Her Discussions by Dr Faye - Medical Misogyny: Why Women with ADHD Are Still Being Dismissed

Episode Date: August 3, 2026

Before you dive into today's episode...We've been nominated for ITV Podcast Creator of the Year (!!!) 🏆If you've learnt something from the podcast this year, I'd be so grateful if you could take a minute to vote for us. It genuinely means the world: https://www.bcreator.co.uk/awards/vote/1. Select ‘Creator Shortlist’2. Scroll down to ‘Podcast bCreator of the Year - Her Discussions with Dr Faye Bate’THANK YOU 🤍___Did you know that ADHD can look completely different in women?Dr Helen Wall, a GP and BBC Breakfast health expert, who has spent 25 years refusing to let women's health be dismissed.On today’s episode, I’m joined by Dr Helen Wall, a GP and BBC Breakfast health expert who has spent 25 years refusing to let women’s health be dismissed. After experiencing the impact of hormonal changes on her own brain and seeing her daughter diagnosed with ADHD, Helen began questioning just how much we’re missing when it comes to female hormones and the brain.What you’ll learn:‼ 4 ways ADHD can show up in women🧠 Why high-achieving women are still missed for ADHD🔗 The link between ADHD and PMDD👀 Why women can have ADHD without looking ‘hyperactive’⏳ 3 things to do while waiting for an ADHD diagnosisResources & links mentioned:Dr Helen's book ‘Menopause and ADHD’ - https://www.penguin.co.uk/books/477104/menopause-and-adhd-by-wall-dr-helen/9781529978735?utm_source=chatgpt.com Dr Helen’s Instagram - https://www.instagram.com/doctorhelenwall/ This episode is sponsored by @CeraVe and their NEW sun range: hydrating formulas for face and body. 🔔 Join the HERd* broadcast channel here: https://www.instagram.com/channel/AbY4liwxlLnewx4H/?igsh=MWhuaXFweGtucTB3cA==📱 Find us on socials: Instagram & Tiktok - @drfayebate Podcast Instagram & Tiktok: @herdiscussionspod📩 Want to reach out?Email: [e-mail]🛑 Disclaimers:Opinions are my own. This content is for educational / entertainment purposes and not medical or financial advice.

So many women not getting what they need from healthcare. The research is not great in anything to do with women, but particularly women with ADHD. Today we are talking to a woman who has refused to let women's health be dismissed for 25 years. Helen Wall is a GP and BBC Breakfast Health Expert. I'm one of the few people talking about the intersection between ADHD and women's health. Helen is here to make you think about neurodiversity differently. It's number one for heavy menopause, menopause management. I get so frustrated that it's not talked about enough.

When I first became a GP, the main HRT we were giving was pre-Marring, which is pregnant, horse urine. It's all, you know, very much different now. Many women with ADHD are high achievers, perfectionists, but there's always a cost to that. Whether you've had an ADHD diagnosis or you're thinking about it more and more, Helen may have the answer for you.

If you are waiting for an ADHD assessment, I would... And before we get into the conversation, if you could do me a favour, that literally takes you two seconds. Hit the subscribe button or leave a five-star review depending on what platform you're listening on. It really helps us to continue to grow the podcast

and bring you guests to help you live a happier, healthier life. Thank you. Dr. Helen, I'm so unbelievably excited for this podcast episode as a goalie with ADHD to talk all about how hormones affect our brain, even in women who don't have ADHD, but first I would love to talk to you a little bit about what led you to being so interested in this space. You're probably not as excited as me because very rarely do you get to talk about female hormones on the female brain. It is so huge and I get so frustrated that it's not talked about enough.

I have always been into women's health. I was actually going to do obs and gyny. I got a place for run through training. Oh my God. But I was doing my foundation year two job and I was heavily pregnant. I was one of those crazy people that got married at medical school. I was heavily pregnant with my daughter, who's now 18. I was just being treated really badly by like surgical jobs.

And I just said to my husband, like, I can't do this. Like I can't have this family and do this like world. So I've always tried to weave in like women's health throughout my GP career. So I've done like my family planning training, my sexual health training, my diploma in obst and guiney and then my menopause training. So it was like that was running in the background. And then I hit what I probably think is a little bit of an early perimenopause. My brain just stopped working.

Like I was 41. I couldn't function. I've got family history of breast cancer. So my mum had breast cancer and died where I was at medical school. So I was having annual mammograms and the GP didn't want to give me HRT. He said you were too young. He said you've got a family history of breast cancer. But I literally sat in my lounge and was like, I can't go to work.

Like I can't function. My brain is just not working. So that started me thinking, you know, something else is going on here. Like, this can't just be perimenopause and menopause. Anyway, I went privately for HRT. And then after that, my daughter started to unravel, like, her executive function or emotional regulation. She'd hit puberty at this point. And so all these things are stacking up.

And then I, she got diagnosed of ADHD. And I just thought, this is like, something's not right here. Like, there's got to be more to hormones. and the brain. And yeah, I just went down a rabbit hole. And the end of that rabbit hole was this book kind of thing. So, yeah, I've just become really interested in it. And I've seen so many women now and spoken to so many women who've been impacted by hormones on their brain. But worse than that, they've been dismissed, they've been misdiagnosed, they've been fobbed off. Because we don't talk about it in medicine. It's not taught in medical school. It's not taught in GP training. Like,

so frustrating. I have been dismissed by GP. And I failed in my A levels. I had to re-sit. I did all right academically. But I was always being sent out of class for talking. I was... I can't believe it. Oh, yeah, up until I remember I was eight,

because I got like the highest GCSEs in my school. And then I just vividly remember one time, well, a couple times when I was 18. And I was in year 13. I'm a grown woman at this point. And I was sent out of class on multiple times. And then the head part of the... senior leadership team of the school

would walk down the corridors and go what are you doing outside? And I was like I got sent out. So I just was constantly getting in trouble. I was in internal exclusion a couple of times. I was always getting in trouble. I had a really difficult relationship with my mum. Puberty just absolutely, mentally

was a whirlwind. I got my first speeding ticket two weeks after I passed my driver's test and then got my next speeding ticket a couple of months after. Like I am late to everything. I see my bedroom floor about twice a year. These are all, you know, the hallmarks of ADHD and women.

But then on the surface, I'm an overachiever. Yeah. I say it's like a duck. Like a duck drifting along, kicking their feet frantically. Because I think there's so many issues with executive functioning. If I overachieve, I make up for all the... You're overcompensating. If I overcompensate.

And then I got to a point in my A levels where I got burnt out. And I couldn't overcompensate anymore. And I failed my A levels. was determined to be a doctor, so I went, no, I'm going to do this, I'm going to make this work, got the grades, went to medical school, and then was able to keep up, keep it up for another three years. And then suddenly I started to feel burnt out again because I was overcompensating. At the time, I think ADHD was becoming a lot more, you know, what everyone says, oh, everyone's got ADHD now. Or maybe it's a lot of women who previously weren't recognized and now becoming

more educated, you know. So that was becoming more of a conversation. We had. had some lectures about it in medical school and I was putting two and two together going, oh, maybe this explains why I can't, I feel like I'm working quite hard to keep up, or it explains these symptoms. And then went to my GP and the first, I said, I can't, I can't focus. I, I'm really struggling. And the first thing he said was, you're in medical school. You can't have ADHD. I knew you were going to say that. Honestly, I've heard it so many times. Yeah. Like I actually had a GP colleague say to me, they can't have ADHD because they've been to university. And then I get women message me all the time on social media saying things like

my GP said, well, I've never been in trouble with the police. I've never had alcohol or drug addiction, so I can't have ADHD. Like it's just absolute rubbish. Like many women with ADHD are high achievers, perfectionists, like flying high to all intents and purposes, smashing life. But there's always a cost to that. There's always a cost. And the cost is, either burnout or relationships or, you know, something else has got to give because we're not superhuman. What you're doing really, really, really resonates with me. And I think it's extremely important as well doing it in educating other healthcare professionals. Yeah. I mean, that was the wild card from this really. I mean, when I wrote the book, it was very much for the

women who are in that space where they're being dismissed, they're being misdiagnosed, they're being fobbed off, they don't know where to turn. But something that I didn't really expect was I've had quite a lot of feedback from colleagues who were like, oh my God, I didn't know. Like a gynaecologist, I don't have you saw it on my social media in the week. A gynaecologist actually posted on my social media, bless her. I didn't realize that this, that hormones could affect the brain like this. Like that was like a whoa moment for me. Yeah.

It's just, yeah, it's just huge. I've got some quick fire statistics to run through with you. But before I come on to that, just a quick tangent, it's really interesting that you mentioned you wanted to do Wabs and Guiney. because that's the place that I'm in right now. But for anyone who's not in the medical world, Obsingaini has the highest burnout rate of any specialty. It is brutal. Brutal.

One of the reasons that women's health is struggling is because Obstangany is, when you look at the burnout rates, the most difficult specialty for people to succeed in. Out of every single rotation I had, obsenguey was the consultants were the most, sad about their lives. They did not,

they were sobering out, they had completely lost their passion and just a little bit of context is they, if an emergency happens overnight, not it's the specialty where the consultant will come in quite a lot more often

than other specialties, I'd say. So you have a really difficult work life balance. If a baby dies or a mother dies, that is an awful, awful experience for any like doctors to go through. But then you have the added pressures for the NHS and those things that could be improved.

You can't change that losing a mother or a baby is an awful experience, but you can help make working in the NHS a bit better for doctors, you know? Yeah, and it's such an underserved area as well. So many women not getting what they need from healthcare. Yeah. But I guess the danger is somebody who's, you know, prone to being so passionate about these things

is that they're going to get into that and think they can save all women, you know, and it's, yeah, you can't do that single-handedly. I think I probably would have ended up burnt out quite quickly, yeah. And I think that's probably where I'm at

at the moment where I'm thinking, Faye, you're waiting to push yourself down? Such a shame though, because when you're so passionate about it, yeah, it's the system that's wrong, I think. It's the system that needs to change so that passionate people can be in that field and succeed and change things for the better.

Yeah, yeah. Coming on to changing the same. Well, so I've got some quick-fire statistics for you. So women are diagnosed with ADHD on an average four years later than men. Why do you think this is the case? I'll be honest. I would have thought it was a lot longer than four years. I thought so as well, actually.

I've looked at the study attached. It is four to five years. Is it? But I think, yeah, I think that's a way like underestimated. Underestimated. Absolutely. Like, I feel like from the women, I've got about 260,000 followers now across social media. 96% of them are women, a lot of them have got ADHD.

I cannot believe they're only being diagnosed four or five years later than the men because most of them are getting to midlife and not realizing that this is why they've struggled. Many of them get found when they have children or particularly teenage children who are undergoing assessments. That's when they have that light bulb moment.

Yeah. I mean, I think it's multifactorial why. There's symptoms, the diagnostic criteria and the medical education is all tailored towards boys. You know, it's very much hyper, even the name, you know, attention deficit, hyperactivity disorder. Yeah. It doesn't describe on the tin what most women and girls present with.

I mean, obviously, this is a generalisation, and you get boys that present with inattention, loss of focus, etc. But you also, you get women who have hyperactivity and impulsivity, and there's a crossover, there's a combined form. But a lot of girls in schools who have ADHD have predominantly inattentive, symptoms and they lose focus and they get called ditsy and scatty and you know all the societal gender things like you just wouldn't call a boy and so they get a daydreamer yeah exactly they get missed so i think that's a big thing and i think there's still a lot of i'm going to probably say this

word so many times medical misogyny like we still think of it as a boy's disorder i've still got colleagues medical colleagues who see ADHD as that boy's disorder with the hyperactive boy in the classroom, you know, throwing the chairs around, climbing on everything, can't sit still, can't settle. And it's often really not for girls and women. And I think the other thing is women are so good at masking. I think from a young age, girls are conditioned to be good, to sit still, to not rock the boat, to not be seen as being, you know, out there. We inadvertently condition them to do that. I've got a daughter and two sons. When I've reflected on this work that I've done for my book, I have inadvertently done that. Like, I remember taking my daughter to the

doctors, I was a patient because GP still need to see GPs. And I had her with me and she was in the waiting room. And I gave her a book and I was like, sit and read that and be good, like be quiet. I'm like, she was really good. I remember taking my middle child, my son to the doctors and he was like a nightmare. He was climbing on everything. And I just thought, it's all right because he's a boy. Yeah. I remember vividly thinking it's not great. Obviously I told him to sit down and like tried to like get him to behave. But I remember thinking, well, this is what boys do. Boys do climb on everything. They do run around the way to them. Exactly. So even like me, I've, I've conditioned my children to be good girls and active boys and hyperactive boys. And I think, you know,

society does that time and time again. And I used to think this was an NHS issue because I've worked in the NHS for so many years because we've been institutionalised. But I get messages from all across the globe. Like, this is not an NHS issue. This is a societal female issue that we just, you know, we expect girls to be good and and fit in. and pretty much push them into masking. And it's only when they get to later life that when things become too much, whether that's people, you know,

piling the pressure on because we carry a lot of mental load as women, whether it's hormones, whether it's sort of doing lots, juggling lots of balls in the air. And we can't do that anymore. Then we're often women unmask and then things come to the fore.

To go off in a little bit of a tangent with endometriosis, the delay for diagnosis is actually quite similar around the world, you know? So it's interesting that you find that as well with ADHD. Yeah, definitely. A medical misogyny, medical training, medical research. Yeah, I can't even blame the NHS anymore.

It's just like a societal thing. Yeah. And do you know what? Like when we're up against hundreds of years when women were not included in research, women couldn't even be doctors. Yeah. It obviously makes sense.

Women weren't in those rooms to speak, to advocate for our needs. Well, they couldn't even get a mortgage, could they? Like, without their father or their husbands approval are like so not that long ago. It's really not that long ago, you know? And I think we forget that sometimes. We're, yeah, we're further along than we were, but we're not that. No, I know, I know. You know? Absolutely. You've done some phenomenal posts explaining how hormonal fluctuations, how progesterone and estrogen impacts the brain. And I cannot wait to dive into that with you. But first, we've got a section of the podcast called Bye by or Bye. Okay. And I'm going to show

you something and I would like to know whether you would say bye or bye bye bye to this as in goodbye. Okay. And the only rule is we love a little bit of nuance. On social media, we often don't get enough nuance. So feel free to give balance. We do love balance. Yes. Okay.

Starting with magnesium glycinate. Okay. Yeah. I think this is a cautious buy. Okay. So I think for some people it can help. We know that it can help with sleep. For some people, it can help with like nervous system.

and yeah, some people get good benefit from it. I don't think it's going to like solve all your problems. Like I think you've just got to take it with a bit of like caveat that it might help, it might not, but it's not going to solve like all your perimenopausal menopausal ADHD issues. So yeah, it's a cautious buy for me that one. Nice. The first ever all-electric 26 Subaru Trail Seeker is the EV for the trail obsessed with up to 444 kilometers on a full charge and DC fast charging from 10 to 80% in about 30 minutes in ideal conditions.

Plus, ample ground clearance and symmetrical all-wheel drive make the 2026 trail seeker the most capable EV Subaru has ever built. Test drive it at your local Subaru dealer or visit Subaru.ca. ADHD meds. Okay, well, yeah, again, I think it's very individual. One of the criticisms I got about my book was that, you know, you're just trying to get all these women diagnosed and on medication. And absolutely not.

I think ADHD mays can be life-changing for some people, male or female. They're definitely the number one thing that's recommended in all the evidence and the studies to help ADHD. But not everybody wants to be medicated. Not everybody can take the medication. And I think there's plenty of other things you can do to support with that as well. So, yeah, I think if you're suitable for them and you're keen to try them, then buy. if you don't feel pressured into it, I think,

because it's not for everyone. The criticism around ADHD meds is really, really interesting. The example that I will give is people with ADHD are known to have a higher rate of death by traffic accidents. I'm away with the ferries, and I am a much safer driver when I am on my ADHD meds. And I can see that. My daughter's medicated.

I can definitely see the safety of it. So I think, yeah, I think there's definitely safety aspects and they say it about all sorts of things you've got really bad ADHD and it sort of starts

to affect your mental health you know getting on medicine medication can help that so I think there's lots of pros and cons to it I just think it's like anything it's got to be an individual

decision for you like weighing up your pros and cons like what are you like without it what you like with it yeah it's an individual it can often be seen as I don't know

it's got this really big stigma attached to it I don't take them every day then that's personal choice for me because it affects my sleep and because it can affect my nervous system and you know but the I'm I exactly what you said it's an individual choice. I think the frustrating thing is that it's not an it's not equal choice for all because there's the system so hard to navigate because like you know where I'm where I'm

practice in Bolton there's like four year waiting time for an adult ADHD diagnosis and then when you've got there you have to sort of you know go onto a medication titration pathway if that's what you want to do and then you've got to try and get your jeeathing to take that on, etc. So there's like just so many barriers. And I think it should be an equal choice for people so that they can make that informed decision and individual choice.

I think the difficulty is at the minute a lot of people are having to go privately and then, you know, it's just health inequalities, isn't it, at large really? And then there's the issue of going privately and then the diagnosis not being accepted in the NHS because it's seen as paying for a diagnosis which is just an issue in itself, isn't it?

Yeah, so buy if you can if it's right for you, I think. Yeah, a little bit of nuance. We love nuance. We love nuance. You'll never get a straight answer at a me, fame. No, but that's good. You know, there's nuance and there's balance and everything, and that doesn't fit into a quick viral clip, you know?

That is the passion I have for this podcast for giving a platform to balanced points of view, you know? Yeah, absolutely. Tracking your cycle. Yeah, you see, I'm a big fan of tracking your cycle. I'm really bad at it myself. I never do it myself because I just can't remember. number from one day to next. But I think it's so helpful to know where your hormones are and how you feel. I do quite a lot of work with the PMDD community and that's so helpful for that

being able to sort of know where you're at in your cycle because you can almost start to predict how you're going to feel. And, you know, I've got some patients who will literally like planning meetings when they know they're going to be in their good phase, like the non-lutile phase like the first a couple of weeks and then plan to have much less pressure in their luteal phase. You know, there's all sorts of things. And I think with ADHD as well, we know that women's abilities change or how they feel, their confidence and how their brain functions, their executive function can change throughout the cycle.

So, yeah, that's a definite. I said you never get a straight answer to me, but I'm going to say definite bye for that. Nice. Yeah. Oh, no, I'm going to have some nuance, actually. Okay. Some people get a bit obsessed with it, don't they? And then it can really like effect.

Yeah. I have seen women who've got very obsessed with it and then it has a negative effect, but mostly it's a good buy. I think when it puts the limit on your potential, important caveat is if you were, say for those women who book in meetings at those different times,

I hope you're seeing a doctor about that because that shouldn't be normalized, but that comes from tracking your cycle, doesn't it? Part of your plan, your management plan that you're happy to go with and feels right for you, then great. But yeah, absolutely, you shouldn't be doing that without, like, you need to go and see your GP or somebody about that,

because that should not be how you're living your life without it being a plan. HRT. Yeah. So this is definitely number one in all the guidance, whether you're looking at the British Menopause Society guidance. You're looking at American guidance, Australian. Like HRT is number one for perimenopause menopause management. But again, it's not nothing.

There is nothing that's right for every woman. Like, you know, some women can't have HRT. Some women can have it, but don't want. to have it. They don't want to, you know, I saw a woman the other week who's sort of been on contraception for 30-odd years of her life. And she was like, I just can't. I'm so glad that I don't need any hormones anymore. I refuse to go on to HRT now as the next chapter. And, you know, and I think that's reasonable. That's her decision. But I think for me, it's about women having that informed information. There's a lot of myths about HRT that stop a lot of women having it.

there's a lot of myths amongst medical colleagues that stop women accessing HRT and that's the bit that drives me nuts. Something I find really interesting is how we're seeing a rising people taking HRT, but we're seeing a dropping people taking birth control. And I've heard that one of the main reasons is the natural hormones that are used in HRT in comparison to the synthetic hormones. What are the biggest myths that you hear when it comes to HRT? I get lots of these sent on my social media. I get lots of inbox about this. So I get a lot of, you can't have HRT until your periods have completely stopped. That's just like total rubbish.

You can't have HRT if you've got family history of breast cancer. It's a little bit more nuanced that one, but it's not an absolute no. I think the difficulty is there's still a lot of colleagues about who still hang on that million women study. Like back in the 2000s. Like when I first became a GP, we couldn't, you know, it was like the last resort. Giving HRT was like the absolute last resort. And I remember my trainer going, oh, well, if you have to give them HRT. And we only ever saw women who were in their 50s who'd pretty much stopped their periods

or hadn't had one for like ages and they had the classic hot sweats. And it was stopping them sleeping and functioning. Never ever saw women who, you know, were in their perimenopausal era. Well, I did. No, I did see them. But I diagnosed them as something else, like far up my old. or anxiety stress because we didn't recognise it

we didn't recognise this perimenopause thing and yeah I think we've still got quite a few colleagues about who are still feeling that you know HRT is bad and it's dangerous

and we need to move away from that now because we've got so much better HRTs like we've got body identicles I mean when I first became a GP the main HRT we were giving was pre-marine which is like I think it's pregnant horse urine it's the estrogen taking out of pregnant mares

urine. It's all, you know, very much different now. And we need to move with the times. Nice. When we need to get that information accurately to make the decision. Nice. Seed cycling. You know, I think I had heard it like on some kind of social media thing, but never really clocked it. It just looks like absolutely rubbish to me. Like I don't think there's any evidence for it. And obviously the evidence, you know, absence of evidence is not evidence of absence. I say that all the time about loads of things because we haven't got a lot of evidence for a lot of the things affecting women. But yeah, I think seeds are good for you,

aren't they? Like, there's lots of nutrition in them. Yeah. But I certainly wouldn't be like, eat them if you like them or you want the nutrition from them, but I wouldn't be like balancing your hormones with it. I don't think there's any evidence for that whatsoever. We've already got enough to be worrying about before we go. Who can be bothered doing that? Like, who can actually be bothered? Yeah. Cycling. Yeah. Like if you eat sunflower seeds every day of your cycle, that will only do you good. There's got to be something good can come out of that, hasn't there? Yeah. If you eat it in the. the wrong phase according to seed cycling and I say wrong with like quotation marks for anyone

who's listening but you're not going to negate the health benefits of having seeds you know eat your seeds but yeah just eat them at any time I think yeah it's the key so I'm going to say bye bye bye to that one. Bye-bye. Nice. Okay, so your book is about menopause and ADHD, but there's a broader conversation around hormonal fluctuations and the effect on the brain.

So could you possibly give me a whistle stop tour of what happens when different hormones rise and lower at different points in a woman's reproductive life? The key thing is probably estrogen. So we know that women's estrogen rises and falls. It rises in pregnancy. It falls soon after pregnancy. So in the postpartum period, it fluctuates wildly in perimenopause and then starts to reduce it and sort of get quite low in menopause.

And the key thing about estrogen is it has such a positive impact on all our chemical brain messengers, so our neurotransmitters. So things like dopamine or adrenaline, it impacts those things, which I don't think we talk about enough. and if you have ADHD, you already have a difference in the signaling of your chemical brain messengers. And historically, I think we've said, you know, people with ADHD don't have enough dopamine. They're chasing dopamine. And that's very simplistic, actually. It's not necessarily the absolute quantity of these chemical messengers,

but it's the way that they signal or the way that the receptors in the brain receive them and then can act with those chemical messengers. We already know that people with ADHD have altered function in those signaling pathways, which are really important, not just for our executive function, but like, so by executive function, I mean like, you know, thinking, processing, and planning, changing from task to task, etc. But also for our emotional regulation, particularly as women, there's a key one for us. And memory as well, it affects our memory. So it's not just, I think a lot of people think about dopamine as this like reward motivation chemical.

And, you know, if you have it, you feel great. And if you don't, you don't. But it does so much more in the brain. And similarly with no adrenaline, you know, that's really important. And serotonin, they're all really important in the brain for the overall function and well-being. And if you haven't got estrogen or you've got estrogen that's fluctuating wildly as happens in perimenopause, the brain's really good at compensating for things that it knows and can predict. But in perimenopause, it can't predict

what our hormones are going to do. It's just wild. And therefore, it's basically just send your chemical messengers wild as well. So we know that in girls going through people, puberty in women who are pregnant or postpartum, again, in perimenopause and menopause, those estrogen changes can have a massive impact on the brain chemical messages for every woman, not just for women with ADHD, but for women with ADHD, it can be the thing that breaks, you know, the straw that breaks the camel's back, basically. And similarly with progesterone, progesterone is also very important for our brain. And I don't, again, don't think this is even like recollected by many medical colleagues. Generally speaking, what generally happens in a woman's brain

is progesterone is converted to allopregnolone, which is a neurosteroid, which then acts on our GABA receptors in our brain. And the GABA receptors, as you well know, are those receptors that when you have that first glass of wine and you feel chilled out, or you get sleeping tablets from your doctor or, you know, anything that sort of calms you down, benzodiazepines, helps you relax and feel calm. So, you know, in a in a normal woman cycle, estrogen's rising initially and then and then falls and then progesterone starts to rise and fall. These changes are happening every month, but in a predictable way. So, you know, progesterone also has that calming effect in most women. And there's a few studies about this, but the studies are really sparse. The research

is not great in anything to do with women, but particularly women with ADHD. We think that neurodivergent women often have a paradoxical effect to progesterone. So rather than them get that calming, anxiety-relieving effect, which some women feel, you know, that thing before your period where you feel a bit sluggish and a bit like groggy, that might be the progesterone rising and then it drops off and falls and you bleed. In neurodivergent women, we think that more often,

they have a paradoxical response. So they're rather than getting calm and, you know, anxiety relieving, they get quite agitated and irritable. And this also happens in women. women with PMDD, and there's a huge crossover between PMDD and ADHD. You know, there's a sharing of, there's a lot of women have both. And yeah, so I'm just fascinated how it all impacts on the female brain. And the reality is we don't have enough research and evidence.

We know it impacts. We know that it can have quite huge impacts because we see women with PMDD who have a different sensitivity to progesterone, who often, you know, become really, really unwell just before their period or at their period. We know it impacts hugely, but we don't have enough research and studies to show, you know, which women are going to respond in what way to what kind of progesterone or progestogens. Because there's a massive difference between progestogens as well, you know, some are synthetic, some are body identical or natural.

It all plays a huge part. And, yeah, that's pretty much what happens in this phase of life, you know. but I think you can extrapolate it. It's not just about perimenopause and menopause. Although I'm a menopause specialist, that's where, and that's where I was seeing the women, so I wrote the book about them. But I think you can take that theory

and extrapolate it throughout a woman's life. Guys, would you believe me, if I told you this cerevates and absorbs in one second? I don't know about you, but the thing that always used to put me off applying sun cream to my body was how long it would take. Every time I thought about it,

I am instantly transported back to being a kid on holiday waiting for what felt like hours to jump in the pool while my mum kept saying, you have to wait for your sun cream to absorb. I don't have the time for that, but I still, of course, want to protect my skin. So I've been trying it for the past month because I wanted to try the one second claim and it works. It's formulated with three essential ceramides and it helps you to retain moisture and protect the skin's natural barrier alongside the broad spectrum SPF 50 protection.

The formulas are super silky and hydrating and take me just a couple of minutes. to cover my entire body. I would love to hear a little bit more from you about the differences between bioidenticals and synthetic hormones, because there seems to be a rise in the conversation around birth control and HRT specifically. Yeah, yeah.

Yeah, and this has long since irritated me a little bit because I think there's a lot of clinicians out there who would quite comfortably give women the combined contraceptive pill. They may check the risks, they're not overweight, check they're not smoking. You know, there's lots of cardiovascular risks we need to assess for. But they would often feel like okay about giving them combined contraceptive pills.

But then the same person might not feel okay about giving HRT. Yeah. I think that's changing over time. But certainly, you know, a couple of years ago that was quite common. And for me, HRT is almost a bit kinder in that, you know, yeah, there's risks with it and there's risk with any hormones. but we use a lot of body identical hormones for HRT now. So we still have the synthetic versions, which are the man-made.

So they're the hormones that are made in a lab, you know, and they often come with perhaps more side effects for some women, and they come with some more risks. So they're a bit worse on breast tissue in terms of breast cancer risk, often, and stroke risk, etc. A lot of what we're using in menopause medicine now, we're using body identical, so that's mainly the transdermal. There is a couple of oral ones, but mainly sort of the patches, the gels, the spray.

Those are sort of more natural hormones. So they come with, the fact that they're beginning through the skin as well, they come with less clot risk. The key thing with estrogen is that when we take it orally, it triggers the clotting cascade in our liver because it goes through the first past metabolism of the liver. So, you know, for those who aren't medical, what that means is all your clotting factors that help your blood thicken up, made in the liver and the process of breaking down the estrogen orally then triggers that to happen and then therefore your clot risk goes up so your blood clot risk goes up so we're using a lot more transdermal now because that goes through the skin it avoids that mechanism the evidence tells us that

it's often better tolerated it's often got much less risk in terms of cardiovascular risk stroke blood clots even breast cancer risk is less so I think we've had a huge shift in in what the kind of hormones we're using, I think the flip side of that is we're now getting women who are not wanting all contraceptives or birth control because there's been so much hype around the fact that we've got all these natural HRT

and a bit safer and a bit kinder that younger women probably quite rightly are saying, well, I don't want synthetics. If we can have natural hormones, why can't we have natural hormones? And I think that's going to be the next big thing that sort of lands now. I think there's a lot on social media being touched.

Women are finding out information for themselves. The conversation around hormonal birth control, I think is really, really, really interesting and not nuanced enough on social media because I'm pro birth control in the sense that I think for women who it is right for, however, I'm someone who hasn't taken hormonal birth control for the past four years.

There's some emerging data on some birth control's impact on women with ADHD and how that might be different. And that's only just coming out now, ADHD, autism, neurodivergence. I really struggled with a lot of birth control. Yeah. And I definitely got birth control fatigue,

which is a term that I heard from an obstin galli doctor recently where she said, so many women get given probably quite a cheap older birth control by their GP. Maybe they've got endometriosis or PMOS. And they're giving this birth control wrongly,

as a substitute for a referral to a specialist. And they're often given an older generation that's maybe cheaper. They then have quite bad side effects. They come back. They have another one. They still have bad side effects and they still haven't been referred to the specialist. They come back. They get another one.

And by the time they get to the specialist or they're admitted into hospital, maybe they've got endometriosis and they're admitted because they're losing so much blood and they need an infusion or whatever. And the specialist says, oh, well, actually, for any, demetriosis or actually for PMOS, you shouldn't have been given that contraception. That's not the best one to treat your condition. I would like you to try this birth control pill and we're going to give you a scan and we're going to reinvestigate it properly.

And these women are going, they don't trust the system anymore. They don't. You try birth control pill from when I was 16. You try birth control pill and they go, give it three months to see how you work out. And I'm like, I'm doing my GCSEs. I'm doing my A levels. I don't have three months. We just don't listen to women enough.

I don't have three months to just see how it goes, you know? And women just get sick of it. I completely understand the anti-birth control rhetoric. But I also, especially in endometriosis and PMOS, where there are benefits, there are benefits for being on birth control. But because it's been used as a plaster and it's been prescribed incorrectly, they don't trust it, you know? Yeah.

And I often find that, you know, that's the same for a lot of things. I see a lot of women who've been around and around the system. They've seen different dots. They've been to different people. And then, you know, they come in almost. I think I talk about it in my book, actually. Almost like it feels, you can almost palpably feel that they've coming in waiting for fight.

You know, whatever they're going to ask for. They've sort of geared themselves up to like, I'm going to get this and I'm going to really like push back. And I'm like, yeah, okay, that's, you know, let's just talk about it. And they're almost like, oh, okay, I'm not going to get fight. she's actually just going to listen to me. And it sounds like I'm dissing like loads of, like there's loads of great medics and doctors and colleagues that do this as well. Like this is not, I'm not a soul like warrior here.

Yeah. But a lot of women have been fobbed off, dismissed, misdiagnosed, you know, just not listen to, not their real lived experiences have not been validated that, you know, we're almost on a back foot when we see some of these women. And women are on a back foot because there are things that could help. help them, but they've lost faith, they've lost trust, and they don't want to go there. Yeah. And it's so sad. It is so sad. And you're so right. I've had it with patients where you feel

that energy when they're coming and you're like, I promise I'm one of the good ones. I promise. You're trying to build that rapport with them. And then when you do get it and they can relax and you can see the whole body language change and like shift and you just think, yeah, this is such a shame that we've had to start from this position. Because as you know, like time short and NHS clinics are really tight. And, you know, you're starting from that position. If you, I mean, I just run late. That's just my MO.

Like, I just run late the whole time. Like, my patients know you bring a book, you go on your phone, whatever. When you get to me, I'm going to give you the time you need. But it's quite stressed. I've been a GP in many years. I think if I was having to practice like that as a newbie or like without being in the same, in practice for so many years so people didn't know me. I think you would be under a lot more pressure

and it is quite pressured to do consultations knowing that you've not got much time. Somebody's coming already with their energy a bit off, expecting a fight and it's hard. It's really hard for women to get what they need. And I think you're dead on that we're not attacking individual doctors. It's the system that's an issue because we know that when we're under pressure, you fall back into prejudices.

You fall back into prejudices. And when there are prejudices against women that's ingrained in the medical curriculum, they're ingrained in the medical system. When you're pressurized, you're operating on automatic, you revert to these stereotypes of women that are often the attention-seeking woman, the hysterical woman.

Yeah. And that's why I don't, it's a system. It's a system issue. Yeah, definitely. It's a system issue from the moment somebody starts medical school. Yeah. To the moment they're like working in the day-to-day job. Like there is huge system things that need to be challenged and changed.

Yeah. And good on you for still fighting the good fight. Still there. Trying. I won't say it's a bit easy. Yeah. Yeah. We're going to come on to the section called Real or Not Real.

Yeah. I'm going to show you a video and I would love to know your thoughts. Let's talk about ADHD. When it is left untreated, it has bad consequences. And when we talk about medicine, you always want to know what are the side effects. But you also want to ask the question, well, what are the side effects of not treating ADHD? So the hallmark symptoms are short attention span, but not for everything. The second one is they're easily distracted.

It's like the world comes at them too fast. The third one is they tend to be disorganized. They tend to procrastinate. They don't do things until. someone's mad at them to get it done, and they tend to have impulse control issues. So the first thing, if you have someone who has ADD, it's focus on getting their diet healthy. Magnesium can help. Zinc can help.

Omega-3 fatty acids can help. But if it doesn't work, I will use the medicine because left untreated, there's serious problems with addiction, school failure, bankruptcy, and so on. I thought. You know, I think he's got some good underlying points. I think, you know, there are huge consequences to people who are not supported, not listened to, not supported, particularly women when they go their whole lives without being, you know, diagnosed and dismissed and so on. I worry that a real like that sort of backs up people's theory that you have to be in trouble

with the police and, you know, have addictions and all the rest of it to have ADHD. you absolutely don't. There are plenty of women who are, to all intending purposes, smashing life, like overachieving and getting on with it, juggling everything.

And sometimes things like that make it seem like they can't possibly have ADHD. Yeah. Actually, you know, that's a huge cohort of women that are in that zone. They're not doing any of those things

because ADHD is undiagnosed or untreated. But yeah, I think, you know, I think the sentiment's right. Like we've got to listen. and we've got to support. And it's not always all about medication, although it can really help people. But yeah, we just,

there's a lot of women that have a hidden cost. The cost is hidden to them of ADHD. I give you an example. I had a lady who said, you know, she had this really great job. She was a lawyer in the city. She was, you know, she had great house. She was making lots of money.

Like she was going out for dinner all the time with clients. Everybody thought she had it all switched on. And she said to me, yeah, but every time I have a really important meeting, like, which is most days, I have to go home and I have to prepare for that for three hours. Like, I rehearse every conversation. I rehearse every question I might get asked. I read and read everything that might come up and make sure I've like memorized it.

I'll even sometimes practice in the mirror about how I'm going to like present something. And the cost of that to her was that she hadn't had a relationship for about eight years because her relationships had all like broken down because she didn't have the time for it. she therefore was like on her own which is you know absolutely finds nothing wrong with that but she wasn't happy with that she wanted children she wanted a family she wanted those other things and you know she was quite sad about that and there's always a hidden cost and that's what we don't always measure in women I think women with ADHD is a duck floating along on the surface just frantically kicking their legs trying to keep up yeah yeah another interesting point um I don't know on that gentleman in specific I don't know if you've seen many of his clips

I have to take everything he says with a pinch of salt because there's a brilliant clip that Dr. Mike did where he's one of the social media doctors that I think is one to be careful of. There's a brilliant clip of him on Dr. Mike's podcast where Dr. Mike says he makes this claim, this bold claim, and Dr. Mike is like, but what studies, none of the studies you've ever done

randomized control trials. So anyone who's wondering, like the golds, standard of a study. None of the studies are like this goal standard. They're low quality of studies but he's done extremely well for himself and there's a yeah he's he's made some kind of outrageous claims. But he's he mentioned some stuff about nutrition. Do you have any nutrition suggestions you make to any of your patients? Yeah I think he made some some decent claims there. There's definitely some evidence that mainly childhood studies. is so ADHD and children. But omega-3 fatty acids have definitely got some thing riding on them

in terms of sort of evidence base. And, you know, magnesium, I think, can be quite helpful. For some people, it's not like a panacea at all. But I think, you know, there's a lot more information coming out now about gut microbiome. And there's a thing called estrobolo, which is like the estrogen recycling. You know, we make a lot of our serotonin in the gut. We recycle our estrogen from the gut. And I always... talk about when I speak to women in menopause or who are having HRT, you know, I can give you HRT, but it's all about the pillars of health as well. It's about having all those things in place because, you know, the best HRT in the world or, you know, probably the best ADHD

medications in the world are not going to overcome like a really poor like diet. And if you're drinking lots of alcohol, you're eating loads of processed foods. You're very, very stressed. Yeah, all of those things, you know, that you're just not going to, you're not going to feel your best. So there's a lot of information coming out now about, you know, eating loads of plant foods. I think they say something like 30 or more a week, you know, your probiotics, prebiotics and just getting your gut health in perfect order or as perfect as you can. Nothing's ever perfect. It can be really beneficial. I'm starting to talk to that a bit with my patients as well, those with menopause, ADHD, because I think we can't go.

For a long time, I think I was very like medicine focused and everything was like, what can the doctor do? but I think there's so much more that we can do as people. I think the difficulty is when someone comes in and they're like totally distressed, being fobbed off, feeling at their wits end. Like for me to turn around and I go, you just need to eat 30 plants a week. Like that is not going to fly. Like that is just not. Yeah, absolutely like you've got to like run for cover if I was to say that.

So yeah, it's about trying to get people as balanced as they can with the help you can give. But then I start to sort of grip in, you know, these things don't work at their best unless we, manage everything around them. And I think it's great because it gives people control as well, you know, these lifestyle factors. We've got a couple of community questions before I ask you the final question that we ask all our guests.

So those community question, any advice for late diagnosed or untreated ADHD? This is a question I get all the time because where the waiting list is so long, I found when I was waiting, I knew, I realized, okay, that I do think I've got ADHD. waiting for that diagnosis felt like a lifetime.

Yeah, any tips. Yeah, I think if you, most of the women I come across who think they've got ADHD, have ADHD. You know, as women, we are usually very switched on at finding out information for ourselves, you know, doing all the right things to assess and get, we have that gut feeling, don't we? And I think if you are waiting for an ADHD assessment

and you're pretty sure that's what's going on, I would do what I discussed in my book sort of self-identify. So you can still go and seek resources. You can still go to support groups. There's some great support groups. I've just become a trustee of one of them, ADHD AF. And, you know, they're up and down the country and they will actively, you know, they advertise on their banners, you know, you don't have to have a formal diagnosis to be supported. Women just turning up, you know, sharing stories, sharing support mechanisms. I also talk a lot in my book about sort of the strategies that you can use to things that you'll have heard of, like body doubling and budding up

and things like that. I mean, it's all a bit cliche, but I think, you know, women often wait until they've been diagnosed. They put their life on hold. You know, we don't feel validated. So we'd sort of go, well, I don't want to overthink it

and I don't want to pretend I'm ADHD. You know, I actually had women say to me, like I feel like a fraud because I haven't actually got an ADHD diagnosis. Just go and access the support groups, access the resources, access the strategies, the tool, you know, the toolkit tips.

Because so what, if you end up not getting an ADHD diagnosis, If they help you, then what's to lose? We know the waiting list is so awful. We know that it's so easy to be dismissed. Empower people. What we're waiting for? We're waiting for women to sort of disintegrate.

Waiting for a diagnosis. Yeah. Final community question. How do I stop feeling guilty for talking about ADHD where there's so much stigma around everyone has ADHD? No, don't feel guilty. Like everybody does not have ADHD. on the back of, I think it was West Streeting that said this.

Oh, God. I think it was West Street. Somebody in government said everybody's got ADHD and we need to do something about it. Yeah. There was an audit done. I think it was 9,000 GP records were audited. Yeah. And the diagnosis rate of ADHD in people's records was something,

I can't mean exactly, it was something like 0.25%. Yeah. And we think what, between 1 in 5 and 1 in 7 of people who are neurodivergence. So we are under-diagnosing ADHD. Just because we're giving, women a voice, we're raising the ante in terms of, you know, awareness and insight and we're giving women a voice to try and make sense of the struggles that they've had very often for all their lives does not mean we're over-diagnosing it. It means we're finally seeing things that have been

not seen for years and years. And that means we've got a backlog. And people don't like that. They don't like the fact that all these women are now coming to the fore because it creates havoc. And I've had that criticism about my book. Like a psychiatrist said to me, like, do you realize what you're doing? Like, the system is already bending with the number of referrals we've got, like, bowing out. Like, you can't add to it. I was like, what about the people? Yeah, I'm going to add to it. Because I'm sick of seeing women who can't function, who feel like, and I am damned if I'm going to let my daughter get to menopause, perimenopause, and still be in that position. Like, I'm not, I'm not having it. Throughout my

daughter's life, my mom died at medical school, sadly, and my, my, my, my mom died at medical school, sadly, And my dad and all of us used to say, she's so much like your mum. She's just like your mum. It was almost like this is a genetic thing. It's like your mum. Yes, she was like my mum. She is like my mum.

Because I think my mum had undiagnosed ADHD. Yeah. And all the trials and tribulations that come with that. And, you know, it just nobody would even have, like, that didn't enter anyone's head. And I'm not going to sit back and just let that happen, like continuously on repeat. Because when you've seen it, you can't unsee it.

It cracks me up every time that we're having. having the conversation around over diagnosis of ADHD, as soon as there's more recognition for women, you cannot tell me there is not, that is a coincidence. You cannot tell me for a second that is a coincidence. I know, I know. People don't like it, but so what? No. No. I don't like the situation women and women are just being like left. Yeah. So. Yeah. You've been absolutely phenomenal. We will leave all the links for your book. West. find you on social media, everything in the description. But before you go, we have one last question that we ask all the guests.

Dr. Helen, what do you wish every woman knew by the time she was 25? You're enough. Like, nobody cares what you're doing, what you look like, who you are, like, just be you. I think I spent so much of my, like, younger years, um, caring really about what people thought, how I'd look, like, how I seemed, not just, like, looked physically, but like what my actions entail for people. and then you hit perimenopause and you're like, I don't give stuff. Like just I wish I'd known that at 25.

Like just be you and just enjoy it because life's so short. I love that. Thank you so, so much. It's been an absolute pleasure. Thank you so much for having me.