Nurse Maureen‘s Health Show
Welcome to Nurse Maureen's Health Show Podcast where we dive deep into all things health, sex, menopause, relationships, parenting, communication and more! Hosted by a passionate nurse with years of frontline experience, we bring you expert interviews, real-life stories, and the latest insights on staying healthy aging. Nothing is off limits as we delve into overall health, sexual health, mental health, and sexual health. Whether we’re breaking down medical myths, discussing cutting-edge treatments, or chatting with top health professionals, this show is your go-to for practical advice and inspiring conversations.
Nurse Maureen‘s Health Show
ADHD in Women: Hormonal Challenges in Menopause with Dr. Anita Parhar
Could the future of ADHD diagnosis and treatment be hiding in plain sight? Join us as Dr. Anita Parhar, educational director and director of women's health at the ADHD Center, uncovers the realities of ADHD in women and challenges the stereotype that it primarily affects young boys. With her wealth of experience, Dr. Parhar enlightens us on the systemic misdiagnosis issues that leave countless women struggling without appropriate care. This episode promises to reshape what you thought you knew about ADHD and highlights the essential role of education and advocacy in transforming perceptions and improving life outcomes for women living with this condition.
As we navigate the complexities of ADHD during hormonal transitions, the discussion turns to the startling findings of a 2021 survey by the Centre for ADHD Awareness in Canada. With 46% of women initially misdiagnosed with other disorders like depression and anxiety, Dr. Parhar emphasizes the need for a nuanced understanding of ADHD's long-term impact. She delves into the compounded effects of hormonal changes during perimenopause and menopause, bringing to light how these fluctuations exacerbate symptoms like brain fog and concentration difficulties. The conversation also explores how societal misconceptions can delay appropriate treatment, often for decades, and urges a closer examination of the coping mechanisms women develop to manage these unique challenges.
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Speaker 1:Good evening and welcome to another episode of Nurse Maureen's Health Show Podcast. Thanks so much for tuning in If it's your first time. I'm Maureen McGrath. I'm a registered nurse, nurse, continence advisor, sexual health educator. I see lots of patients in my clinical practice who are experiencing perimenopause, menopause, postmenopause, midlife issues, lots of other clinical issues, including our subject today.
Speaker 1:We often associate ADHD attention deficit hyperactivity disorder with little boys in school who are fidgeting, but the reality is that ADHD affects boys, girls, men and women alike. Adhd is a highly genetic neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity and impulsivity that are inconsistent with a person's developmental level. These symptoms can impact individuals across their lifespan, affecting their academic performance, work life relationships and social interactions. Adhd is one of the most common mental health disorders, affecting approximately 5-10% of children and about 2-5% of adults worldwide. While traditionally linked to childhood, many people continue to experience symptoms well into adulthood, and it affects both men and women alike. However, adhd often goes undiagnosed in women, partly because of the way symptoms manifest themselves, the coping mechanisms that women develop and the influence of hormonal changes. This lack of recognition can lead to untreated ADHD, which can significantly impact a woman's quality of life and increases the risk of secondary issues like anxiety, depression, low self-esteem, substance use.
Speaker 1:The list goes on. Joining me on the line to talk about this is Dr Anita Parhar. She's the educational director of the ADHD Center and the director of women's health at the ADHD Center for Women. In all of her educational endeavors, she focuses on working with communities who have been under-recognized. In working as a university instructor who trained teachers, she recognized the need for a greater awareness of ADHD and the importance of diagnosis and treatment of adults living with ADHD. Dr Parhar has extensive experience in understanding the many ways ADHD presents in adults and the challenges many living with ADHD work through on a daily basis. Good evening, dr Parhar. Thanks so much for joining the podcast. Good evening.
Speaker 2:Maureen, thank you very much.
Speaker 1:I really appreciate you coming on. What role do you believe education and advocacy play in improving the understanding and treatment of ADHD in women?
Speaker 2:Well, although ADHD is a common neurodevelopmental disorder that negatively affects women's daily functioning, it remains misunderstood, undiagnosed and undertreated. So through education and advocacy, we hope to positively impact the lives of women living with ADHD and women and their families.
Speaker 1:Which is an awesome goal, and you mentioned that women are often misdiagnosed. Why do you think this happens and what are some of the consequences of this misdiagnosis?
Speaker 2:Why do you think this happens and what are some of the consequences of this misdiagnosis? That's a fantastic question. There are numerous factors, One main one you mentioned it to begin with in your introduction and that is, unfortunately, the stereotype of ADHD as being a behavior disorder, of traditionally boys in elementary school is still pervasive. So many practitioners, educators, parents, adults, among others, have an image in their mind still of a disruptive, unmanageable boy who can't be still as having ADHD, and I totally get it. I had that image in my mind, but that was 30 years ago when I first began teaching in elementary schools.
Speaker 2:I didn't know much about ADHD. I didn't learn about it through my teacher training in university. One thing, though when I was teaching in the classroom, I was aware that there were children whose parents would come at lunchtime and give them something medication and that would help them get their child through the afternoon in school, but I really didn't have an understanding of what that was all about, and at that time, for the most part, others parents, other teachers, the principal, even students judged our competency as teachers by our classrooms. So, in other words, it needed the classroom that is needed to have kids that were calm, sitting in their desks doing their work. We expected kids to participate in group discussions and group activities as well-behaved kids. Now it was a problem when the classroom was loud, when the classroom door was closed and the activity in the classroom could be heard in the hallway, or the teacher's voice could be heard in the hallway. So, as a child who could not sit, still didn't seem to be listening, called out, walked around the classroom, possibly doodled, I remember kids playing with their liquid glue, making bouncy balls, clicking their pens repeatedly, going to use the pencil sharpener. They would disappear when they went to the washroom they didn't look up at us when we spoke to them, so really they didn't pay attention and it's quite embarrassing, especially now, given how much research has been done and we've learned about just ADHD in general. It's quite embarrassing to admit that it was the child that was considered the problem, not the structure that we provided the kids that contributed to the so-called problem.
Speaker 2:We have come to know that people living with ADHD display differences in cognitive processes. It's not a behavior issue. The processes affect memory, self-awareness, managing those impulses, managing emotions, planning, organizing, initiating tasks. So, in looking back at my experiences as a teacher and looking at behavior of the kids, while it wasn't the behavior that was a problem. Of course their behavior is going to look different if their cognitive processes are different, so that's one. The gender and stereotype is definitely still a barrier to that.
Speaker 2:Additionally, we know that a lot of people have criticized the diagnostic criteria used in the assessment and diagnosis of ADHD as being outdated. So the rating scales, the questions that were used, have been normed. They use studies that were mostly based on studies where the participants were males, and not only that geared toward diagnosing children. So they're not very specific to the experiences of adults, particularly women. And I guess the third area I'll comment on is the information that's being provided to us practitioners, the public, about accurately diagnosing women based on research. So there's a lack of research in the field of ADHD and women to guide practitioners and, I guess, those really responsible for accurately updating the diagnostic criteria. So, as a consequence, women living with ADHD has significantly increased rates of vulnerability to both physical and mental health disorders.
Speaker 1:There's just so much to unpack there. I mean, I heard stigma, you know, with parents coming in and giving medication in the middle of the day, unawareness, unaware that this is a neurodevelopmental disorder. You know, people going undiagnosed, lack of research in women's health. We see that not only in ADHD but also perimenopause and menopause. You know, oftentimes, when women present with symptoms, wondering what is it that I have? There's obviously something wrong with me. I've struggled my entire life. Can you tell us, dr Parhar, why ADHD manifests differently in women as compared with men?
Speaker 2:That's really key there, maureen. I guess for those of us who have begun to listen to the lived experiences of women, we find that, unlike boys and men, women more so internalize their symptoms and impairments. So women want to be seen as competent. I mean, who wouldn't Women tell us that they were expected to be quiet when they were young, going through elementary school, then becoming a teen, becoming a young adult, they were expected to be polite, to follow directions, to have nice handwriting, to be neat, organized and sensitive to other people's feelings. As a result, they mask their symptoms, they blend in, want to be like the neurotypical world, which makes their struggles easier to be overlooked.
Speaker 2:Right, so we use terms that we see fit, I guess, because they make sense to us and possibly explain the behavior of the perfectionist or the people pleaser. But really that's inattention being overcompensated for. They struggle with self-doubt, fatigue, anxiety. Women exert an extraordinary amount of effort to conform and appear competent. They exhaust themselves, hiding their struggles. And then we have women who say, yeah, they were influenced by family expectations, despite the so-called culture that they come from and social norms. They need to manage themselves, they need to manage the home, they need to manage the family, and we know that women living with ADHD well their lives aren't wired in the way to accommodate all of those demands, in the way that we would expect a neurotypical person.
Speaker 1:That's just amazing. I've heard so many patients say that they were a perfectionist, but also say they were ADD or attention deficit disorder, which I never put the two together and I never realized. So many women were compensating as well. It's also very difficult for GPs to come up with a diagnosis of ADHD in women or ADD in women, for many of the reasons that you spoke about earlier. What are some of the common signs of ADHD in women that are often overlooked or mistaken for other conditions?
Speaker 2:Right. So we know that as stress for girls leading into adulthood women, they increase. So we see anxiety, for example, increase, symptoms of depressed mood increase, eating orders developed and this often leads to anxiety and depression incorrectly being diagnosed as the primary disorder. So there's, you know, we know there's a lot of overlap between ADHD symptoms and what appears to be depressed mood, what appears to be anxiety. But there are some differences that we can tease out, the overlapping symptoms of what ADHD with anxiety?
Speaker 2:What anxiety is in itself an anxiety disorder, but if anxiety and depression are secondary conditions, treating them is great. But that still doesn't get at the root of the issue of ADHD. There was a paper released in 2021 by CADAC, the Centre for ADHD Awareness in Canada, that in their service, in a survey sorry that they conducted of Canadian women with ADHD, of Canadian women with ADHD, they found that 46% were misdiagnosed with another disorder prior to actually being diagnosed with ADHD. So the primary difficulty they were having were related to ADHD, but it wasn't teased out. Instead, depressed mood and anxiety were the ones that were seen as issues that need to be addressed first, and then 60% of those women felt that their treatment had been delayed one or two more decades than it could have been.
Speaker 1:Wow, all sobering stats, if I must say, the first one being the association between ADHD and eating disorders. That is incredible that an eating disorder can mask ADHD in women.
Speaker 2:Definitely for sure, and a lot of it stems back down to the self-esteem, self-worth, wanting to fit in and then finding ways to cope, whether it be not eating, binge eating, anxiety may be related to that, depressed mood may be related to that, but definitely eating disorders, uh. And women, now young girls, leading into teenagehood, into women uh, that's something that's being looked at. Well, why is that? Why is eating something that we've overlooked, I should say, in the past?
Speaker 1:Right, that's just unbelievable, and you see a lot of women. They say eating disorders are a lifelong disorder, as is ADHD.
Speaker 2:That's right.
Speaker 1:Yeah, it's just amazing. We're just going to take a moment, dr Parharam. We're just going to go to some of our fabulous sponsors. We'll be right back. If you enjoy the show, there's one simple way you can show your support Just hit the follow button on the app you're using to listen to the show. Right now, I'm working so hard to take everything on the show to the next level, and your follow means a lot to me. It's the only free thing I'll ever ask of you and it truly makes a big difference. Thank you sincerely for your support. I truly appreciate it.
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Speaker 1:Welcome back to Nurse Maureen's Health Show podcast. I'm talking about ADHD attention deficit disorder with Dr Anita Parhar. She's the educational director of the ADHD Center and the Director of Women's Health at the ADHD Center for Women. We're talking specifically about ADHD in women, which often goes undiagnosed or is diagnosed much later in life, often decades after symptoms started to appear. Dr Parher, thanks so much for staying on the line and I wanna talk about perimenopause, menopause, postmenopause. It's having not just a moment, it's having a movement. Hormonal changes seem to play a significant role in how women experience ADHD. I see a lot of women coming into the clinical practice in their mid-40s 50s saying I'm not sure what I have. I'm not sure if it's perimenopause or if it's ADHD. Can you explain how these changes affect focus and concentration for women?
Speaker 2:For some women, hormone fluctuations varying levels of estrogen do impact focus and concentration. For certain weeks of the month. Some women find focus and concentration more difficult. Some women living with ADHD may experience PMS more acutely. Women going through perimenopause and menopause they report to us that they feel greater fuzzy thinking, their memory isn't as great, their moods vary more so, they're tired, they're fatigued. So we know that the experiences of women who are going through different hormone fluctuations, when they say that their memory, focus, attention, is impact, we should actually listen to them.
Speaker 2:And many say that you know, I've been holding it together. I can't believe that I've gone through all of these years doing what I've been doing. I appear to be organized. People say I look organized, I'm calm. But what they don't know is that all of these years I put a tremendous amount of energy and time into keeping it together. But now I can't keep it together anymore and I don't understand if it's really menopause that's causing it. And for us, then, is to ask the questions of what underlying struggles, what underlying issues have you had all these years and what are the different masking coping mechanisms that you have been using to keep it together? And is there really an overlap between now the estrogen levels affecting the brain and brain chemistry. More so, that's also taking into consideration the past of having symptoms of ADHD.
Speaker 1:You know and so many women report brain fog and you know, sometimes it can be a new symptom. Does it matter if it's new or it's been there for a while?
Speaker 2:Well, that's kind of the key For ADHD. We know it's a lifelong disorder, so it has to do with partly brain development and so as a young person, your brain an ADHD brain did develop differently as a result. You know that carries through for a lot of people into adulthood. So, depending on the coping mechanisms, depending on the scaffolding, depending on where one has sought help, how much they've learned, grown, the symptoms may be there, they may not be as prevalent, they may have been more manageable, Whereas with differences in chemistry in the brain now, as a person who's a little bit older, the symptoms that were there before are now reappearing more prominently and possibly in a different way. That wasn't accounted for before.
Speaker 1:Very interesting and I just want to mention that perimenopause, or the years leading up to menopause. It can be 10 years before the menopause. Average age of onset is 51. You're poised, fortunately, because there's so much lack of understanding, misinformation, awareness raising that's needed. So you're poised, to open up a new ADHD center, a new attention deficit hyperactivity disorder center, strictly for women. How will this new ADHD center for women aim to address the specific challenges that women with ADHD face?
Speaker 2:Well, we have consultants that are very much in tune with women's issues ADHD. They're in tune with, but with, women's issues ADHD. They're in tune with, but specifically, women's issues. So, for example, the questions they may ask will be more specific to women's histories, coexisting conditions, the impact of hormones, the developmental years, For example, for adults, for women, a more for women. A more appropriate question, maybe asking them to what degree have you been having trouble reengaging with tasks Once your attention has been diverted?
Speaker 2:You're in the kitchen, you're cooking, your child comes, asks you a question. You get really frustrated. You take it out on the child. So are you frustrated by the fact that your child is interrupting you? Are you frustrated by the fact that you're just being interrupted? How often is your time and energy taking up with coping and holding it together, with no time for fun and relaxation? How often do you feel that you have great ideas you have so many ideas of what to do, plans with the kids and the family, but you're unable to organize them and act on them. How often have you had difficulty processing what people are saying to you, even though they're speaking directly at you? How often does that extra request somebody asks of you at home put you over the top emotionally. So it's taking into consideration what women are saying, their stories as one, recognizing them to be true and then teasing out from within that lived experience. What does that look like for you as an individual woman, in your circumstance, and how can we help you move forward?
Speaker 1:It just sounds awesome, you know, for women listening out there right now who might think this is me. What advice would you give to a woman who suspects she might have ADHD but has not yet been diagnosed?
Speaker 2:Well, I think first it would be to go to your primary care provider and have a conversation. It could be with a physician, your nurse practitioner, a counselor, a psychologist. Start a conversation about could this possibly be ADHD? This is what I'm experiencing, this is what I've experienced in the past, this is what it looks like now, and if it seems to be ADHD related, then maybe seek out a formal diagnosis.
Speaker 1:And how can listeners get more information about the ADHD Center for Women or access the support and resources that it offers?
Speaker 2:Oh well, they can go to our website ADHDCenterForWomencom. All the content is there. Information is there. Our how to access services are there? A lot of other resources pregnancy, menopause, sleep coaching, counseling, dealing with relationship finances all specific for women are there.
Speaker 1:That is awesome and you know, there just sounds like there's so much hope associated with this for women who have been struggling for decades in school, with relationships, professionally, personally, to all of a sudden have a proper diagnosis. I would say that can be life-changing. What do you see in women that you treat?
Speaker 2:Definitely life-changing and to change the trajectory of women's lives moving forward, for them to feel like they've been heard, they've been recognized and that they can change their lives in a way that they would like to see how they would like to improve. And the goal is for women to feel that they are living their best future life.
Speaker 1:That's awesome, Can you just say for the listeners? The website again, Dr Parhar.
Speaker 2:It is ADHDcenterforwomencom.
Speaker 1:ADHDcenterforwomencom. That's where you women can get more information about ADHD and to see if that is the diagnosis that you perhaps should have been given, instead of anxiety, depression or something else. That was just a Band-Aid. Thank you so much, dr Parhar. Really appreciated having you on the program.
Speaker 2:Thank you, Maureen.
Speaker 1:You're welcome. That was Dr Anita Parhar. She's the Educational Director of the ADHD Center and the Director of Women's Health at the ADHD Center for Women, and I am Maureen McGrath. Thanks so much for tuning in to the podcast. Thanks for all of your follows, your downloads and your comments and your ratings. I really appreciate it. Until the next episode.
Speaker 1:You've been listening to Nurse Maureen's Health Show Podcast. Thanks so much for tuning in. I'm Maureen McGrath and you have been listening to the Sunday Night Health Show Podcast. Thanks so much for tuning in. I'm Maureen McGrath and you have been listening to the Sunday Night Health Show Podcast. If you want to hear this podcast or any other segment again, feel free to go to iTunes, spotify or Google Play or wherever you listen to your favorite podcasts. You can always email me nursetalkathotmailcom or text the show no 604-765-9287. That's 604-765-9287. Or head on over to my website for more information. Maureenmcgrathcom, it's been my pleasure to spend this time with you.
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