Later Life Diagnosis: The Relief, The Regret, & The Reality with Linda Roggli
Here’s a story a lot of women know. You’ve been getting by — maybe not perfectly, but you’ve been getting by. And then something shifts. Suddenly the coping strategies that used to work don’t. The brain fog is different. The irritability is new. And nobody around you — including your doctor — seems to have a particularly good answer for why. For women with ADHD, the answer is often estrogen. And for too long, that connection has been wildly undertreated.
Linda Roggli has been living this story and researching it and coaching women through it for twenty years. She’s the founder of the ADDiva Network for ADHD Women 40 and Better, and she joins Pete and Nikki to trace the whole arc: what estrogen actually does for the dopamine-depleted ADHD brain, what happens when it starts its perimenopause roller coaster, why the Women’s Health Initiative study scared a generation of women away from hormone therapy that could have helped them, and what the science now says about timing, delivery methods, and who it’s actually for. It is a lot of information, delivered with the kind of warmth and hard-won clarity that only comes from someone who has personally been told by a doctor, “You’re not in menopause” — and then spent decades making sure other women don’t get that same non-answer.
Links & Notes
Linda Roggli — professional certified coach, award-winning author, founder of the ADDiva Network for ADHD Women 40 and Better
Driven to Distraction by Edward Hallowell and John Ratey — the book Linda’s therapist recommended at her diagnosis; she read it in the bookstore on the way home
Women’s Health Initiative — the federal study whose 1990s findings caused a generation of women to stop hormone therapy; Linda explains why the study was fatally flawed
Dr. Patricia Quinn — ADHD specialist whose research on estrogen-only therapy for ADHD women
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Pete Wright
Hello everybody, and welcome to Take 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 hi, Nikki Kinzer. So good to see you today. How are you feeling?
Nikki Kinzer
You know, a little bit of a hot flash, but I'm doing good.
Pete Wright
Are you hot? I've cranked my AC just to be in solidarity. I'm freezing my ass off, but just to be one of the crowd. We are talking about later life diagnosis. And let's be honest, it's not going to be really a me show today. I don't have a lot that I feel like I can authentically contribute to some of the conversations around hormones and things that we're going to talk about, but I am present. I'm part of the team.
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We have been exploring what ADHD looks like as we age, and today's conversation starts with the moment a lot of that reckoning begins: late diagnosis. For women, that story carries an extra layer, because perimenopause and menopause reshape the hormonal foundation the ADHD brain runs on. And for many women, that's the moment everything that was manageable suddenly is not. Our guest today has lived that story and built an entire career helping other women navigate it. Linda Roggli is a professional certified coach, award-winning author, founder of the ADDiva Network for ADHD Women 40 and Better, and one of the most recognized voices in the world on the intersection of midlife hormones and ADHD. She lives and works in beautiful Durham, North Carolina, with three ADHD Shelties, a non-ADHD cat, seven hens, and one very supportive OCD husband. Linda, welcome back to The ADHD Podcast. It's so good to have you.
Linda Roggli
Thank you. Thank you. Thank you.
Pete Wright
Thank you.
Linda Roggli
It's actually my first time I've ever been here, so I'm thrilled.
Nikki Kinzer
Actually, no. You've been on the show once before, but it was a long time ago.
Linda Roggli
Where was that? My ADHD memory doesn't go back that far.
Pete Wright
Yeah. It was a long time ago.
Linda Roggli
Well, thank you for welcoming me back.
Pete Wright
You're very welcome.
Nikki Kinzer
So Linda, I'm taking the lead on this one because Pete's like, you know, I don't know much about menopause and perimenopause and all these things.
Pete Wright
I've already been corrected in the chat room. I am aware that men go through their own kind of — I'll go ahead and say it — manopause. It does happen for men too. I'm aware of that. And that's sort of not what we're talking about today. So go for it.
Nikki Kinzer
And you have a wife.
Pete Wright
And I have a wife, believe me.
Linda Roggli
The actual official name is Andropause.
Nikki Kinzer
Androids.
Pete Wright
Okay. Well I'll just say for the record, I haven't noticed it yet.
Linda Roggli
How about that? Okay. It's very different, that's for sure.
Nikki Kinzer
Well, this is where I want us to start. I want to take us back to your own diagnosis. When you were in your forties, perimenopause was definitely in full swing. What was going on in that moment when they said, hey, I think you have ADHD?
Linda Roggli
Well, actually my husband and I were in couples therapy. And I don't know why, but I went by myself one time to couples therapy. The therapist would ask me questions and I would be — and then he would ask another question. It was the same kind of thing. And he stopped and he looked at me and he said, "You know, you might have ADHD." And I literally laughed in his face. And then I realized he wasn't laughing back. He then realized he made a mistake and he's like, oh, whoops, um, okay, never mind. Just run by one of the bookstores and pick up this book, Driven to Distraction.
Pete Wright
Okay.
Linda Roggli
And I'm like, fine, I'll do it right now. And it was like November and I had my winter coat on. And I went to the bookstore and I said, "Well, where's this book? I have every self-help book there is. Why would I not have this one?" And they pointed it out to me and I said, "Well, I'm gonna prove them wrong." And I sat down on one of those glossy benches where the magazines are and I opened it up and I started reading it. And then I realized: oh my god. I ran to the cash register. I was reading it at the stoplights because I was trying to find out what it says. And then I went, oh my god, this is me.
Linda Roggli
But honestly, I didn't really connect it to menopause until a couple of years later because I decided, oh, you know, so what if I have ADHD? I went through all the medications. They didn't work for me. Actually they worked exactly the opposite of what I thought they would work — they put me to sleep, which actually now that I know more about it is probably appropriate.
But when I really went into the estrogen piece, I said, well, am I in menopause? And I went to a doctor — now this is an interesting story. My OB-GYN was a man, and he had been having affairs with two of the nurses in his office. Both found out and he got beat up by one of the husbands and they sent him to sexual rehabilitation or whatever it was. So they hired a guy who came out of retirement. And I sat down with him and I said, "I think I'm in menopause." He said, "Are you still having periods?" And I said, "Yes." And he said, "Then you're not." That was all I got.
Nikki Kinzer
Wow.
Pete Wright
Wow.
Nikki Kinzer
So you had all of the drama in the office and you were told that you're not in menopause, and that was it.
Linda Roggli
Yes. Well, now I know more about this. What happened was they said, well, why don't we check your hormones? But you can't check your hormones while you're still on birth control pills. And I was having such bad migraines that they put me on low-dose birth control pills, and that really got rid of the migraines. I mean, I was migraine-free, which they were really hormonally related migraines. And so I went off of them and I just went loopy. They checked my hormones and they said, yes, you're definitely probably in perimenopause. And I said okay, but they didn't ever tell me to go back on the pills, so I didn't.
And I remember walking into Macy's one day and I was the only one in the department. I went up to the register to pay for something and she said, well, do you have a card or whatever. And I said no. And she goes, well, let me just get your address. And I just — I couldn't remember my address. And the woman leaned over and patted my hand and said, "It'll get better, honey." She was a little bit older than me and I thought: when will it get better?
So it actually got better for me when I switched doctors and ended up with a psychiatrist who was also an OB-GYN but couldn't do OB-GYN because she had an injury. And you'd think that combination would be perfect. And she said, "I think you need to go on estrogen." And I said, oh no. The Women's Health Initiative had just come out and said they stopped it because women were getting breast cancer and having more heart attacks and all this stuff and I'm like, oh no, you're not getting me to do that. It took her a year to convince me that having fifty or sixty hot flashes a day was not a good quality of life. And I finally said okay, I will do it. And I accidentally got the right kind of estrogen, because she prescribed me these little patches — these little estrogen patches — and I changed them twice a week. And I swear to you, it was like I woke up. People talk about like putting on glasses when they take ADHD medication, which I don't, by the way, but it was just like that. I was back to me again.
Nikki Kinzer
You're talking about estrogen. Let's go back to that. What is estrogen actually doing for the ADHD brain, and what happens when it starts to drop? What's going on?
Linda Roggli
Well, it's interesting because estrogen — this is not just for women. Men have estrogen as well, just like women have testosterone. But for women, estrogen is released through the sexual organs — your ovaries — through that process where you release eggs and all of that. It also impacts every single part of your body. When you run out of estrogen, everything is affected in your body for women, including your brain.
Estrogen acts as a kind of little helper for dopamine. And if you remember from listening to lots of these podcasts, you know that dopamine is really important for ADHD brains. We actually don't have attention deficit — we have dopamine deficit, which is why we rush up against deadlines because it triggers all that dopamine again. So when we don't have that estrogen, that little helper for dopamine that our already-low ADHD brains need — when it declines, we don't get as much dopamine support in our brains either.
And keep in mind that during perimenopause, let's go back — when we start out around puberty, maybe ten or twelve, our estrogen is just starting to kick in. It's kind of irregular then and it really doesn't settle down into regular monthly cycles until we're maybe eighteen or twenty. And then it stays that way while we're in our fertile years. And then at perimenopause, rather than having this relatively regular cycle, it goes crazy. It recognizes that the ovaries are not releasing the prompt for more estrogen, and it says, oh, but I guess we need to provide more and more and more. So it skyrockets way up. And then it says, well, I guess it's not doing any good. And then it goes way below anything we ever have in our regular monthly cycles. And it skyrockets again, but not quite as high. So we have this enormous, not just a roller coaster, but a skyrocket roller coaster going up and down and up and down.
And at perimenopause, those cycles are lower and lower and lower. I just want to be clear, because I didn't really understand this at first: if you're still having periods, you're not in menopause. Menopause is actually the last period you have, and you have to have no periods for one whole year.
Nikki Kinzer
And now I'm in menopause.
Linda Roggli
Exactly. After that period, you're postmenopause. So menopause is one minute.
Nikki Kinzer
Oh, interesting. I didn't know there was a postmenopause.
Pete Wright
Get ready.
Nikki Kinzer
Well, I'm there. I'm postmenopause. Did not know it, but I am. So the world knows that now.
Linda Roggli
Well, yeah, but it's a thing to be proud of. So we better learn to really enjoy it. And you just mentioned that you were having a little hot flash. The thing about postmenopause is that it has a lot of the same symptoms as perimenopause. It doesn't necessarily go away.
Nikki Kinzer
It never goes away? Is that what you're telling me?
Pete Wright
What a drag.
Linda Roggli
I know. I literally have talked to seventy-five-year-old women who say, "I'm still having hot flashes. When do they stop?"
Nikki Kinzer
I want to go back to when you first got that diagnosis and you were like, nope, I don't want to take any kind of hormone replacement therapy. Because there was this big fear and when I was going through all of this, there was still that talk around it. But as your doctor said, I felt like my quality of life — I needed a better quality of life. I was miserable. And I know for me personally, Linda, it changed my life for the better. What is the science around that now? What can we talk about that will make people feel more comfortable and more educated about whatever decision they make — whatever's best for them?
Linda Roggli
Right. Well, they used to call it HRT, hormone replacement therapy. It never actually replaces the amount of estrogen that we have when we're younger. And I said I don't want to go on hormone replacement — or hormone therapy, they now call it. And the doctor at that time said, well, you know, the amount of estrogen that you're getting in the hormone therapy is actually lower than it is in your low-dose birth control pills. And I felt a little bit better about it.
But here's the deal with the WHI — the Women's Health Initiative. The Women's Health Initiative had several segments, and the only one that they stopped was this one about hormones and menopause. Unfortunately, what they did was they started with women who were already postmenopause. Many of them were already in their sixties. And they found two things that were wrong: more heart problems and more breast cancer incidents.
So what they've now found is that that part of the study was fatally flawed. Number one, they enrolled women who were already past menopause. Number two, they used chemical hormones — both estrogen and progesterone together in pill form — and it was conjugated urine from horses, which is just how they did it then, which sounds horrible. They also used an artificial progesterone. So the pill itself wasn't really helpful, and it metabolizes through your liver, which can cause more problems. The patch does not. My little patch doesn't metabolize through your liver. And now it's a different kind of estrogen.
When you are in your reproductive years, the estrogen that's being released is estradiol. There are three — sometimes they call it four — different kinds of estrogen. Estradiol is what the replacement patches are. When we are pregnant, we have something called estriol, and that's the estrogen that goes up and down — right after you deliver, that estrogen and progesterone just tank completely, which is why a lot of times we have baby blues and postpartum issues. And if you're nursing, that actually delays the onset of starting up the estrogen cycles again. But you also have the hormones that are happy hormones that kind of make you feel — you know, things like when you feel like you're in love with your baby. So it's somewhat mitigated there.
But when you go into postmenopause, we don't have any more estradiol coming from the ovaries. Do you know that we start with two million eggs when we're babies? And we lose about a thousand a month. So by the time we're forty, we're down to about ten thousand eggs, which is one reason it's so hard to get pregnant when you're older. By the time we use that last viable egg, we're at menopause. And at that point our body says, well, we need estrogen from somewhere. It can't produce estradiol. The way it now produces estrogen is through fat. It produces a different kind of estrogen called estrone. And estrone is not as potent and it doesn't have the same kind of brain activity as estradiol does. And where does that fat usually come from?
Linda Roggli
Belly fat.
Nikki Kinzer
Yes, yes, yep.
Pete Wright
That's why my foot disappeared and my belly battery came in.
Linda Roggli
What in the what is that about? And now my jeans don't fit anymore.
Linda Roggli
So all that to say: we do have estrogen throughout our entire lives. But I think what I'm hearing from a lot of the women I talk to is that doctors are becoming a little bit more comfortable with prescribing what they now call MHT — menopausal hormone therapy. And a lot of times the patches seem to be the better option for a lot of people. It's shown to be a little bit better than taking pills. Some people use creams. There actually are estrogen pellets that go subdermally — in the top of your thigh kind of thing. There's estrogen cream, there are estrogen rings. There are all kinds of ways to get this supplementation.
And it kind of goes back to: do you just do estrogen only, as Dr. Quinn originally talked about? Progesterone itself is very calming, but it also can cause some brain fog, which is not what we need. So I did estrogen only for years and years and years. By the way, this is not medical advice. This is just my own experience. And some women have had estrogen-dominated breast cancer or other issues that say, you can't do estrogen. Please talk to your doctor. But more and more doctors are feeling more comfortable prescribing estrogen for perimenopause and even postmenopause.
I will say that the science now says that you must start the hormone therapy within five years of your last period. If you start it ten years later, like they did in the Women's Health Initiative, your chance of having heart issues or breast cancer goes up.
Pete Wright
That is crazy to me. What kind of generation of women did we hose by having this bad research?
Linda Roggli
A lot of them. The Women's Health Initiative came out in, I believe, the mid to late nineties — I think it was ninety-six. Because I was in that first cohort of people who said, oh no, I don't want to do this. And according to the studies, ninety-five percent of the women who were on hormone therapy dropped it. And because of that, many of them had more medical problems.
Here's the other interesting thing — I didn't know this until I'd done a lot of research. There's one person who's just so adamant, so furious about the effect of the Women's Health Initiative. He's an OB-GYN and he says that breast cancer is not detectable for nine years. So that means that some of those women in the Women's Health Initiative already had the beginnings of breast cancer and didn't know it. Because they screened for breast cancer before they started the study — they eliminated people who had breast cancer — but some of that breast cancer wasn't even detectable, even with mammograms.
Nikki Kinzer
Wow. Interesting.
Linda Roggli
So the other piece is that estrogen is supposed to be good for your heart and it can be good for your heart. There's ongoing research. I have to say, there's never enough research about women. Never enough. I just was listening to a podcast from someone who talks about menopause and she used the term: they think we are little men. We are not little men. We have a completely different physique, different apparatus, and our body chemistry is completely different. And she's the one who reminded me that when you lose that estrogen, every single part of your body is affected.
And you mentioned that men also have something similar because testosterone declines too. Testosterone goes down gradually. Testosterone has never had these cyclical up-and-down kinds of things, but estrogen goes whoop whoop whoop bam. No wonder we're kind of in shock. Our bodies are like, what the heck is going on? And our brains — even if you are not diagnosed with ADHD — many women who don't have ADHD feel like they might have lost their brains.
Nikki Kinzer
Absolutely. One hundred percent. And I'm that person.
Linda Roggli
So Linda, you have built a business around forty and better. You have lots of presentations and you've spoken at events including the Women's Palooza, which you've been doing for years and which Nikki has been a part of. This is obviously a passion of yours. What is it that people want to know from you? When you are doing these presentations and you get Q-and-A — what are women craving to learn more about and understand?
Linda Roggli
I think most of the women that I work with are diagnosed later — like at forty or fifty, or sometimes even sixty or seventy. I've talked to one woman who was eighty-eight years old and she was planning her ninetieth birthday party. What she wanted to do was clean her house and make books for all seven of her grandchildren — hand-embroider everything. And she's still trying to do this at eighty-eight years old.
So I think what most people want is a little reassurance that they're not alone. Because it feels, as both of you know, ADHD can be a very isolating experience. We have these blinders on — we think everybody else has got it together, except for me. And I don't want anybody to know, which is why people come to ADHD with a mask on. They come with: I have to act like I understand what's going on even though I'm clueless. I can't keep up with conversations. I can't keep my house organized. Everybody else can do it. Why can't I? I have forgotten to pick my kids up after school.
Nikki Kinzer
Mm-hmm.
Linda Roggli
I mean, it's just one of those things and it was horribly embarrassing. Because the people are standing there going, "Excuse me, you were supposed to be here twenty minutes ago." And my kids are going, "Mom. Again."
Linda Roggli
As my kids grew up, they learned to not expect me to pick them up from the airport on time.
Nikki Kinzer
Oh no.
Linda Roggli
I have to say, these days — I've been doing this for twenty years. It's like, oh my God, how long? I can't be that old, but I can, but I am, but never mind. For at the beginning of this, when I was learning about my own ADHD and realized: it was ADHD and it was estrogen. It wasn't me being horrible. It wasn't me being silly. It wasn't me forgetting things and pretending I didn't. It was that nobody knew about this hormone connection then. So when I talked about the hormones, people were just like, really?
Now the hormone issue is out there a little bit more. It's not always out there accurately. But a lot of the women that I talk to are in perimenopause and they're just freaking out because it's just too much. We have ADHD, and keep in mind when you're over forty or fifty, we also have normal aging things going on as well. And that compounds the issue of ADHD and compounds the issue of perimenopause. So you have this Venn diagram — here's you in the middle, totally freaking out because you have all three things going on.
I heard from my son when he was in grade school that our brains shrink as we get older. And he used to taunt my mom with that constantly. "Oh, grandma, your brain is shrinking, your brain is shrinking." Now what I found out is your brain starts shrinking in your thirties. Every year you lose a little brain capacity. And by the time you're sixty-five, most of that brain shrinking is happening in the prefrontal cortex.
Nikki Kinzer
Yeah.
Linda Roggli
Exactly where ADHD does its little dance — or doesn't dance, actually. So there are lots of things that women want to know. I did a survey — 125 questions. This is so un-ADHD.
Nikki Kinzer
Wow.
Linda Roggli
Some people actually filled it out. And I had a chart and I said, which of these things are the most difficult for you now? And which of the things were most difficult when you were younger, when you were a kid? And when they were a kid it seemed like it was more about education — I don't do well in school, that kind of idea.
