ADHD and Hormones in Women: Why Symptoms Change Across Your Cycle and in Perimenopause | Agnes K. Simone & Annika Joya

Jolene Brighten (0:00)

What is the best time for the ADHD brain in the cycle?

Agnes K. Simone (0:03)

Definitely the follicular phase. I've seen so many women struggle during the luteal phase.

Annika Joya (0:08)

One week out of the month, and I'm on fire outside of that week. I either like, wow, I wish I could just quit everything, or I'm like, this is annoying.

Jolene Brighten (0:19)

The closer we are to ovulation, so much easier because of those estrogen levels. And then they enter their 40s, and suddenly nothing works anymore. Their brain is not their own. Can a woman suddenly develop ADHD at age 45?

Agnes K. Simone (0:34)

It's not exactly a late onset of diagnosis. It's...

Jolene Brighten (0:39)

Life has been difficult, and they've internalized these ideas that they are just lazy. They do just need to try harder.

And they put all of their energy into looking put together on the outside, while on the inside, they're completely screaming. And then they enter their 40s, and suddenly nothing works anymore. Their brain is not their own. They feel like they have to leave their career. They're no longer going to be able to function at work anymore. And they're feeling even worse about themselves. And they're being told things like, this is just late onset.

Agnes K. Simone (1:12)

Definitely not. We know ADHD is a neurodevelopmental condition, meaning it starts from childhood or adolescence. But what I see so often is that women are so good at masking. They develop all these coping strategies throughout their life to manage their ADHD symptoms. But then during perimenopause is what you're referring to, when hormones are all over the place. Plus, they have all these stressors like raising children. Perhaps they have aging parents. They have a stressful job or maybe they're at the peak of their career.

All these things add up, and those coping strategies just do not work effectively anymore. And so, it's not exactly a late onset of diagnosis. It's a late diagnosis of ADHD.

Jolene Brighten (1:58)

So many women with ADHD describe all the time. And that is that one week, they are functioning fine. They feel like their brain is solely their own. And then it's as if a light switch flips. And the next week, they can't remember where their keys are. Have they even eaten?

And what the heck was I doing staring into the fridge for the last 30 minutes? And so in today's episode, I'm joined by two experts where we're going to help solve some of these period problems, hormone problems, perimenopausal issues that so many ADHDers face. Can ADHD medication feel less effective at certain points in the menstrual cycle?

Agnes K. Simone (2:35)

Definitely. And I see this all the time in my practice.

Jolene Brighten (2:38)

All right. We're going to unpack that further today. But to Annika, I want to ask you, do you see women who are trying to solve those harder ADHD moments of their cycle, compensating with like sugar, caffeine, binge eating, or forgetting to eat, and inadvertently making things worse?

Annika Joya (2:56)

Yes. There are so many common patterns that we see just with the food cycle.

Jolene Brighten (3:01)

So if you are listening now for the first time, welcome to our ADHD Women's Series. This is our second episode. I want to encourage you to go back and listen to the first one on what is ADHD, so you can definitely get your bearings. But if you're joining us now, there's no reason to quit. Before we jump in, I want to have my lovely guests introduce themselves.

Agnes K. Simone (3:20)

I'm Dr. Agnes Simone. I'm a board certified psychiatrist. I practice in Los Angeles. I actually have two practices, my general psychiatry practice, as well as my midlife women's health focus practice.

Annika Joya (3:32)

I'm Annika Joya. I have my master's in health psychology and I specialize in ADHD nutrition research.

Jolene Brighten (3:38)

We're going to be doing a lot of hormones today. I think the first place we need to start is in knowing your menstrual cycle. For everyone listening, if you're not tracking yet, I think everybody here would encourage you to do that. Day one, it's the first day that you bleed. That's where your period starts.

We go through the follicular phase. We reach ovulation, the one-day event where the egg is released. As we pass that, there's a temporary endocrine structure known as the corpus luteum left behind. That's when progesterone gets to shine. While estrogen is still present, it's taking a backseat to progesterone. Progesterone gets to be the main diva and now estrogen is the backup mic. That's what we call the luteal phase. Once your estrogen progesterone drop, the cycle starts all over again and you start your period.