimenopause in this example,, you're no longer able to do that versus the woman who is, let's say, neurotypical. And she goes into perimonopause and she's like, Oh my God, do I have ADHD?

When we look back at her life, she's like, No, I didn't really struggle with these things before, you know, say before the last year or two. And that's the difference of, someone who  perhaps has gotten to this point and had undiagnosed ADHD versus not, though the symptoms do present virtually identical because we are dealing with really, really low or erratic estrogen, which plays a role in dopamine.

It's just for those of us with ADHD, it's  Much worse  and much harder to navigate because we already struggle with that. And a lot of the times perimenopause more often than not is diagnosed.  By you telling your doctor your symptoms. So yes, of course, very classically, we see like hot flashes is a symptom brain fog, but  unfortunately, we still don't have a reliable blood test to diagnose it.

And that's because in that period of perimenopause, our hormones are so erratic.  And what that means, yes, they, like, they peak and trough constantly, but they can change over the course of an hour. So I could have a blood draw at 8am and it could show my hormones were, let's say, quote unquote, normal for my age. 

I could have a blood draw at 8pm, 12 hours later.  And they could show, oh yeah, like something's definitely off here, your estrogen's way lower than it should be, which is also, I think, those of us that experience, like, PMS or PMDD, you, you understand this because you can go from feeling okay to 12 hours later, as, say, after ovulation,  if you have PMDD,  and that drop comes, you can go from feeling okay to like feeling like absolute rubbish because your hormones have changed and that's exactly what happens with perimenopause except it's You know, sometimes it's over the course of a day, sometimes it's over the course of weeks.

It's that unpredictability that really, really has some of us struggling. Not everyone. Some people get through it and they're just like, Oh yeah, I just stopped bleeding one day. And you're like, what?  What?  But some women do, unfortunately, really have a hard time with it.

It was just a short and sweet episode this week, but I wanted to dive a bit more into estrogen's role in our ADHD. So if you have any questions, as I said in the episode, please feel free to email me. Please feel free to message me on any of the socials. I am happy to. Offer some of my research and the rabbit holes that I have gone down. 

As well as recommend.

Different resources that might be useful for you. Once again, thank you so much for listening.  If you found this episode useful, please share it. Write a review, subscribe. All of that helps us grow. 

Which means I am going to be able to continue to get amazing guests to come on and share their. Knowledge with us.