In this week’s episode of The ADHD Women’s Wellbeing Podcast, we’re exploring the complex and often overlooked intersection of ADHD, hormones, and women’s mental health, particularly during pivotal life transitions like perimenopause.

I’m joined by Dr. Helen Wall, a GP and registered menopause specialist with the British Menopause Society. Helen is also a resident GP on BBC Breakfast, a columnist for Woman magazine, and public health clinical director in Greater Manchester. She therefore brings both clinical expertise and real-world empathy to bridge the gap between professional healthcare and accessible, compassionate advice to ensure women feel heard, understood, and properly supported.

We explore why so many women feel dismissed or misdiagnosed when seeking help for emotional and physical symptoms related to hormone fluctuations, and touch on everything from progesterone sensitivity and HRT, to advocating for yourself at the GP, and the growing need for women’s health education that takes neurodiversity seriously.

I discuss the crossover of ADHD and hormones in my new book, The ADHD Women's Wellbeing Toolkit, which is now available. Grab your copy here!

Key Takeaways:

• Why so many women with ADHD report mental health declines during perimenopause, including PMDD, anxiety, and mood disorders.
• The connection between hormonal sensitivity and neurodivergence, and why it's often overlooked by mainstream medicine.
• How stereotypes and stigma contribute to late ADHD diagnosis in women, especially in midlife.
• The shift in how menopause is being discussed and treated post-COVID.
• The dangers of a "one-size-fits-all" approach to HRT and why personalised prescriptions matter.
• Why clinicians must join the dots between long-term anxiety and depression and undiagnosed ADHD or hormonal issues.
• The growing importance of patient-led care and better GP education around menopause and neurodiversity.
• How to advocate for yourself at the doctor’s office when your concerns have been dismissed.

Timestamps:

• 01:50 – ADHD & Hormonal Concerns
• 04:00 – Perimenopause & Mental Health
• 06:10 – Misconceptions About ADHD Hormones
• 10:06 – ADHD in Women: The Hidden Struggles
• 16:19 – Personalised HRT & Progesterone Sensitivity
• 25:12 – Women’s Health Advocacy in Practice
• 31:21 – Self-Advocacy for Better Treatment

Join the More Yourself Community - the doors are now open!

More Yourself is a compassionate space for late-diagnosed ADHD women to connect, reflect, and come home to who they really are. Sign up here!

Inside the More Yourself Membership, you’ll be able to:

• Connect with like-minded women who understand you
• Learn from guest experts and practical tools
• Receive compassionate prompts & gentle reminders
• Enjoy voice-note encouragement from Kate
• Join flexible meet-ups and mentoring sessions
• Access on-demand workshops and quarterly guest expert sessions

To join for £26 a month, click here. To join for £286 for a year (a whole month free!), click here.

We’ll also be walking through The ADHD Women’s Wellbeing Toolkit together, exploring nervous system regulation, burnout recovery, RSD, joy, hormones, and self-trust, so the book comes alive in a supportive community setting.

Links and Resources:

• Find my popular ADHD workshops and resources on my website [here].
• Follow the podcast on Instagram: @adhd_womenswellbeing_pod
• Connect with Helen on Instagram @doctorhellenwall
• Kate Moryoussef is a women's ADHD lifestyle and wellbeing coach and EFT practitioner who helps overwhelmed and unfulfilled newly diagnosed ADHD women find more calm, balance, hope, health, compassion, creativity and clarity. 

Welcome to the ADHD Women's Wellbeing Podcast.

I'm Kate Moore Youssef and I'm a wellbeing and lifestyle coach, EFT practitioner, mum to four kids and passionate about helping more women to understand and accept their amazing ADHD brains.

After speaking to many women just like me and probably you, I know there is a need for more health and lifestyle support for women newly diagnosed with adhd.

In these conversations, you'll learn from insightful guests, hear new findings and discover powerful perspectives and lifestyle tools to enable you to live your most fulfilled, calm and purposeful life wherever you are on your ADHD journey.

Here's today's episode.

So hi everyone.

Today I'm absolutely delighted to welcome a doctor who is here to help us cut through all the noise around hormones, women's health, ADHD and really give us some clear cut answers because there's just so much going on out there.

We've got Dr. Helen Wall here now.

She is a GP, she's a partner and she's also a trainer in the north of England in Bolton.

She's also a BBC breakfast contributor, she's a menopause specialist and she also, most importantly, advocates for neurodivergence in women and helping women understand what hormonal health alongside their adhd.

You may follow her on Instagram.

She's got a fantastic page on there where she really does just give us what we need to know.

Lots of science, lots of research and that is why I know that we're going to get a great conversation.

So Dr. Helen Wall, welcome to the podcast.

Well, thank you, it's great to be here.

Maybe I'll just go straight in there and ask you, what are you hearing the most when people are messaging either online or coming into your doctor's practice and they are saying either I think I' ADHD or I think I'm neurodivergent or I've just been diagnosed and I'm struggling so much with my hormones.

What, what are you hearing the most?

The saddest thing and probably the commonest thing that I hear is that women don't know which way to turn and they feel dismissed and fobbed off and unheard and unseen and not listened to.

There is a lot more movement now.

We women are very switched onto this and they're becoming more and more switched on.

But, but unfortunately there's still a huge lag in standard clinical practice and what clinicians understand about this and their insight into it.

And the first thing I always start with when I talk to Other clinicians and colleagues and doctors is just listen, you know, we don't have to.

I think sometimes as clinicians, we can feel quite overwhelmed if we're not sure about something or, you know, it feels like the person in front of us perhaps knows more than we do, we might feel a little bit insecure.

I'm that person in other topics as well.

You know, I'm a specialist in women's health.

I'm a menopause specialist.

I'm really switched on into neurodivergence and how hormones intersect with that.

You know, I'm really passionate about it.

But someone might come in with a dermatology problem, a skin problem, a joint problem, and I might not be as switched on, but it doesn't matter because really the first thing we need to do is see and hear these women and they need to be seen and heard.

And that's my biggest message to clinicians because I hear from so many women who have battled and battled with themselves, themselves, with their lives, relationships, school, careers.

They may not even have realized at the time because they've masked so well how much they've been putting, putting themselves through.

And then they get to this point, particularly when perimenopause kicks in and the hormones start to go into flux and things start to unravel and then they turn to someone for support and help and they get dismissed or they get belittled or fobbed off.

People say this is a drama, this is dramatic, but I think that's catastrophic for a woman and it's catastrophic for a woman's mental health, for her onwards journey in that recovery of where she is and self acceptance, self compassion.

And I get so, so very frustrated with it.

And that's what I'm seeking to change.

Yeah, I mean, thank you so much for your advocacy because we, we definitely need it.

And I mean, I hear again because I'm not a clinician, but I just have quite a big community of women and I've been hearing from them and speaking to them over the years where there is this common thread of perimenopause hitting, mental health, declining, not being listened to, not quite understanding.

But they, they've seen how their mental health has been impacted from their hormones.

It's hormonal sensitivity.

They find out they're neurodivergent.

Later on in life, they're able to look back where the PMDD has been there every single month.

They've also struggled with other, you know, hormonal or women's health issues, such as maybe endometriosis fibroids, cysts.

A lot of women I hear from, and maybe generationally, there's been hysterectomies and not been given HRT afterwards.

It's the mental health.

And unfortunately, you know, it's horrendous to, like you say, it's catastrophic because, you know, we're hearing more and more about suicide in midlife.

And I just read a post recently on LinkedIn about a lady whose mum took her own life at the age of 49 because she had a hysterectomy and then wasn't given the hormones.

And we need to build more awareness, create more awareness around this, about this intersect intersection of neurodivergence and not getting the hormonal balances right.

I've seen it in my family as well, and I want to ask you again, I'll use myself as an example.

At the age of 41, I started noticing my perimenopausal symptoms.

I could see that perimenopause hit early on in my family life.

This has been validated by doctors.

Dr. Sandra Coy, who says that perimenopause tends to hit earlier and harder in neurodivergent women.

And we need to change the narrative that it's not too young, late 30s, very early 40s, to go and inquire about hormonal help.

Can you give us a little bit of an insight as to why we're still getting this pushback from clinicians?

Yeah, I mean, it's fascinating, isn't it, why we're in this place, really?

And I think, you know, we could have a whole different podcast about how women are misdiagnosed, dismissed, mistreated in terms of the whole picture of medicine throughout the ages.

You know, it dates right back to the term hysteria, when women were, you know, classed as having a wandering womb that made them anxious and agitated.

And, you know, we've been sort of almost belittled for a long time in medical.

Some people call it medical gaslighting, and I think that's quite a strong term.

But, you know, it does ring true in some things that we see.

But I think there's a whole piece of the jigsaw missing for many clinicians here that we really haven't put into standard clinical practice yet.

You know, we spend a long time as doctors at medical school, training afterwards.

You know, we learn about nerves that we never, ever see again and muscles that we never talk about again.

But we don't talk enough about the effect of hormones on the female brain.

You know, as Far as medical students, by and large doctors are concerned, female hormones are talked about in terms of periods, puberty, fertility.

They're not talked about in terms of mental health.

And actually, we know there's very clear research and neuroscience evidence to show that the female hormones have a huge impact on our chemical messenger systems within our brain.

So they affect our serotonin levels, our noradrenaline levels, our dopamine levels, glutamate, gaba, the list goes on.

So it's no surprise that we are affected mentally by fluctuating hormones.

And I don't think that's thought about nearly enough or, you know, within the education system, among standard practice.

And that's one thing that I really sort of hone in on when I'm talking to colleagues and doctors.

We have to get this into our day to day language.

To me, from an outsider, it's so, I mean, I guess I see the bigger picture.

I'm not in the nitty gritty.

I know that the pressure on GPS is huge at the moment, but from an outsider's perspective, I see women and I guess I've got a bit more of a radar.

Like I can sort of spot ADHD and neurodivergence and someone gives me like a bit of a family picture and I'm like, oh, okay.

And I can sort of see it from all angles.

And what I don't understand is why we don't have more awareness and gps to almost be able to spot this neurodivergence in women.

We need better awareness to ask those nuanced questions, to discover, okay, where's this anxiety coming from?

Where's the depression?

Where are the hormonal imbalances or the very, very debilitating hormonal fluctuations?

Absolutely.

And I think this is multi layered.

You know, ADHD for many clinicians is still a childhood condition.

It's not really, you know, the services are not, are not fully there yet in terms of adult adhd.

It's not recognized as a, you know, a thing.

I think there's a huge male gaze on the diagnostic criteria of adhd.

So, you know, even now if I ask some colleagues, what does ADHD mean to you?

And we're talking about very experienced colleagues, doctors, clinicians, GPs here, they'll say it's the disruptive child in the classroom that's throwing things about that's in trouble.

You know, I had a lady actually say to me that another GP had said to her that she couldn't possibly have ADHD because he went through a few questions and A couple of the questions were, have you ever been in trouble with the police?

Have you ever had a drink or alcohol problem?

And you know, this lady was a very high functioning lady.

She had had a great career, she was top of her tree.

She had seemingly to everybody around her really, you know, smashed life.

But internally she was burnt out and she was really, really unraveling.

And you know, these, this is not well known about yet in the medical community.

I don't think, I don't think that we've got it out there yet properly that women can look and seem completely and utterly in control and flying in life and actually internally be struggling and masking and burning out.

And it links back to that thing I was saying about was not joining the dots with the hormones on the brain.

With ADHD being actually quite common in women in terms of different symptoms to what we'd expect in the, you know, the behaviorally destructive child in the classroom.

And I think this issue around us, seeing women a lot younger now in their perimenopause journey is also key in that.

So there's, you can see there's multiple bits to this jigsaw so far.

Even five, seven years ago.

We talk about before COVID and after Covid, don't we?

So you know, that, that cut off, if I think before COVID it was very unusual to see a woman in her late 30s, early 40s coming to me saying, I've got all these symptoms and I think it might be perimenopause.

We tended to see by and large women who either had stopped their periods or hadn't had period for six months, nine months.

You know, they were very scattered and they were very much in the throes of full on menopause or you know, coming up to that point of menopause because of course menopause is when you haven't had a period for a full 12 months.

We looked at menopause with a whole different viewpoint.

We looked at it as hot flushes, night sweats, feeling really hot and bothered, occasionally a bit of mood swings and mood instability thrown in.

We didn't really talk about the bigger picture, which is joint aches and pains, brain fog, memory issues, you know, feeling completely out of your depth in normal day to day life.

We didn't recognize that because again, we hadn't factored in the effect of these hormones on the female brain.

So we're not joining up the dots.

We've got all these bits of information, we've got evidence that says dropping estrogen can affect our brain Chemical messengers which can affect our memory and cause brain fog and all the rest of it.

We've got information that perimenopause can be wider than hot flushes, hot sweats, and we've got information that says that ADHD is not just being impulsive and disruptive in the classroom, it can be inattention and internal restlessness.

But nobody's joining these dots together and nobody's presenting this in a whole picture, but people are.

But not in standard, you know, not in day to day standard clinical practice.

And I guess that's in part what I do with my Instagram.

I try and fit all those pieces together and say to people, look, you know, this is an actual diagnosis, this is a picture, this is what we see commonly.

I've seen these women and interestingly I've seen women like this that I can think back to even before I started to recognize this sort of 10 years ago.

I can still think of women 10 years ago that I saw time and time again in my GP room where I hadn't joined up the dots.

And I feel incredibly sad about that, incredibly sad, because if I had joined up those dots, then that woman may have had a completely different journey.

And you know, if I'd given her some HRT for or supported her in her menopause journey, if I had recognized she might have ADHD and got other support for that, then her whole life course could have been completely different.

And unfortunately I'm probably a little bit ahead of that curve now.

But there's lots of clinicians that hopefully in a few years time will be saying, if only I'd join those dots sooner.

But what we need to do is speed up that joining of the dots process.

And that's, that's sort of where I am on all of that.

Yeah.

And I think, listen, you know, to give you compassion, you only know what you know.

And this is such new area and we need that research coming through and we need a real focus to help educate the clinicians who are the ones who are the gatekeepers to the hrt, the sending people for diagnoses.

And you know, I always use myself as an example because I don't care about sharing.

But you know, I was offered anxiety medication before my ADHD diagnosis.

I, when I was 40 and I knew that there was something else and that's when I got my diagnosis, you know, long story.

And I knew that it wasn't anxiety medication that I needed.

And thankfully I had a doctor who did listen.

But she was also very uneducated in this area, she even, you know, she held her hands up and went, I don't know enough about this.

And I had to go and select, which was really hard work.

And a lot of women do, you know, they're coming at this late 40s, really, in the throes of perimenopause, rock bottom mental health on the floor, relationships broken down, looking after neurodivergent kids, you know, struggling with hormones and mental health.

And I see these women and I'm like, desperate to help them.

And then there's also, you know, let's go into the nitty gritty of the hormones.

You know, thankfully, menopause, we're talking about this now.

There's a lot going on in the media, and thankfully we've got, you know, all sorts talking about it, but it's still very estrogen led.

And I want to come.

I've done a lot of work with Adele Windsor, lots of podcasts and workshops, and we want to talk more about the progesterone and helping women understand that they think there's a progesterone sensitivity and understanding that there's.

There may be.

The progesterone sensitivity has been with synthetic progestins, you know, on birth control, different types of contraception they've been on.

But actually understanding the connection between the GABA and the progesterone and helping women understand that it helps with anxiety, sleep.

They may need a lot more progesterone than they've been prescribed by their gp.

And understanding this hormonal sensitivity, our sensitivity as neurodivergent women, you know, we.

I see ourselves, and I know that Paula Rastrick talks about this, the trauma, the sensitivities that are in our body that goes into our hormonal pathways, our nervous system.

And again, I'm not a doctor, so I use these words, but I don't understand the, you know, the intricacies of it.

But I see this bigger picture.

I see it anecdotally, and I want to help more women self advocate.

How can they ask for a different type of prescription that's more personalized than this one approach that all women are getting from, I guess, doctors who aren't aware of neurodivergence and these hormonal imbalances.

Yeah, absolutely.

And I think, you know, so we're here to talk about neurodivergence, but I think this is the case for all women.

You know, there is such a huge spectrum in how women respond to progesterone or progestogens.

You know, we can't get away from the fact that there are a number of tangible reasons why one lady may respond completely differently to the next lady.

In terms of a progesterone, for example, you know, women can have different receptors, progesterone receptors in their body.

They can have different levels or components of enzymes that break down that progesterone.

They can have, you know, genetic reasons in it for those things that happen, that their own underlying hormones can interact with how they are metabolizing hormones that we take in.

So, you know, there's a whole list and I talk about that on my Instagram, you know, the tangible reasons.

And I, it's interesting you should bring this up because earlier on in the week I went to do some education for some GP colleagues and I was talking about this because I think there is this mindset that micronized progesterone is good and synthetic progesterogens are bad.

And I, I don't think that's necessarily the case.

I don't know what people who've been here before have said, but I think it's all about what's right for the individual woman.

It's not about good and bad.

What's right for one will not be right for the next.

And we know that women with neurodivergence are often very sensitive to different progestogens and they need tweaking.

And I think what we need to say to clinicians as a whole that the training I was doing earlier on in the week is that there is no one size fits all for this.

Yes.

You know, most women, many women will, will feel better with micronized progesterone.

That's your trigger and your jeopardy.

It's the one that you take at night as a capsule.

But it's not a set in stone thing.

Some of those women might feel better with a different type of progesterone.

And what I, what really, really frustrates me, I've got a lot of things that frustrate me around this.

But one of the other things that really frustrates me is when I hear from women, you know, I do a menopause clinic and very often those women have been through their GP or they've seen other clin and then I sort of see them if they're a bit more complex.

So they get referred on to me as complex cases.

And actually they're not usually, not always that complex.

It's a case of, you know, they've been told, well, HRT just doesn't work for you.

It just doesn't suit you, you get too many side effects.

And actually, when I speak to these women, by and large, they've tried one hrt, they've tried one progesterogen, they haven't tried different things.

And my message to the clinicians I was talking to earlier on in the week is don't give up on, on these women.

And equally, women don't give up on hrt.

You know, there's obviously a lot of women that can't take hrt.

There's a lot of women that don't want to take hrt.

Kudos to them.

Absolutely fine.

But if you are keen to have hrt, you have to just keep going.

And there's a trial and error approach to this.

Yes, there might be one that we think will work better for you, and that's often the more natural micronised progesterone.

And as you said, some women actually need more of that.

You know, some women actually get this kickback where it activates the GABA in the brain, which is our calming chemical messenger.

It's the response that you get if you have that glass of wine on a Friday night and you suddenly feel relaxed.

It's the response that you get from sedatives, from sleeping tablets, from diazepam.

That's what activates your GABA receptors initially.

So some women do get that very calming effect from progesterone, but some women, particularly neurodivergent women who are.

Have an altered response to that can actually feel worse on it.

So it's just sticking to that mantra of there is no one size fits all and what works for one woman may not work for the next.

Yeah, I, I think it's the understanding how they can ask the questions and I understand, you know, how, you know, over, over.

There's this sort of difficulty in the nhs, I guess, to get this more personalized approach due to time and maybe you know, just, just having that time with the gp who is.

Is as where as.

As you are.

And I hear from so many women going, well, well, I don't know what to do now.

Like, my GP doesn't understand and I don't think my HRT is working.

They don't understand about estrogen dominance or that I do need to up my progesterone and I only need, you know, one pump of estrogen or I need to change it and tweak it throughout my cycle to understand how that interacts with my ADHD medication.

And we are low on understanding, we're.

Low on evidence as well, and we're low on studies that support this.

And that's the problem.

You know, if something has a lot of evidence and research, but it's not within the guidance, then clinicians, by and large, you can sell that to clinicians.

If you know it's in the guidance, you can sell that to clinicians as standard clinical practice.

At the minute we're in a very difficult place because there is no real guidance on how we manage women with who are neurodivergent and hormones because there is no backstory to that.

You know, there's no evidence and research and it's very, very under, under researched area in my, in what I've looked at.

So I think it's really difficult.

And some of the terminology as well is quite challenging because, you know, some of this terminology is not recognized.

Like oestrogen dominance is not a recognized term by the British Menopause Society, who I sort of follow and a specialist with.

It is easy for clinicians to feel very bamboozled by the different terminology that's coming out and the different things that women are hearing and seeing.

And I think it's easy for women to get sucked into some of that as well and not know what is right, what is real and unreal and what they should be advocating for, you know, in terms of advocating for themselves.

So can I ask because like you say, you know, we haven't got that research and it has to be, you know, as clinicians you have to follow these guidelines, which I totally understand, there's huge risk if something goes wrong.

But are you seeing neurodivergence in women especially this topic is more patient led.

We've got anecdotal evidence which is way, way ahead.

You know, we know the DSM 5, the way it describes ADHD, especially in women and girls, is so behind, it needs updating.

I think the British Menopause Society, I don't know how often it updates its clinical evidence, but I think it's behind.

And is there a way of clinicians understanding in this particular sector it has to be more patient led or trial and error?

I'm not by any manner of means saying that we have to follow guidance.

We are clinicians and we are trained and we're experienced over many, many years, as many of us and you know, we shouldn't be following guidance just because it's guidance.

That's absolutely not what we should be doing.

But I guess what I'm saying is, you know, if you are gps, by and large are not specialists in menopause and I get a Lot of comments on my in or hormones and I get a lot of comments on my Instagram saying all gps should know this and all gps should be able to do this.

And I disagree with that because actually we are specialists at being generalists.

We know a lot about many, many things, but we don't know the in depth and granular detail of things unless we've chosen to take time out and put training into that.

I mean, I. I took time out of practice on my annual leave.

I've done this in evenings, I've done it on weekends at the detriment of missing out on my three children and things they were doing.

I've paid a lot of money to take on this extra training.

We can't expect all gps to do that.

I did it because I'm very passionate about it and I'm interested in it.

I think the difficulty is that you're not going to get a GP that is necessarily so comfortable and experienced in dealing with this that they're willing to divert from the guidance.

And that's the issue.

So, no, we don't.

Shouldn't be following guidance rigidly because it's guidance.

But in order to deviate from guidance, you have to have a certain level as a clinician of comfort and experience and knowledge and be experienced in these anecdotal stories that you're getting from patients enough to feel that you've got enough to go on to deviate from, from that guidance.

And the majority of gps, if they, not.

If they've not taken time out and specialized and trained in this, will not be in that position.

So when they meet a patient and they're unsure what to do because they haven't got the experience or the knowledge, they will deviate to guidance and they will follow guidance.

And I don't think we can berate them for that because that is their safe place and that's what we expect them to do.

That's what I would expect my GP trainees, I always have at least one trainee on the go in terms of training them in practice.

I would expect them, if they got to a position where they met a patient and weren't sure what to do and didn't have that experience or knowledge, to deviate to the guidance and to follow that guidance because that's a safe place for them, I might think, well, that's not right for that patient.

So I'll try this because I've got evidence of this or experience.

But we can't expect all gps to do that.

And I think that's where we're at.

So what we need to do is almost like there's two parts this isn't.

It's empowering women to advocate for themselves and to keep not feeling bad about going back and asking for more, but also to empower clinicians to learn more about this and experience more and become passionate about this because it is a great area to work in if you do ignite that passion because you can literally change and save lives.

You know, we've always.

You've spoken about the detrimental effects of perimenopause.

One in six women in perimenopause, regardless of their neurodivergent or neurotypical, have had suicidal ideation.

And that's huge, you know, and we need to, we need to really focus on that and make changes.

And you know, you talked about, you get sent the complex cases and I'm just interested to know the complex cases.

How many of these women, I guess maybe percentage wise, do you sense as neurodivergence there?

And I just.

Before you answer that question, I want to bring in the different maybe traits that I see in women who have only found out they've neurodivergent later on in life.

And I often hear that they've had endometriosis, pmdd, cysts, fibroids, mental health conditions, ocd, addiction, this picture.

And I wonder, the complex cases that you're seeing, what percentage would you say encapsulates this?

It's difficult to put a percentage on it, isn't it?

But I think if you're seeing somebody who's been through other clinicians and perhaps not got quite, you know, got the answers that they need.

I probably do see a higher percentage of women who are neurodivergent, which is perhaps what led me down this path to be so passionate about it.

Because, you know, I've met a number of women over, over the years who you just think, you know, there's something else here, there's something else going on.

These hormones are wreaking absolute havoc out with what we would expect.

And I have, you know, directed a few of those women through adhd, particularly ADHD pathways to be diagnosed.

You know, I would say probably a 20% if I was going to put a figure on it, it may well be higher.

I think one of the key things that we need to get out to clinicians is if you are recurrently seeing women with anxiety and depression, mental health disorders who are treatment resistant, I. E. You're doing all the things that you would do with any other Patient therapy, medication, et cetera, and they are not getting any better.

Then think about underlying neurodivergence.

Because the anxiety and depression, it can obviously coexist with neurodivergence.

It's more common in women who are neurodivergent.

But is it a symptom of the underlying neurodivergent or is it the diagnosis?

And I think we're not, again, we're not very good at separating the two and recognizing that it could actually be an underlying reason.

And then obviously perimenopause lands on top of that and the hormones go all in flux and then that just compounds everything and everything implodes.

So yeah, I do see a lot of women where, you know, they've had this history of often treatment resistant anxiety and depression, but often they've really coped seemingly on the out to the outside world.

They've really coped and flown in life and then everything's come crashing down and it is a really, you know, it's a really hard thing to watch happen and we need to be better at recognizing it and understanding it.

I think as clinicians.

Yeah.

And my last question to you is, and I'm not sure if you'll have the answer answer to this, but my question is, say a woman who is below perimenopausal age has consistently had PMDD and really struggles.

Why are we not able to prescribe types of hormones instead of it being, you know, anxiety medication or antidepressants, you know, progesterone or topical progesterone, vaginal progesterone.

If we know that the PMDD is hormone led and obviously it's impacting our mental health, why is that not a prescriptive pathway and why has that not been considered?

It's a great question and it's one that I often mull over.

And I think it goes back to that previous point I was making.

You know, we just don't have the framework to hang that off.

So I think, you know, we're just not far enough along that journey of joining up those dots.

So, you know, the more passionate and involved amongst us will know that there is significant impact of women's hormones fluctuating on their brain and their mental health.

2023.

So just two years ago, before the first study was pulled together on this, exploring mental health in perimenopause.

I mean, just let that sink in.

We are in sort of we're in a world of AI and you know, all the other high flying technology things that are going on at the minute.

You can order something online, Amazon and it be delivered the same day.

But we have only just started to join the dots between the effects on the brain of women's hormones and put it out there into clinical practice.

So I hope that that will become standard clinical practice in the future.

But these things take time to come, to filter through, to embed, for the research to be there to back up putting it into standard clinical practice.

And that's the difficulty that we're in at the minute.

So there are a few doctors out there who are doing this, but they are, I suppose I don't want to say going off piece because it's not that I disagree with it, but they're working out with sort of standard clinical practice and it's difficult for the day to day clinicians who are not specialists in that area to do that, I guess.

Yeah, listen, thank you so much.

I know you've got a busy GP practice to get back to.

My last thing.

What would you be your parting message to anyone who is nervous to go to their gp, who has been sort of maybe fobbed off or dismissed or told that this is just the HRT pathway to go with?

How would they then go back with confidence and self advocacy to really get what they need?

Well, look, I think it's really hard because at that particular point in time as well, because we've just talked about all the ways you may be feeling, you know, your life may be imploding around you.

To then say, oh, you just need to have, have confidence and go back, that's like just telling an alcoholic not to drink beer.

It's, it's difficult.

But I think, you know, the work that we're doing here is just to really empower women to say it's not, it's not you, it's them kind of thing.

It's okay to, to question even medics, you know, question them, go back, give, you know, just keep going back.

Because actually you need to advocate for yourself.

We're just not because the doctors are bad or they don't care necessarily.

It's because we're just not in that place of full understanding and acceptance of these use.

And we've not yet joined up the dots in standard clinical practice and until that happens, I'm afraid women are going to have to just keep going back and advocating and it doesn't make it right.

But, but I'm being completely honest about where we are.

Yeah.

I appreciate that.

And thank you so much for sharing your advice, your guidance, your insights.

I know this is going to be very, very helpful.

So really, really want to thank you, Dr. Helen Wall.

And people want to find you.

They can go to your Instagram, which.

Is the full word.

Dr. Helen Wall.

Yeah.

Thank you.

Fantastic.

Thank you so much, Helen.

And I'll speak to you soon.

Thank you.

If this episode has been helpful for you and you're looking for more tools and more guidance, my brand new book, the ADHD Women's Wellbeing Toolkit is out now.

You can find it wherever you buy your books from.

You can also check out the audiobook if you do prefer to listen to me.

I have narrated it all myself.

Thank you so much for being here and I will see you for the next episode.