Hormones, ADHD & the Chaos in Between with Dr. Dara Abraham
In this episode of Taking Control: The ADHD Podcast, Pete and Nikki sit down with Dr. Dara Abraham—board-certified psychiatrist, women’s mental health expert, and founder of Dr. Dara Psychiatry—to explore the complicated and under-discussed relationship between ADHD and hormones.
Dr. Dara walks us through the key hormonal transitions across the lifespan—puberty, pregnancy, postpartum, perimenopause, and menopause—and how each stage uniquely disrupts ADHD symptoms and medication effectiveness. She shares why estrogen is your brain’s best friend, how hormonal shifts wreak havoc on dopamine regulation, and why women are so often dismissed when seeking help. From the science of hormone replacement therapy to practical tips for self-advocacy and lifestyle support, this episode is a must-listen for anyone navigating the double whammy of ADHD and hormonal change.
Whether you’re struggling with brain fog, sleep disruptions, or medication that suddenly stopped working—there’s help, there’s hope, and Dr. Dara is here to share it.
Medical Disclaimer: This episode on ADHD and hormones expresses the opinions of our guest, Dr. Dara Abraham, and should not be taken as medical advice. The conversation is being provided for informational purposes only. Everyone’s situation is different, so please consult your healthcare professional for any and all matters regarding these topics.
Links & Notes
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Pete Wright:
Hello everybody and welcome to Taking Control: The ADHD Podcast on TruStory FM. I'm Pete Wright and I'm here with Nikki Kinzer.
Nikki Kinzer:
Hello, everyone. Hello, Pete Wright.
Pete Wright:
Oh, Nikki. We're continuing our ADHD and the bod series. That's what it's called now, I think-
Nikki Kinzer:
The bod.
Pete Wright:
... I was called out for using the bod last week, and now it just stuck. ADHD and the bod. And today we're talking about hormones, which we've danced through hormones in the last couple of episodes. And today we're going deep. Very excited to do that. We have a very special guest to help us. Before we dig in, head over to takecontroladhd.com to get to know us a little bit better. Listen to the show right there on the website or subscribe to our mailing list, and we will send you an email when the latest episode releases each week.
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Today, we are diving into a topic that is often overlooked, yet deeply, deeply felt. The complex and frustrating intersection of ADHD and hormonal changes. For women with ADHD shifts in estrogen and other hormones during puberty, perimenopause, and menopause can reshape how ADHD shows up entirely. Today, we want to come to understand these changes and reclaim a sense of control during life's most unpredictable transitions. To help us do that, we welcome Dr. Dara Abraham, a board certified psychiatrist who brings both clinical insight and lived experience to her work through her boutique practice, writing for Attitude Magazine and advocacy in the mental health space. Dr. Dara has become a guiding voice in helping women understand how ADHD and hormones interact and how to get the support they deserve. Dr. Dara, welcome to the show.
Dr. Dara Abraham:
Thank you for having me. Can you hear me okay?
Pete Wright:
Oh, yeah.
Nikki Kinzer:
Yes.
Dr. Dara Abraham:
Okay, good.
Pete Wright:
I hear you great. All right, let's dig in. What was it that drew you and your studies to talking about hormones and hormonal changes?
Dr. Dara Abraham:
I've always been interested in ADHD. So I got into really loving talking to women about ADHD and somehow figured out that really women were just being dismissed constantly because they didn't present the typical way as men did. And that was since childhood. They didn't present as hyperactive, really impulsive. Really it was more of the daydreamer just like myself. Really more anxious, sometimes even more high achieving. Just really just very people pleasing and just very different than little boys. But what I also noticed that a lot of times during their cycle, this was not as common for myself, but for many, they really did not... Their medications were not as effective. And what I noticed was they were being dismissed again.
And so it was this constant feeling in that feeling like they were crazy. And so really it was just really learning about the different reasons why. And so I started to notice that it happened right when they would go through puberty and then again during something called PMS. And then PMS on steroids, and then again during pregnancy, postpartum. And that's not just postpartum depression, but what we call after pregnancy, the postpartum period. And then again during what's called the perimenopause before someone goes through a menopause. And all of this, putting it all together, I realized what's going on? And it really is the change in hormones.
So really it was just really my patience trying to figure out what was going on with them and trying to really help them solve the problem, which is what I'm always doing is really working in that space of what can we do? There's always a solution. That's always been really a popular topic. And so I went with popular.
Nikki Kinzer:
And boy, are we so glad that you are here today. This is a topic that has been brought up many, many times with my own clients, with our listeners. It's a popular topic that we just don't talk a lot about. So I have questions, I have thoughts, and it's so interesting when you're talking about the different stages that we are as women and the hormones. I remember being in the hospital right after I gave birth to my first son, and I could not stop crying.
I thought for the first time I understood how hormones can affect you without any control. You have no control. I was uncontrollably crying because he came back in from the doctor and he got clipped, whatever. He was crying and I was crying and I couldn't stop crying. I mean, the whole thing was a huge mess. And then perimenopause and now I'm in menopause... And I don't have ADHD. I will just say that. I don't have ADHD and I know what it feels like as a neurotypical to go through all of those things. And then you add ADHD on top of it.
Dr. Dara Abraham:
It's bizarre.
Nikki Kinzer:
Yeah. So I think it'd be helpful, unless, Pete, do you want to say something before I get into-
Pete Wright:
No, no, no. Believe me, I'm ready for this. But I think that this is... It's so funny. An hour ago, long before we started the show, we had our first question come into the chat room. And usually we save these for after, but I thought it would be a really good sort of table setting to understand where we are as a community around hormones. This was Angela who said, "So hormones." I kind of picture her crossing her arms and leaning against a wall. "So who hormones, I'm told we all have them as biological organisms that is. However, as someone who took biology until 19, I found we're only introduced to those that separate us relating to biological sex. But surely there are more that we share as humans. What are some key hormones and their actions that we should be aware of from an ADHD or human perspective?"
So I present that question as a table setting, recognizing that this is a conversation that for us today affects predominantly women and the hormonal changes that are so huge, but also humans and dudes too. So that's our foundational argument. And thank to Angela for getting that on the table. And now I step back like Homer Simpson in a shrub. Let us begin.
Dr. Dara Abraham:
Yeah. So that's a great question, and I think it really does point to why males and females do present differently at different times with ADHD, even going back to males presenting younger and a little bit sooner. Basically what happens is we can think of... Well, let's back up for a second. So there's really three main sex hormones, and those are estrogen, progesterone, and testosterone. And yes, we all have all of them. Even females have testosterone, but we have less than males. And this is biological, and this is excluding with transgender.
I don't want to exclude, but we're going to exclude that for now, biological females and males. And then males also have some estrogen, female sex hormones. But if we keep things as females have more estrogen and progesterone, what happens is it's not during puberty that things change. And so what happens is everything is equal. And so they mostly have the inattentive symptoms, and that's just how it is. And then once they go through puberty is when things start to change. And then they become a little bit more hyperactive and impulsive, and that's when they get a little more chatty.
That's where you see their impulsiveness and they get a little more loud and they talk back to the teacher, their parents, and they become more hormonal. What happens is their estrogen increases. However, what happens is that the estrogen actually can be helpful for the dopamine. So estrogen is our friend and it helps, but then they have this menstrual period that comes on. So even though it helps dopamine, which is our friend for ADHD and attention and concentration, then every month it goes down again. So that fluctuation, it's what causes the ADHD to get worse for females between the ages of 11 and 16.
And so that's why you notice that females who need a dose change in their meds between that time like 12, that's why. As opposed to boys can go on the same dose for years. And then testosterone actually has a negative effect on dopamine. So they've always-
Pete Wright:
Oh, amen.
Dr. Dara Abraham:
But, yes, it's just always been not so helpful. However, the one thing really to be mindful of, and I don't think we... I don't know how much... There's never that much studies on this, but there's inference is that these sex hormones, what happens is they become like neurotransmitters, like these neurochemicals, and they act just like... They can act... Well, kind of dumb it down, they act like dopamine and serotonin and norepinephrine or basically chemicals in the brain the same way. And so they can act just as similar and that's why they can make you feel sad postpartum and feel depressed or feel less alert.
If they act like serotonin, you feel sad and anxious. If they act like dopamine or the dopamine goes down, you feel less alert, less able to concentrate, things like that.
Nikki Kinzer:
Let's talk about hormones and ADHD. How does the addition of ADHD then affect the interaction that our bodies with hormones happens? I mean, you've talked about that a little bit. Let's expand. I guess more of the question of what do we do in this situation? Because we know it's not good we know it's not good. We know that our medication gets affected.
Dr. Dara Abraham:
Well, number one, we have to make sure that we're aware of it. We know that we're not crazy. We're not making it up. It's a real thing. Number two, that we have a provider that is listening to us that's open to this, even though they may not have learned about it in their training or really known about it, that you're able to maybe advocate for yourself even if they are not aware of it, that you can go about educating your provider, your prescriber if you don't feel comfortable and if you are able to find someone you're able to talk to. Or if you can't, because there's a lot of times you can't, coming up with ways to communicate it maybe in a way that your provider, prescriber can hear.
And also coming up with maybe some therapies, ways to manage such as coaching and executive skills training, like behavioral management. I know this is a lot of just gibberish, but really there are ways to help yourself if you really pay attention to your cycle. Not everyone has a regular cycle or you know that you are going to be getting pregnant again, really knowing where you are in your job or your support system. It takes a village to have a child sometimes, but really make that village big postpartum. Sometimes people don't want their in-laws there, have your in-laws plus all their friends around, things like that.
Nikki Kinzer:
We had a similar conversation around this that we had a member of my membership who stopped taking her medication in the hopes of getting pregnant. So she had stopped her medication and talking about just the extra support needed around that time because you don't have the medication. And so what you were saying, the coaching, the therapy, the extra tools, the strategies and things like that. One of the things I know on a personal level is I had to change from my primary doctor to a women's clinic.
Do you find that common in your practice? Because my primary doctor was fine for certain things, but when I started talking about what I found to be perimenopause symptoms and she wasn't necessarily catching that those were perimenopause symptoms, and then when I switched to more of a specialized clinic, it was a game changer for me. I don't know if that's something you notice.
Dr. Dara Abraham:
Yeah, I mean, I do. Unfortunately, I think that hormonal imbalance include throughout life is not really well understood or well discussed in training. And I think that really there's a whole subsection of perimenopause, menopause. I don't even think that all OB/GYN training is really well... that is even that much that those folks are really trained on. So I think unfortunately when people don't really know enough, there's a lot of dismissing. And so I think that can happen with any field, whether it's the primary care or the OB/GYN, if they don't know, there's more of just, "Oh, that's not menopause or that's not a symptom."
So I think it's really finding whether it's a female or a male, but really usually it ends up being a specialized clinic who really has the time to spend with you and really knows it's really just kind of sitting there, really spending the time and going through all the symptoms and being willing to look at the research. Things change. Years ago there was a lot of concern about giving hormonal replacement. Then we learned that it wasn't as dangerous during the perimenopausal years, especially before menopause, long as women didn't have a high, high risk of breast cancer or hormonal type of cancer at a young age.
Nikki Kinzer:
I was going to ask you about your stance on that. So as long as you don't have those higher risks-
Dr. Dara Abraham:
Yeah. Real high risk. It's all risk versus benefit. And so we always have to remember that at this point, there is risk of having even early menopause and having that decrease in estrogen and then having the risk factors for cardiovascular disease as well as dementia. Low estrogen has been proven to lead to dementia. So cardiovascular disease, meaning heart attacks, stroke, and then also osteoporosis, which can be significant in itself. And this is all the years between before perimenopause can range. So that can be a year, that can be six months, that could be three years, that could be five years, 10 years. And so unfortunately-
Nikki Kinzer:
That's, I think, the most unbelievable thing about it is that I remember in my early 40s starting to get hot flashes and thinking, "What is going on?" I just couldn't figure out what was going on. And then my sister who's older than me, was like, "Oh, you might want to see if you're going into more perimenopause." I'm doing the research and it's like up to 10 years. And I'm like, "What?" But it's true because I'm 52 now and I'm in menopause, and it did take about 10 years to get through perimenopause.
Dr. Dara Abraham:
I mean, in full disclosure, I literally just saw my OB/GYN yesterday and I think I may be in the beginning, but I think I could even be early perimenopause, menopause. And we were laughing saying, "I think I could have gone through it a couple years. This could have been a couple years." And he's going through all this stuff. I'm like, I don't know. That was just me, the hot flashes. [inaudible 00:20:10] it's been me for the past 10 years. I'm like, "I don't know the difference. I don't really know." I'm always stressed. I'm always waking up. I'm always this. So a lot of women, none of this is that different, especially the ones with anxiety, ADHD. I wouldn't know.
Nikki Kinzer:
What do you notice as the ADHD... What ADHD symptoms tend to intensify during this transition that you see?
Dr. Dara Abraham:
Yes, so definitely the working memory. And so there's two different types of working memory. There's the verbal and the visual. So both usually more the verbal. A lot of the verbal, like the fluency, just the word finding. What else? The concentration. A lot of the cognitive parts, the aspects of ADHD. What else? I would say the fogginess. And that's sometimes a little bit hard to tease out what is just part of... And that's what is part of just menopause and what is ADHD? I mean, there's been studies that show that neurotypical folks will benefit from ADHD medications, specifically a type of amphetamine, Vyvanse, long-acting amphetamine, and also a non-stimulant called Strattera. There has been studies to show that. So it's really figuring out what's doing what. And then also some of the ability, the distractibility, so lot of the inattentive symptoms.
Nikki Kinzer:
So if you're in that age then where that could be a possibility, what is your recommendation? Because it is hard to know whether or not is this just ADHD or is this worse now because I'm in this period of life? How do you approach that to your doctor? Your concerns?
Dr. Dara Abraham:
You want to use a two-pronged approach since it's pretty hard to have your OB dying talking with your psychiatrist or the one who's prescribing your psych medications. So you may have to be the middle woman and the one who's really the case manager, but you want to at least have some sort of evidence from your gynecologist that you are in perimenopause. It's usually just clinical confirmation. I'm thinking about it now. You may just get a quick note from them or just confirmation and just verbally and go back to your prescriber of the stimulants and let them know that you think you are in perimenopause, and they may be fully aware that at this point it would be helpful to increase your meds, the doses, or to add to or to consider adjustments at this point.
And then I would first suggest doing it that way if they're maybe not too stimulating or maybe adding extra, if you're not on PRNs, meeting extra short acting doses throughout the day, later in the day, depending on where you're having trouble or sometimes adding something a little bit more activating that can help for some of the fogginess along with the stimulants, things like that. And then after some months of trying that, trial and error, then going backwards and talking with the gynecologist and seeing if at this point possibly adding on the hormone replacement therapy would also be helpful.
You could do it the other way, but when you're already diagnosed, it would be useful to start with... And there's no evidence for this, but it would be useful to start with the stimulants since we know there's so quick acting. You can know pretty quickly if they're effective. And I do that with many types of comorbidities with ADHD because unless someone is going to destabilize, I'll know if I increase that Adderall or Vyvanse. I'll know within a couple days to a week if I'm going to get a better response.
Nikki Kinzer:
So I'm going to ping pong back to the hormone replacement therapy. Can you explain more about what this is and how it works and what are the effects? Why is it a benefit or why could it be a benefit to someone?
Pete Wright:
And then how it specifically interacts with the meds, with your strategy around meds? That's fascinating to me.
Dr. Dara Abraham:
I don't personally prescribe it because I'm not a gynecologist, but basically what you're doing is there's different ways to go about it. You're either going to be giving a replacement of estrogen and progesterone or you're just going to be doing, it's less likely to just be doing estrogen itself. And usually it is oral form of the estrogen and progesterone. And there are times... So basically you're giving back what your body has... You're giving back during that perimenopausal time.
You are increasing that estrogen that you have lost. So you're bringing it back to somewhat of a normal level for that time period. And it's important that you're not doing it in the postmenopausal or when you're in menopause since that's when your body is supposed to be at a decreased level. It's not supposed to be at a decreased level during this time.
Nikki Kinzer:
So once you hit menopause, then do you stop taking the hormone replacement therapy? Okay, good to know.
Dr. Dara Abraham:
Yes. Unfortunately, the whole idea behind this is we don't know what is normal for each person. We don't know where they began. We weren't growing levels their whole life. But what we do know is we go by symptoms. The other thing is some people, if they are nervous about hormone replacement or they have a family history of breast cancer or ovarian uterine, hormonally dependent cancers, they can do even topical type of estrogen. So that can help with some of the vaginal dryness, some of the urinary symptoms, things like that.
Also changing some natural types of over the counter vitamins and supplements can be really helpful going to... Not a prescriber, but someone who really knows that type of stuff really can really provide a regimen that is helpful. What else? And also making sure that testosterone is not left out, testosterone pellets. And that's why you really want to see someone who really knows what they're doing. Unfortunately, just like everything else, there's now these clinics popping up online. Get your hormones within 20 minutes. Everything you need monthly. But figuring out what symptom is what. Decreased libido could mean this hormone is lowered. But to testosterone may need to be replenished. And you could do that with adding that into the hormone replacement as well.
Nikki Kinzer:
I think it really does make a difference on the doctor because the person, the clinic I go to, we do a lab every three months. I get my blood checked and she checks the lab. She looks at all the hormones. She looks at everything. I'm on different supplements that she's recommended. And I can tell you, I feel like night and day. I mean, compared to when I first went in with all of these symptoms, brain fog, memory, mood, edginess, crankiness, all of these things that weren't me, that weren't me on a normal day-to-day life, weight gain, all of that stuff.
And it really does make a difference. So how do we empower people when they're feeling so horrible? What are those first steps of, "Okay, I can feel better?" Is it that conversation with the doctor? Is it research? What is it?
Dr. Dara Abraham:
I think it is the conversation with the doctor. Really I think possibly even bringing some information if they can, that's just general information. Sometimes even if they can email or a message just so it's put in their... Can you still hear me?
Nikki Kinzer:
Yeah.
Dr. Dara Abraham:
Just so it's put in their message box and they don't feel like they know that just saying something like, "Hey, I wanted to talk to so-and-so during my appointment, so it's not out of the blue. Just making sure there's enough time. I'm been struggling with this." It's always nice to know what someone is going to bring up, making sure that you set enough time and also coming up with ways that you can basically be referred in the right manner and also know that you may not leave that one appointment with the information that you want, but that's the first step that you've advocated.
Nikki Kinzer:
That you've added?
Dr. Dara Abraham:
Yes. And so-
Nikki Kinzer:
And you've said something like something is not right.
Dr. Dara Abraham:
Exactly. And so almost unfortunately lowering your expectation, but knowing you're that much closer to getting the treatment that you need.
Nikki Kinzer:
So it starts with that conversation, and that is a process. I mean, from my own experience, it was a process of a lot of trial and error and again, taking my blood again three months later. Where are we at now? What are some practical strategies that you tell your clients who have ADHD and who are going through these hormonal changes that can help that aren't necessarily around supplements and the hormonal replacements and things like that?
Dr. Dara Abraham:
So really, it sounds so simple, but getting adequate sleep. The sleep-wake cycle is so important. People don't realize how important, but really most of these disorders, including... It's not a disorder, but perimenopause is related to... It can be somewhat... if we think of it as PMDD, and we think of it, the depression component or ADHD, a lot of those disorders had this sleep-wake dysfunction where the natural melatonin, which is another type of hormone, is released at the wrong time. And so in order to reset the system, we have to really make not just adequate sleep, but I think what women can do is try to go to sleep the same time every day and try to wake up the same time every day.
Even on the weekends. And that's really important. And also making sure that they have a well-varied diet and really... There once was this thought that you really couldn't eat the soy and all of those estrogen-containing products, but I think if you do it in moderation, you don't have this really high family history of the hormone-dependent cancers than just making sure that you're having enough products that have phytoestrogen and just soy beans, things like that.
What else? Exercise, cardiovascular, weight training, making sure that you're getting enough of that, and then really connection, really socializing, having support. I can't really emphasize that enough. Just every other type of mental health issue, and again, this is not a mental health issue, but I'm just going to compare it in that way, opening up the dialogue, being open and transparent. The less that we stigmatize this, the more we have conversations. I think the more it's going to lessen the shame and the guilt surrounding it.
Unfortunately, this is not discussed enough. We're not able to even have time off from work. No one would even think about saying, "Hey, I need a menopause day." Right?
Nikki Kinzer:
Mm-hmm.
Dr. Dara Abraham:
I mean-
Nikki Kinzer:
Although I think it's good.
Pete Wright:
So hearing you say it seems so absurd that we don't. Listening to you guys talk about this, I'm like, "Why do you go to work for 10 straight years?" Just take the decade off. It sucks. Find a boat and go relax. You deserve it.
Dr. Dara Abraham:
I mean, I think we're ready to start menopause day.
Nikki Kinzer:
Yeah. I love that.
Dr. Dara Abraham:
I know. Because somebody has got to start it. Hey, a quick question. You cardiovascular. We know the benefits of health, but I read a bit that struck me about how important strength training specifically is during this decade. If you're not lifting heavy things on a regular basis, you could be doing so at your detriment. I mean, you just said strength training is important, but I'd love to know why, because I think that's probably a thing.
Dr. Dara Abraham:
You really want to really make sure that you're getting enough calcium, and then also you want to make sure that you are weight training. Because you're having less estrogen and less estrogen means that you are basically not having the same muscle and bone. And you could really... Depending on your family history and where you are with your bone density, you want to be getting DEXA scans and making sure that you don't already have propensity to osteopenia, which is the beginning of the early stages of what's called osteoporosis, which is something that women in their later stages, especially women who go through this menopause earlier, can develop.
So I think almost perimenopausal, especially if you're 10 years of it, you really want to be weight really lifting and keeping yourself strong enough, that doesn't become an issue because once it does, it's really hard to change it. Although, there are more meds out there that are pretty keen, like really very different than we had years ago. However, it's once the damage is done, it's done.
Pete Wright:
Yeah. I just want to make sure we highlight that because I think there is... And I'll speak just locally, the women who are going through this in my circle, their expression of fitness doesn't include lifting heavy things and actual strength training. It's like I get on the bike and I do my cardio or I do the things I've always done, but everything I'm hearing is if you're not doing that and including actually getting stronger, you're doing a real disservice to your bones and your skeletal structure.
Dr. Dara Abraham:
So important. So important.
Nikki Kinzer:
It just reminds me though, I can't believe that I have this image of myself because we never really picture ourselves older, but I have this image of myself doing mall walking with gray hair with my little five-pound weight.
Pete Wright:
That's what you're aspiring to now?
Nikki Kinzer:
Yes. With my five-pound weights. I'm going to be out there and I'm going to be walking with my weights.
Dr. Dara Abraham:
I love it. I remember my grandma doing that in the hallway.
Nikki Kinzer:
Yes. It is so important. This is great.
Dr. Dara Abraham:
You can lift more than that, Nikki. Five-pound weight. If you're doing five-pound, you should be lifting a lot more than that by then.
Nikki Kinzer:
I know.
Dr. Dara Abraham:
You should be bulking up.
Nikki Kinzer:
I should be [inaudible 00:37:50]
Dr. Dara Abraham:
You should be shredding. Just start shredding. I think you could start competing in bodybuilding competitions. Let's just say we have-
Nikki Kinzer:
At 70 years old.
Dr. Dara Abraham:
... a path.
Nikki Kinzer:
That's where I'm heading. This is great.
Pete Wright:
Oh, Dr. Dara, you're amazing. Thank you so much for coming on and talking to us about this and helping people. We sure appreciate you. I've got links to your LinkedIn and to your website. Do you want to tell us a little bit more about what you have going on at your practice?
Dr. Dara Abraham:
So I basically see adults and adolescents with adult ADHD and then adolescents and all their comorbidities which ADHD does not exist in a vacuum as well as women with PMDD and postpartum, and perimenopause, and menopause. I just love what I do. We're expanding and have another prescriber, nurse practitioner. Right now I am working on writing a book. I just have two small kiddos and enjoying life, trying to keep up with everything.
Pete Wright:
Well, thank you so much for doing all that and making time to come talk to us today.
Dr. Dara Abraham:
Thank you so much.
Pete Wright:
You're a treasure. Thank you so much for doing that. Thank you everybody for downloading and listening to this show. Thanks for your time and your attention. Don't forget if you have something to contribute to the conversation, we're heading over to the show talk channel in our Discord server, and you can join us right there by becoming a supporting member at the deluxe level or better. On behalf of Nikki Kinzer and Dr. Dara, I'm Pete Wright. We'll catch you next time. We're right here on Taking Control: The ADHD Podcast.
