The Dr Louise Newson Podcast - 287 - ADHD and perimenopause: Sumi's story

Episode Date: December 17, 2024

On this week’s episode, Dr Sumi Rampling, a GP and Menopause Specialist who works alongside Dr Louise at Newson Health, shares her personal story of attention deficit hyperactivity disorder (ADHD). Diagnosed in early adulthood, Dr Sumi talks openly about the challenges of her ADHD diagnosis, as well as the impact that hormone changes, including perimenopause, can have on women with ADHD. She talks about the determination her condition has given her, and also offers advice for women navigating hormone changes and ADHD. Download balance’s ADHD and menopause booklet here. Click here for more about Newson Health.

Hello, I'm Dr Louise Newsom. I'm a GP and menopause specialist and I'm also the founder of the Newsom Health Menopause and Wellbeing Centre here in Stratford-Pon-Avon. I'm also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research,

bust myths on menopause symptoms and treatments, and often share moving and. and always inspirational personal stories. This podcast is brought to you by the Newsome Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on the podcast I've got with me someone who I do know well and I have met in real life and I'm very lucky because she works with me in our Newsom Health

clinic. So I've got Sumi with me who is a GP, she's still an NHS GP, she works for this in the clinic. and she has a really interesting story, which I feel embarrassed because I've only recently learned about it when we went to visit a prison together. And she told her story in front of about 200 prisoners, I think, wasn't it, so me? Yeah, about that. So we had a wonderful day. I've been doing some visits to prisons. And we had a day where we were speaking to the staff.

And then later in the day we spoke to prisoners as well. So you actually told your story twice. And each time I felt very emotional. And actually everybody felt emotional. But they tell you what, the people who were prisoners really got it and really felt very emotional. But it fired something up in them because a lot of what you were saying resonated with them and their past. So let's get going then. Tell me a bit.

Before we start talking about your story, just tell me a bit about you and why you even went into general practice. Because you didn't start off as a GP, did you? No, I didn't. So I've been all around the houses with medicine. So I qualified in Wales in 99. And so back then you could be a bit more sort of, I don't know, freelance for a bit. So I did various jobs, pediatrics, general practice, but just as a standalone, a few other things and then went off to Australia and worked there for a year. So I did A&E out there and psychiatry, which was a lot. this really, really amazing, wonderful experience. And it was when I was out there, I decided to go into public health. And I was thinking actually at that time to move away from the NHS completely. So I was applying for master's degrees in global health. So I wanted to do more of a sort of global health focus.

I went then to the States and did my master's over there. And then I did a little bit of nothing major, just sort of a bit of internship work with the UN for a couple of summons. and did some research in Afghanistan and El Salvador and travelled around a bit. And then eventually came back to the UK and did public health training within the NHS. So became a public health consultant.

So just to explain what public health is, because some people might not understand what public health means. So public health is the health of populations. So rather than looking at the health of the individual, you're looking at the health of populations. So some of it is centered around health protection, infectious disease control, some of it is more focused on policy. So it's quite broad. And you don't have to be a medic to go into public health.

So you can go into it as a medic or if you've got different backgrounds, you can go into it as well because it's so broad and the field benefits from so many different backgrounds. So yeah, so I did that. And while I was doing it, it was when I was back in the NHS, I, started to really miss seeing patients. And it was something that really caught me by surprise, actually, because I thought I'd given up on that. And, you know, yes, maybe go back into the NHS and do public health that way. But I wasn't expecting to visit hospitals and miss it, you know, miss being on the wards, miss seeing patients and speaking to people. And I thought, how am I going to get back into this? And what I did was my last six months of my last six months of,

training in public health. I've met all the competencies that you need to meet, or I think had one more left, and I said, I can meet this competency by working in a sexual health clinic. Will you let me go once a week to this sexual health clinic? And I'll work as a practitioner there. And, you know, sexual health is so public health focused. And so they agreed. They were really supportive and they agreed. And so I got back into clinical work that way and then worked in a very big sexual health clinic in Soho in London. And I did that for three years. And they trained me up in contraception. They trained me out to do the HIV clinics. It was just amazing. But I wanted to be a GP and I was too frightened to go into the training because it had

been so long. And eventually I plucked up the courage and did the training scheme. And it took me a time because by this point I was having my children so it took me about seven years part time that I got there and yeah and then here I am now as a GP with a big interest in women's health and in public health and it all kind of worked. Yeah and it's so interesting and I've had as you know a really varied career and I do think it enriches how we manage our patients how we see things in different ways because medicine, when I've spoken about it a lot before and even on my Instagram too, has become very siloed, you know, and people have become very specialized very quickly now in medicine, which can be good, but it also can be not so good when we've got a condition that's

affecting multiple organs in our body. But also it stops us thinking about the bigger picture. And I went into medicine to help individuals, but now I've sort of done a big circle of thinking, No, I really want to obviously help individuals, but I want to help global health improve as well. And so a lot of the work we're all doing together is public health medicine. It really is. It has come around in a big circle, really, hasn't it? It's so interesting. It is. And, you know, the work that, you know, we do every day, you know, with HRT, we're helping to prevent conditions like osteoporosis. That's, you know, cardiovascular disease, dementia, type to diabetes. This is all public health.

Yes. And it's important and it's so easy that we obviously get so frustrated because it's such an easy, cheap and cost-effective and clinically effective treatment to reduce so many diseases. But we're going to focus on your story because as clinicians, people think that we're just machines, that we don't have emotions, we just keep going. And sometimes we have to be a bit mechanic because otherwise we would fall over because there are so many things that we hear and experience. But actually we can. still can have illnesses, conditions, and sometimes we talk about them and sometimes we don't. It's not the sort of thing at a job interview you talk about your medical experience. No, not too. But you've shared it twice one day. I know. So you're going to share it again because I think it'll resonate with so many people.

So tell me if you don't mind a bit about how you spoke in the prison that time. Yeah. So I remember I visited a prison with you previously and you came up to me and said, oh, you know, I'm going to this other prison and would you like to join? And I was, yeah, of course. And then you mentioned up and maybe you can tell, you know, your story about, you know, perimenopause because I think you knew that it's something that I've gone through. And in the back of my mind, I was thinking, oh, boy, because, you know,

it's not something I had shared with anyone. and, you know, it's quite a big thing. So I was diagnosed with ADHD. You know, obviously I've had it all my life. I was diagnosed as a young adult, and I can talk to you a bit more about that in a bit. But in the prison, I was speaking about my treatment for ADHD. I had treatment when I was first diagnosed with stimulant medication,

which I only took for about a month. And I came off it because I felt it was absolutely amazing in that I took it. and it was like this, I don't know, this sort of, there was like a misty glass that was sort of surrounding me and it was removed and it was just amazing but frightening. And also a little bit sort of on off. So, you know, the medication would run out and I'd be back to how I was. And I thought, well, this isn't the solution. What if, you know, one day I'd become pregnant, what, you know, how does that, you know, I don't know how many, you know, studies have been done on this. What's the, you know, how will it interfere with my long-term health? And I stopped taking it after a month. And then

that was years before. And then, as I mentioned, I went to the States. This was a few years after I qualified as a doctor and I did a master's degree out there. And when I got to the States, I did the first few weeks of this program. And I was doing all right. It was fine. Obviously, very hard, very challenging, but I was managing. And I took the medication. And in the beginning, it sort of made the difference from me doing well to me doing exceptionally well, which fine, you know, either way I think, you know, that's fine. And then what happened was I was noticing and I was in my late 20s now just before my period, and this was always the case. This wasn't a new thing. My focus was all over the place. Really, you know, can't remember what my, I can remember

what I mean was, you know, like really not, not great. And I was, you know, I was. I was. finding, okay, well, I've got this medication now. Let me take a bit more. So I would take a bit more in those periods, and that was fine. And then I started doing not so well. And I was taking more and more medication, but not just then. I was doing it all the time. And I was, you know, I was overdosing on it, really. It was quite dangerous what I was doing. But I wasn't doing well. And I was just taking more and more and more to try and manage my mood, to try and manage my concentration, my focus. And I got myself into a bit of a situation in that I was now reliant on this medication. I couldn't get out of bed without it.

Literally, it was by my bedside. I couldn't get out of bed without this medication. And this is medication for ADHD, which is often based on amphetamines, as it is. Yeah. And I couldn't function. Literally couldn't function without it. And it got to the point where I spoke to someone in the faculty, because they had noticed that, you know, I'd been doing really well, and then I was doing really badly.

And I said, what's going on? And this was possibly, this was sort of towards the end where I wasn't even sure if I was going to graduate, actually. And I said, this is the situation. I've got ADHD and now I've got anxiety as well. And, you know, I think my mood is affected. And they said, well, why didn't you tell us this before that you have this ADHD? And I thought it being, you know, it's a, prestigious institution, they're not going to want to know me if I've got this condition. They're going to ask me to leave, but it was the opposite. They said, we come across people with these conditions. And had you told us earlier, we would have been able to help. And, you know, if you need your own room to do your exam so you don't get distractions, we'll give you your own room. They were, you know, what do you need to get through this and we'll help you? And, you know, and I got through it and I sought help. And I went to see a practitioner. and doctor who helped me come off the medication completely. And my mood was really, really low. So she started me on some antidepressants as well, which I then stayed on pretty much for years.

I did sort of at times I would come off them. I didn't stay on them when I was pregnant. But, you know, I was on them for the long term after that. And then it was only when, this is years later now, So I had since got married, I'd had problems with fertility, needed numerous rounds of IVF, needed a special protocol for it to work. I'm very thankful for that. But it was only years later when after my son was born, and I was studying, I was training to be a GP at this time. Only then did it clock that this was perimenopause and I was perimenopausal. And I spoke to my GP at the

time and I was still fairly, you know, it was probably, how old would I have been, maybe 41 or something like that? And I explained it to her. And she said, well, why don't you go on the oral contraceptive pill, combined pill? So I did. And it helped a little bit. And I was on my antidepressants. And it all helped a little bit. But it just wasn't doing the job. It wasn't, you know, I wasn't quite there. And then I did the training course, the menopause training course, your one actually. Yeah. But I did that training course. And that's when I, the penny dropped in that. I need testosterone. And so by this point, I convinced my GP to start me on transdermal, body identical HRT.

So I'd started that and I was doing a lot better again. But then I added in the testosterone. And honestly, it was such a game changer in terms of my ability to focus, concentrate, you know, just operate. And how long did that take, Sammy, from starting testosterone to feeling that your brain was clearer and easier to manage. It wasn't immediate. So there were some sort of effects that happened quite quickly in terms of my energy got better

within a couple of weeks. But it probably took a few months before I started to feel like this is how I'm meant. This is me. It took me a few months before I felt that way. I was still on the antidepressants. I was on, by this point, I was on maximum dose second line antidepressants. So it was just hardcore stuff. And I'm off them completely.

now. So it's taken me a year to, because I went initially when I was on the testosterone, I didn't even think about coming off the antidepressants. I thought, let's just keep things stable. But then over the course of about a year, I've gradually reduced my dose down and now I'm not on it at all. And that's not to say that testosterone is a replacement for antidepressants, because sometimes people need both. Yeah, and I think that's really important because so many people think it's hormones or nothing. And in medicine, we can have more than one diagnosis. You know, If I've cut my finger and I have a migraine, hopefully you would give me a plaster and you would look at the pain and the discomfort for the migraine. So, and it's the same with hormones.

And it's very interesting, isn't it? Because we see a lot of women and speak to a lot of women who have been diagnosed with ADHD. And we only need to look. You just Google ADHD. It's massive. And actually, I think many of us have it. I'm sure I've got ADHD. A lot of people can't achieve loads of things unless they've got some ADHD.

So it is a power. It is a good thing as well to have in some ways. But some people obviously, and I do sometimes find when I'm very tired, I have so many thoughts, I can't do anything. Even just emptying the dishwasher is like, no, no, no, I can't. And so it's a balance. But my worry is that it's being medicalised sometimes with the wrong things. Like people who have a low mood and it's due to their hormones,

we shouldn't be automatically giving them antidepressants. although some people will be clinically depressed and need antidepressants and hormones. But with ADHD, it's obviously a spectrum, but there are a lot of women who find that as they become older, as their periods change, that ADHD symptoms worsen, or they have PMS or PMDD and they worsen before their periods when we know hormone levels decline. And all our hormones, estrogen, progesterine, testosterone, our neurosteoids are produced in our brain. But testosterone has a very sort of calming influence, as does progesterone really, works as a neurotransmitter affects other levels of neurotransmitters, including cortisol as well.

But it's been hidden and not thought about for so long. And now the narrative is just about libido. But certainly if I could choose one of the three hormones for women who benefit the most who have ADHD, it's definitely testosterone, just in my clinical experience. And it's very interesting that you say that. And I increasingly see women in the clinic, and I'm sure you do too, who are young and are more testosterone deficient than estrogen deficient. And no research has been done in it.

But I feel there's a lot of women who their testosterone drops before their estrogen and progesterone. And it's probably not the testosterone produced by the ovaries, but testosterone produced in the brain. And I feel there's so many people, myself included, who wish they'd started taking testosterone many years before. I don't know. What do you feel so me? Yes. And I think, you know, the question I've asked myself about this, because testosterone is so clearly beneficial and, you know, and essential for women is why it's been overlooked. And, you know, I'm not sure I can answer it. And I wonder going to look back in history. It was used in the 1930s for women, wasn't it?

It's not something that's new. And I wonder, I mean, maybe I'm right, maybe I'm wrong, but, you know, in the 1950s or whatever it was, the Premarin was introduced, and there was this huge focus wasn't there on estrogen. And estrogen is so important. But I wonder if somehow that took away from testosterone. Yes, you're definitely right.

But I've been reading a lot of history books. And what was very interesting is when they found all three hormones, they need to manufacture them in a way that they could be mass produced. And they had to do that with pharmaceutical companies to make money. So researchers quickly started being funded by pharmaceutical companies. Now, they made the synthetic estrogen in two ways with pregnant horses urine, but they also made an oral ethanol estradiol, which was chemically altered. But they would try to quickly make a synthetic progesterone.

But they couldn't, but by mistake they made a synthetic testosterone. Because as you know, biochemically, they're very similar instructions. No, is it? Okay. But then what happened was it was a chemically altered testosterone. Yeah. Which they then quickly realized was very hard to be absorbed in the body orally. So they then found injections. And now we have more than 300 synthetic testosterone substances.

A lot of them are anabolic steroids, which will have an effect on the muscles, also on the red blood cells. So they were using them to enhance performance. And so the whole narrative was about making money. So that's when people scared of testosterone, they're scared of synthetic testosterone. So it means testosterone's not got to look in because it went straight to men who started using it and abusing it, which is really interesting. But there are some reports in the war time because a lot of endocrine research, hormone research, obviously started in the 30s. they did some amazing research when you read the papers, but then the war came and obviously everything changed. But they were giving testosterone to some of the men who were fighting.

And there's a report saying that it could help with gangrene. It could help with frostbite. No surprise, because we know it's really good for our cardiovascular system. So they were reporting and documenting these other effects. But that's all been forgotten because it's about building up your muscle in your gym and testosterone is the male testosterone. And even the way it was labelled when it was discovered that they could make it, it was about bull's testes. That's where they got it from.

That's where they got the testosterone from to study. So it was mislabelling of a gender inclusive hormone, if you know what I mean. And then they stopped thinking about women because they were so keen on making synthetic estrogen to mass produce. And then in the 60s, it was all about contraception. So if you think about hormones for our brains, it's been pushed to the bottom because all the research on these hormones was all on the wound. So even contraception. Yes, because that's all we are, isn't it? We're just all we are is our uteruses. Indeed, that's all we are is about stopping getting pregnant. So even with the hormones, when they pushed out the synthetic hormones as

contraceptives, they hadn't even tested them as contraception. They'd just tested the wound and saw that people weren't bleeding as much. And after a year, they decided to change the licensing for contraception. But no one ever did any studies looking at the effects of synthetic hormones on the brain and the body, which is just missing so much. Yeah. And the, you know, the side effects that people are concerned about with testosterone treatment is, you know, it's those synthetic regimes. It's not sort of the pure testosterone in its proper form that caused those side effects. But there we are and here we are today having to deal with the situation and change it. Yes. And I think people are realising more and more. And like I said to you earlier,

I was training a whole group of psychiatrists yesterday who specialise in ADHD. And some of them actually do prescribe HRT, which is amazing. And actually one of them I spoke to last night says she prescribes testosterone. I saw good. She's a do-no to men, not to women. But she notices that men with ADHD improve with testosterone.

Yeah, I'm not surprised. There's studies on this. I mean, looking at women, actually, when looking at testosterone replacement and cognition, and there's clear improvements in cognition when testosterone is replaced. And when we say that testosterone is, we shouldn't use it in women because it's not very well studied,

but actually there are so many studies on it that, you know, just need to be made aware of. And cognition is one of them. Yeah. So meanwhile, we're collecting our data. We've got a lot of observational data because we see so many women, but we're also connecting with many other psychiatrists in the UK and abroad. So I'm hoping going forward this conversation will change. You know, you've got children, I've got children.

We want them to not have the struggle that you had. And I'm very grateful that you shared your story because it's very difficult. I think, well, it's difficult anyway where you're struggling mentally with symptoms because it's not so easy to talk about. And then to have medication that you're self-medicating, again, it showed that you were struggling but couldn't talk about it. And there's something more about a medic who can't get help. Yes.

And I've spoken about this before that I can't get my HRT or my testosterone from my NHS. GP. So as medics who have got a lot of training, if we can't get help, what does that say for others? And I know when you were talking about this in the prison, a lot of the prisoners have abused various drugs, but they probably have had similar thoughts and feelings to you, but were medicating with amphetamine-like substances, with cocaine, with heroin, but they were still doing it because they were getting those thoughts. And that's where looking at the audience, their emotions were so surprised that you as a healthcare professional had been experiencing what them in their very deprived backgrounds had experience

and it was a really incredible experience but really sad for everybody because it shows that so many women are not being listened to or not being given the treatment that they need. I know, I know. Yeah, and it was hard to talk about it, but I'm so glad I did. That was the first time I spoke about, you know, the abuse of the medication. I hadn't spoken about it to anybody before that prison visit, but I recognised the importance of it. And I wonder, you know, with amphetamines and, you know, abuse of drugs and, you know, whether there may be a link between that and an early menopause, because, you know, I had an early menopause.

Okay, I'm one, n equals one. That doesn't mean anything. But I, you know, I have looked into it a little bit. And I wonder if there may be a little bit of a connection there in that, you know, if you've had a hard life, if you haven't been able to look after your body or haven't looked after your body for whatever reason, whether that may then have an impact. Yeah, and I'm sure it does. It's always difficult to compare because we don't know what our age of menopause would be if we hadn't had that experience or those drugs. But we do know that women who abuse drugs, especially street drugs, are more likely to have menopause at a younger age, women who have been subject to domestic violence, more likely to have menopause at an earlier. age. And it makes sense physiologically because our body is very good at protecting us from getting pregnant if we're not in optimal health. So if we're abusing drugs, using our body in not a great way, then often our ovaries switch off. And it might be temporary. But even if it's only for a few

months, that's a few months without hormones, without hormones in our brain, which can make symptoms worse. So allowing women to understand that is the most important thing. And then it will follow hopefully that they will seek the hormones that they need. So lots to think about. And I think this conversation about ADHD, hormones, especially testosterone, has got to continue. We hope we can do more research in this area. But before we finish, I've always asked for three take-home tips. So three things that if you are listening and you either have got ADHD or you know someone who potentially has, how would you think differently about hormones with ADHD if you're one of those people? Okay. So I think first of all, just being aware that hormones, you know,

are part of the picture, empowering yourself with that knowledge. So, you know, I go back to when, even when I was a teenager, I had days where I had absolute clarity. And now looking back, it's probably because those were the days when I had that of testosterone and, you know, You have that in your cycle, don't you, that sort of raise? Just being aware that hormones play a role. I'm not saying that, oh, you need to take HRT, but I am saying that it's important to look into it, to be aware that hormones play a role. And if you're struggling and you're in perimenopause and things have gotten worse, look into it because, you know, it can be really helpful. And in terms of side effects, risks with the newer types. It's a different picture we're seeing now to,

you know, how it was or how it was perceived to be in the past. So number one, just have that awareness and, you know, don't be afraid to speak about it with a clinician if you feel like this is something that's going on. So that's number one. Two more things about how hormones impact on ADHD. I think I probably go beyond that because it's, I think it's not just about hormones. It's about looking after yourself in other ways. So things like exercise, diet, so important. And it's difficult when you've got ADHD because focusing on having a healthy diet, you need to be focused and you need to sort of be a bit ordered in your life to be able to do that. And someone who's got ADHD is, it's like to be a bit chaotic. So it's difficult to focus

on diet and exercise, but it's so important. And, you know, and these all interplay, diet and exercise is going to impact on your hormones as well. So that's probably part of the reason why it's also helpful. I don't have a third reason to discuss hormones, but I will say if you're suffering with ADHD, you're not suffering with ADHD, you're experiencing ADHD, or you know someone who does focus on the positives of it. Because as you mentioned before, it can be such an empowering condition to have. I remember when I was a teenager and I was, I'd chosen my A levels. I was going to do science and maths because I wanted to study medicine. I was uncertain because I didn't have confidence, but I was told every day by my maths teacher, you can't study maths, you can't study maths, even though I'd got a good grade at GCSE, you can't do it. And I didn't listen to her. And I ignored her every single day. And what happened, I did well. I went to medical school. I became a doctor. And now I'm here. And I'm using what I learned to look at

studies and to look at the data, you know, and to empower women and to sort of put right the sort of the false situation we've been put in. And had I listened, I wouldn't be here today. So don't see it as a negative. See it as a positive because people with ADHD have determination. It's something that we just need to have in order to survive in this world. And we've got it and, you know, we should use it and just be proud of ourselves for it. That's so important when anybody is given a diagnostic label, it has to be seen as a superpower in some way with the right support, help, advice and treatment.

So thank you so much. I've really enjoyed talking to you. My pleasure. Thank you for sharing your story again for me. My absolute pleasure. Thank you. You can find out more about Newsome Health Group by visiting www.newsonhealth.com.

And you can download the free balance app on the App Store or Google Play.