Hormonal Balance and ADHD Myths Debunked: A Conversation with a TOP ADHD Psychiatrist

Are you currently feeling reactive, chaotic, overwhelmed or maybe anxious? And despite this time of year, we're meant to feel festive and connected with all our loved ones. It can actually be one of the hardest times for many of us. And if this is the case for you, first of all, I'm sending you love, I'm sending you compassion. But if you are looking for some further help and support, then I wanted to let you know that my two-part Reclaim Your Calm workshop is now available

as an on-demand resource. So it's now been recorded and it's available. And during these two workshops, so they're split into hourly workshops, you're able to learn the basics of tapping, which is EFT, specifically for ADHD. And we're going to go into these techniques and these tools to help you, but also your loved ones, your kids, your teenagers,

and help you move through these emotions and help you feel more responsive and less reactive, accept where you are, and to use all these calming and regulating grounding techniques to get you more in touch with what is going on for you, helping you accept where you are, ground you back into your body, but it also gives you clarity and a new perspective and a way forwards. So if this is something that you are looking for right now,

And you're looking for more hope and to lean into more of your desires and also to let go and to release things as we move into this new year. I urge you to check out the Reclaim Your Calm workshops. They're now available on my website, which is adhdwomenswellbeing.co.uk. If you go to the homepage,

you'll see the button it's there and you're able to watch it straight away. I really hope that you find this as helpful as the many people who signed it for it live and I'm sending you all my very best for the year ahead and now back to today's episode.

Welcome back to the ADHD Women's Wellbeing Podcast. It's 2025. Wow, wishing you all happy, healthy, expansive. And yeah, I think a kinder new year for everybody. And I hope that this year brings us all a lot more evolution and growth and love and compassion and safety and peace throughout the world and within ourselves as well.

And today we're having a bit of a break from having our new guests, but we still have a fantastic expert here. We have Dr. Assad Raffi. He is the owner of Sanctum Healthcare here in Manchester. And he is an ADHD specialist. He is part of the Ask the Psych new feature that we've been putting in the toolkit.

But I thought it'd be so fascinating for you guys to hear his expertise here on the main podcast. Now, if you are interested, we have other clips from him on the toolkit, which is why I believe the toolkit is such a fantastic resource. We've really got amazing experts and specialists diving deeper and having these more sort of specific conversations and teachings and workshops. And so that is the toolkit. It's out every other week. It's out on a Monday. It's 4.99 a month.

and it's incredible value for what you're getting. It's really allowing you to get that deep dive into your ADHD and how you want to manage it and treat it and make it your friend with your well-being and your lifestyle. Now, today we are talking with Dr. Raffi about the influence of hormonal changes, particularly how it shows up for us during perimenopause, but also puberty on menstrual cycles, the role that an estrogen progesterone play in

creating a bit of havoc and really sort of unearthing our ADHD later on in life.

We talk about how our hormones, especially with ADHD, impact our sleep on mood, the many different ADHD symptoms such as our emotional regulation, our restlessness, our energy. And it's so powerful to know that we're learning this, that we're learning that hormones are have a massive correlation to how our ADHD shows up. So Dr. Raffi gives us some advice about potentially some progesterone-only treatments. He really emphasizes the need that we do need this hormonal balance.

but sometimes the synthetic hormones or different things the way we've experienced it through our lives perhaps have exacerbated our ADHD symptoms such as a contraceptive pill. There's so many different ways this could have shown up and unfortunately we're still waiting. We're still waiting for science and research to capture, but to have these conversations and to have it validated by a doctor gives us this opportunity that we can find more advocacy, we can find more empowerment

in recognizing that a doctor is telling us this and we can seek alternatives. And we also talk about the importance of considering that perhaps there is early puberty and how that impacts girls, especially on our brain development and the impact that it's having on our mental health. So I think the long and short of it is

This is massively cementing perhaps what many of us have experienced throughout life from early onset of puberty throughout, you know, whether we've had children so postnatally and creeping towards perimenopause and in and out of menopause. It is not our imagination that our hormones have played a huge role in how we have felt mentally. So I really hope that today's episode is helpful for you.

For girls and boys, when you've got puberty, and you've got those hormone changes, and this is something that we've got to be really, really understanding of. When it comes to females, when it comes to girls, we see so many at that 12, 13 year old stage.

because of that transition from a more nurturing environment into high school, but also the onset of puberty in most cases. The advent of menstrual cycles and knowing that link between the luteal phase, which is the phase after ovulation, just before you do in your period, seven to 10 days before we start to see

an increase in ADHD symptoms. We start to see sleep worsening, we start to see a liability towards some of those coping strategies, potentially some of those addictive behaviours, food, nicotine, caffeine, whatever it might be. Also, very low mood people with ADHD are more likely to be up here today. Yep, so mood and emotions. Or is it the RSD getting worse? Yeah, definitely in the mix.

So let's understand why that happens, and I'll try and keep this as simple as possible. But if we think about our female reproductive hormones, and I'll talk about estrogen and progesterone, because to be honest, we don't know enough about testosterone and females, but that is an emerging area, okay? Well, let's just stick, we're going to stick to estrogen and progesterone.

And what we know is that estrogen, and this is again coming from a man, is the most potent, most important hormone transmitter in the human body. Most of us guys can't relate to it. Hormonal fluctuations and the role of estrogen progesterone is so significant.

that when you start to see the impact of those fluctuations, it helps you to try and understand it from a male, certainly from a doctor, just from a male perspective. I don't think any one of us could even walk one day in those shoes compared to what women have to go through. And if you look at the impact of estrogen on the brain, forget anywhere else because it works on every single bodily system that we know of, your bone health, your cardiovascular health, your immune health,

everywhere. Let's just focus on the brain. East region in simple terms helps how dopamine, which is central to your ADHD. That's where the imbalance occurs. East region works in a very positive way to help how dopamine works, but also how serotonin, your mood, neurotransmitter works. When your East region levels start to drop,

ADHD symptoms are going to get worse. Progesterone has the opposite effect. So when progesterone levels go up, you're going to see worsening of ADHD symptoms. This is why the marina coil progesterone only pill marina coil releases synthetic progesterone. It annihilates and it sets ADHD on fire.

And this is why I say, please God, do not take progesterone by itself, do it in combination, because you need the two to balance each other out. You've got to do it in balance with estrogen. And I'm not even an endocrinologist or a hormone specialist, but a de facto become one. You cannot assess, you cannot manage women, girls without thinking about hormones, fundamentally important.

And what we're seeing now is that for ovulation, you're getting that sudden surge of estrogen, and then you're getting the rapid decline. And there's a recent paper which indicates that in that initial drop, the likelihood of impulsivity, hyperactivity, increasing is quite significant. Then you get a further drop

which appears to be more linked to the inattention phase. So you're seeing these phases and trends and what's really important is

Start tracking your cycle, start logging the symptoms, and then as clinicians, collaboratively, dose flexibly. So what we will do is in that week, prior to period, if you need a higher dose of medication, that's fine. It's got to be justified. Look at hormonal intervention, look at cognitive behavioral approaches, looking at stress management, diet, all of those things, as they will all play a part

But this is where we've got to understand managing those hormones. And I walk into schools and in girls' schools and I will speak to them and I will say, listen, if we look at a third of the month, typically where girls are going to be facing those hormonal fluctuations, their ability to concentrate, focus, sleep well, all of the things that we've just talked about with ADHD is going to be compromised.

whether they've got ADHD or not. But it's going to be more amplified if they've got ADHD. And if they're not on the pill, okay, because sometimes parents are horrified when I say, I think your daughter needs to go on the pill. Oh my God, what do you mean? And I say, no, it's not for the fact that I'm suggesting they need birth control. The purpose here is,

to correct that hormonal imbalance. But then what happens, then go into a GP and not closely advising them, what ends up happening progesterone only or even the coil. Your doctor should be asking you about which contraception you've taken, what you've had, even asking about when you started puberty. Because what we now know is that people who went through puberty early

That neuroplasticity process, your brain's maturing process, if that's arrested early, the likelihood of that prefrontal cortex, that junction box in the brain that coordinates all of the activities that underpin ADHD, doesn't work as effectively. What do you consider early?

eight, nine, 10 years old. What we're then seeing is there's that mismatch between the different parts of the brain. So you've got your executive function that's coordinated by the prefrontal cortex. And then you've got the overactivity within areas that manage emotion, like the limbic system. And this is where we've got to be really mindful about understanding, then how do we manage it?

If we understand that whole process around windy puberty take place, what's likely to have happened, how do those symptoms manifest over time? It's all about that neuroplasticity process and when that, how mature your brain was at that particular time. That will then aid us or help us to understand how we manage that client moving forward.

And unfortunately, none of this can be done in the eight or 10 minutes that a GP has got and going back to what you said about contraception. I mean, from my perspective, I was put on the wrong pills several times and everything just collapsed when I was when I was on those hormones. It was hideous. It was awful. It was the worst time of my life. Then after baby number three, I went on the marina coil.

Even more hideous, horrific. And my GP, my female GP assured me, I kept saying, I don't do well in contraception. It's like the hormones have never agreed with me. She said, Oh, it's such a small localized. She literally was like, there's no way you're going to impact badly with the marina. So I put my trust, my faith in her. Three days later, I was

throwing things, screaming, crying. I was up and down. My poor husband was just like, didn't know what to do with me. He was like, you need to go and get this thing taken out. Thankfully, I did within six weeks, it was out. And I felt better within, again, four or five days. And for me, the HRT, I still, I was so nervous, so, so nervous. For the progestering side, I kept saying to my

Thank God specialist and medical aid HD doctor who was very sort of knowledgeable on both sides. She said, right, we're going to play really safe with the progesterone. We're going to go in and we're going to just try. We're going to, you know, do whatever I can within my medical remit.

We get and thankfully we came up with a way and now I can't wait. I get so excited to take my progesterone in the second period of my cycle because it calms me. I feel I sleep better. I feel maybe lower in mood and I would say probably sort of just a bit more like I just want to kind of hide away and sleep a little bit more. But that's not a bad thing because as women we need these cycles of energy and then no one to pull back and when we're having our

our days where we just want to kind of like have quiet time and I think that's really good. We should have ebbs and flows and but it has to be manageable and it can't be at the detriment to our mental health.

If you have been listening to this podcast for a while, you'll also know how passionate I am about understanding our hormones and really protecting them and finding ways that we can live better, we can thrive, we can feel healthier as women with ADHD. So I loved listening to Dr. Raffia Ferm and also validate how important this really is. And I have one more clip for you. And in this one, Dr. Raffia and I are looking at how

we see ADHD and see these messy stereotypes of perhaps

what people think ADHD looks like. And actually, sometimes it's not. We think, oh, how can you have ADHD if your house is tidy or your desk is in order, but actually many of us need this structure and we need order so we can feel calm and rested and grounded within us. So I've really, really enjoyed having these conversations with Dr. Raffi and just having him there to bounce ideas off and have his confirmation. So here is

The clip with me, Dr. Raffi, I hope you find it very helpful. I'm going to break this question down actually, just because I think it's important and it kind of talks about a little bit what we were just saying, is that someone's come and said they've been diagnosed with a combination of ADHD and she has this real sense of do I really have it?

The reason being is because a lot of people have read, say that ADHD people are lazy, and I don't feel particularly lazy. I'd say I'm clean, she cleans the house once a week, during the week the partner does all the washing up. So in short, is it possible to have ADHD but not have a house that looks like a bomb's gone off? And I am just going to put an extra caveat to this of this social media, the means of

showing kind of like one ADHD room looks like or a house and people can't tidy up or there's just a lot of people collect items and like the hoarding and I just want to say that it's nice for someone to be like you know what I think I've got ADHD but it just doesn't present

In that way, especially as a woman, where this sort of social conditioning is, if your house looks like a tip, then you've definitely got ADHD. But if your house is presentable and everything, you look presentable and you're clean and tidy and then there's no way you can have ADHD. Because I have that, I have a tidy house, I look presentable most of the time.

My desk may be a bit messy, but on the whole, I would like to say my house is in order because for me, order, tidiness, cleanliness, hygiene, I would say is part of my self-regulation. However, the weekend,

got four kids, they've all got friends over, chaos, people in the house all weekend. I feel so different on a Sunday night when I'm cleaning, tidying, there's chaos everywhere, shoes, washing, to how I feel probably on a Wednesday morning on my own in the house when everything's tidying clean. Just wondered what your thoughts are on this whole situation.

you don't need to tick every box. And that's the key thing here, that again, when you've got that, not necessarily myth, but you've got this perpetuation of certain presentations on social media, people feel that that then becomes the narrative or the norm. It's not necessarily the case. However, with this particular question, I found this question quite interesting because on the one hand, she's already given me a load of the answers, which is clearly got a partner there who is potentially compensating

for some of her challenges. For helping. Absolutely. And that could be anyone that's you, that's mum at this moment in time. So you're compensating potentially for

if your children have ADHD or not, whatever, you're compensating for them. So it changes and it evolves over time, depending on circumstances, depending on your lifestyle, depending on the people around you. So yeah, it doesn't necessarily mean just because you're not hugely disorganized. You may well have been disorganized in the past, but because you faced consequences, okay, you've started to develop adaptive strategies, but it will be certainly be evident in other areas

So this is the point I was making for ADHD evolves over time and the presentation will evolve as well. Depending upon the outcomes, the consequences that you face and if those consequences are meaningful enough, you will adapt to them and it will change.

Yeah, I mean, I had an interesting conversation with my son yesterday, he's 19, he's going off to university this weekend. And obviously there's lots of big emotions there, but he's got ADHD. And interestingly, he'd been away working, didn't some work over the week. And he said, you know what, I noticed Mum, he said, because he's not, he's obviously gone to school, he's had some jobs here and there, but he did a week of work to get some money before he started uni. And he said, I've really noticed that I can't multitask.

And he always shouts at me because I get, if I'm writing an email or texting on my phone, my kids can go, mama, mama, million times, I just won't hear. And then they have to shout, Kate. And then I jump out of my skin because, you know, that breaks. But, and he said, I noticed myself doing that, that I was doing one thing. And someone was shouting my name and they asked me to do something else. And I couldn't hear. And that's, I guess his first foray into being out of like an academic structure.

He was in a different environment away from home and all of that. But I said to him, I'm really glad that you noticed because that's okay. You know, you've got ADHD. You can see how it manifests in me. And he just said, I really did notice I couldn't multitask. And I said, fine, good. I'm glad that you noticed that we'll work on that together.

But it is just going back to this noticing, isn't it, how it shows up in our life? And I don't know. Can I answer it to interrupt Kate? Not that I've got to prove that I've got ADHD there. But just to address that point that you've just made about your son, because it's really, really important. What type of school did you go to describe the type of school? Did it give him structure, discipline, accountability? All of the things that will help an individual with ADHD

to remain accountable. Yeah. I mean, we're very, we're in a privileged situation. He went to an all boys, very good school. He thrived in it. And the reason why he thrived in it is because the teachers were used to working with boys or similar to him, clever boys with busy brains, active,

Although he started in year five, and in year five, he almost got thrown out, because first of all, we didn't know he had ADHD. And the reason why he was thrown out, nearly thrown out, is because he dug a hole in his wooden desk using a compass.

And he obviously had done it, you know, during lessons, you know, fidgeting and trying to sort of concentrate in his own way. And he destroyed a desk and got pulled into the school within, you know, six months. And thankfully, I always thank this teacher. She just saw something in him and she went, we're going to find something else for you. You know, you're going to fidget with something else. We're going to get you at the front of the class, like,

This is way before we knew our ADHD. And he was nurtured in that school. And he had teachers who just got him and they directed him towards the subjects he enjoyed. He did 3A levels, which couldn't have been more different. And I'm going to just say them here, because I'm so proud of him. He did art, he did economics, and he did Italian. So none of them.

We're connected to, you know, if you look at them on paper, you kind of think, what's he going to do with that? Each subject you loved and remember having a conversation after his GCSEs with the teacher and he went, do what you love. That was his direction. Do what you're good at. You're exactly your instructions. What are you passionate about and what are you interested in? Don't do. Like they even say, I should do maths with economics because that's what really I should do.

And they won't be conforming to suit societies or people's expectations. What was it for me? Do the sciences. Believe it or not, I didn't have any kind of family pressure on me to become a doctor. I booked that stereotype. But there was a pressure there because maybe the non-science subjects just didn't excite me. And that's the route that I went down.

But I had a different driver and a different motivator. And again, this brings me back to having that structure that discipline. Your son was blessed in a lot of ways. Absolutely. Not everybody is blessed to be in that type of an environment where they're understood and they're supported. And nurtured. He was nurtured. But there's a blessing and a curse here. And I'm going to tell you why, because these types of environments, especially when you're high performing,

highly intelligent and you know what, you're getting away with it. When you don't face consequences in life, human behavior doesn't change. Think about it. We only change what we do and how we behave once we face a meaningful consequence. If we keep getting away with it, we don't face those consequences, those behaviors will continue in some way, shape or form. And if we as parents,

continually compensate. That becomes a problem. We will nurture them. We will support them. None of us, I always say this, none of us went to parent school. Okay, we learn on the job. We learned by our mistakes. We're still learning. I'm still blagging it and winging it as a dad. Believe it or not, my kids, I'll tell you that. Okay. But

None of us were taught how to manage children with ADHD. So looking at investing time in understanding parenting strategies isn't me saying that you're a crap parent. It's saying actually learn the skills, learn the abilities that will help you to understand the condition and how your child operates.

That's fundamentally important. But ultimately, we will do our best to support and look after our children, to prevent them from facing difficulties and challenges that we may have faced. Exactly. That is fundamentally what we do. We always give our kids or we compensate for our children for the things that we may have encountered. We may have come across. So if I've forgotten my game's getting into trouble, I can't let my daughter go through that. I'm now going to go home.

And I'm going to get her games, and I'm going to drop it off at school where she's not going to learn. She's got to face consequences. And it's a bit of tough love. But the problem here is they don't face consequences. If they don't face adversity, my kids have not faced adversity. I did. I didn't grow up in a particularly, you know, and that did come from a wealthy background or anything else. It was tough. It was hard, you know, not as tough as hard as for some people, but it wasn't easy.

But ultimately I became resilient, I became hard, I became tough, I learned from that. And it gave me what I call my psychological toolbox to be able to manage things later on in life. The problem that we then have is if we're creating an environment where children are constantly compensated for, they're going to school on the same buses that peer group, they're in school, they've got the same social circles at home, they've not faced the realities and the harsh facts and realities of everyday life.

We plunk them in some inner city to go to university or college or wherever it might be. And then what happens? The wheels fall off. And invariably, it may well be that this high performing child, then no longer is able to perform on that level. They drop out. Worse still, they end up going down the route of coping mechanisms.

And that they will, you know, previously they were protected from, so be that alcohol, be that substance use, which ultimately they didn't wake up one day and decide a fancy start in taking cocaine or cannabis or drinking alcohol excessively.

It's built up over time. They've come across something that's given them that therapeutic release, and ultimately then it spirals into a situation where that becomes a primary problem. And again, the ADHD is missed. So this is where when we see those transitions and you'll see those spikes in referrals,

primary school into high school, high school into college, college into university, university then into the workplace. Because what's happening there is, then that's widening. You're expected to become more independent. And as you're expected to become more independent, symptoms of the ADHD can start to become more apparent. So thank you so much for listening to today's episode. I really think that to have this validated by a doctor who specializes in ADHD, who has ADHD himself,

as ADHD in his family.

To know that he has seen this right now with so many of his clients, he sees it with himself and he sees it across the board that we're learning so much more, especially about ADHD in women and girls. So the next brand new podcast will be back on the 9th January. There are lots of Toolkit episodes out there for you. So if you are diving in and you want to learn more, please do check out the Toolkit and wishing you a very happy new year and a positive 2025 ahead.

Take care.