But when we've got ADHD as well, what are some of the things that you've found that can be helpful for people?

Again, I think the, the knowledge piece can be helpful and p- and empowering.

So just a bit of time self-reflecting on what your challenges are.

You know, is it your sleep? Is that, um, particularly disrupted? And that might be exacerbating everything, ADHD symptoms and, and, and brain fog.

And if it is sleep, then thinking about, okay, how do I address sleep? And whether that's, um, medication, hormonal or other, melatonin or other medications, or the, the first-line recommendation for sleep during perimenopause is cognitive behavior therapy for insomnia, CBTI, which now has a good evidence base specifically in menopause.

And there are free courses that people can do online, I think through the Sleep Foundation.

They have a link for, I think it's four sessions of CBTI, and you know, that's a great resource.

Yeah

Do you think there's a risk that people are being diagnosed with, and this is controversial, it's just been something I've been thinking about, as women go into perimenopause, that they're getting diagnosed with perimenopause symptoms? I know how, like in our family, how we've teased it out, but do you think there's a risk of that at the moment?

Look, potentially, but I think if you're working with a clinician who has a good understanding of both perimenopause and ADHD, there are differences in the diagnostic category.

So if we're thinking about the DSM and how we diagnose ADHD, at the moment there is a requirement that symptoms have to have been present to some extent in childhood or prior to the age of 12.

So if someone has had no signs of any kind of challenges in terms of ADHD symptoms throughout their life and no evidence that they might have been masked or covered up and for the very first time in their 40s, and they have these brain foggy type experiences.

So it might be, you know, changes in sleep.

It might be difficulties with attention and focus and word finding, but if there's no history at all, it's really not ADHD because diagnostically it can't be diagnosed without some degree of evidence.

And sometimes it's challenging to uncover that evidence in someone who might be, you know, have perfectionist traits in someone who, um, has been masking and not looking like they've externally had the ADHD characteristics throughout their life.

But as we get into perimenopause, what are some of the additional challenges that you're seeing for people with ADHD or women with ADHD at the moment that we should be talking about more?

It's not a generic term, brain fog?

Well, no, actually, it is not a clinical term.

So the term brain fog is just a lay term that... that has been used across lots of different conditions.

I think it probably gained its most popularity as a term during COVID and a lot of people referred to long COVID and the brain fog of long COVID.

And I feel like that's where the term itself became more and more popular.

And it has been used in the context of menopause a lot as well.

We've actually started to switch to talk more about the cognitive symptoms of menopause.

How has your understanding of this area evolved throughout your career then?

Yeah,

that space of life.

Okay, so menstrual cycles.

So for listeners who aren't familiar, for most females, they have a relatively regular menstrual cycle, which on average is 28-ish days.

But it can be very variable.

And we often think about different phases of the menstrual cycle.

So we talk about the follicular phase, which is the first part of the menstrual cycle.

So are there any, for parents out there listening and they've got adolescent... girls that have got adhd or um females in their family are there anything any things you should suggest that they talk about to help with that and better understanding so we're not all sitting there thinking well that just that's just me when it might be something that can get help for

What's the cause of these symptoms?

I would say it's a lot of different things.

So the most, um, obvious factor is hormone changes, because it happens more frequently across a menopause transition, or it's identified as being a part of the perimenopausal transition timeframe.

So during perimenopause, our estrogen, progesterone levels, in particular our estrogen, fluctuates and gradually declines.

And there's a huge evidence base, predominantly from animal studies, showing that estrogen can have quite significant impacts within the brain in regions that regulate our cognition, particularly our memory, as well as a- within the frontal lobes, so regulating our ability to plan, to organize, to allocate our attention.

So that provides a bit of a rationale as to, uh, where the estrogen receptors are located in the brain and why fluctuations and a decline in estrogen might impact aspects of cognition.

And we also know estrogen, um, works with neurotransmitters like dopamine and serotonin, the GABAergic and glutamatergic system.

Yeah.