Dr Louise Newson: [00:00:01] So Kate, thank you so much for joining me. I've been looking at your work for a while and I've got your book, which is brilliant, the ADHD Women's Wellbeing Toolkit. It's not often that you get ADHD and women on the cover of a book. And there's a lot of ADHD talk, and it's really accelerated, actually, over the last few months. And I don't know whether it's because I'm more aware or whether it just more people are talking, which is great. But, I want to spend this time just talking a bit about like you, who you are, what you do, what ADHD, I can't even say it, can I?! What ADHD means, because actually what the letters stand for doesn't really help that much, I don't think. So if we just start, if you don't mind, Kate, just saying a bit of your background and what it means to have ADHD and what actually is ADHD.  

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Kate Moryoussef: [00:00:58] Yeah, well thank you for having me on the podcast. So I was diagnosed five years ago at the age of 40 with ADHD and I completely agree with you. I don't like the name, I don't the letters, it's a mouthful to say. It doesn't really give me anything about my profile of how it shows up and many other womens' profile. Yes, there's a hyperactivity, but it kind of is just not quite how it's shows up for many women which is often internalised. So I grew up with two brothers who were diagnosed with ADHD back in the very early 90s and late 80s. They were really at the very beginning of diagnosis. They would obviously boys and I was the daughter, the sister in between who was quiet, a bit sort of head in the clouds, but I wasn't causing any distress to my parents who really did have their hands full with two very hyperactive, in different ways, boys who were really struggling academically. I was getting by just about, but because I wasn't causing any problems, ADHD wasn't even contemplated. We didn't even think ADHD was maybe genetic. There just wasn't this kind of conversation. So fast forward many, many more years, decades, my ADHD was there popping up hormonally at different moments in my life, definitely during puberty. I then have have had four children, postnatally it showed up and then my perimenopausal symptoms definitely began what I thought was so early, probably around the age of 39, 40, all coincided with COVID, homeschooling for children. And one of my daughters who was nine at the time, I was homeschooling, and I could really see she was struggling. And we'd been in and out of sensitive interventions at school. This was before COVID, but no one really put their finger on it. And they sort of said, oh, it could be a bit of dyslexia. It could be little bit of this. She might just need some extra help. ADHD was never, ever mentioned. And it was when I was sitting with her, I saw myself in her. I just had these flashbacks of how I struggled so much to sit, to process, to concentrate, but it was also this sensory overwhelm. It was so much of it and I just started doing a deep dive and I recognised ADHD and very ADHD of me and myself, I straight away tried to find someone to get an assessment, a diagnosis, and I realised that I needed this as well. So within about two weeks of each other, we were both diagnosed in 2020. We then subsequently, I saw it in my other kids as well, showing up in different ways, and it was a big moment. It was a moment in our life, in our family, and for myself as well to get a lot of answers. And then that catapulted me into launching the podcast, which is nearly four years old, the ADHD Women's Wellbeing podcast, which just brought this topic that was very underground at the time. And I didn't find the information that I needed. I needed to know, how can I feel well alongside ADHD? Why do I feel so overwhelmed, overstimulated, anxious, hormonally imbalanced? Like I had so many questions and I wasn't getting any answers. And so I decided that's when I needed to start the podcast. People thought I was mad. People thought, what are you even gonna talk about? How is this even a topic? And that is when I started bringing in experts wherever I could find them from across the world. Who could give me those answers, who could piece together, connect the dots for me, because it wasn't coming from my GP, it wasn't coming from therapists, psychologists, it wasn t even coming from the psychiatrist who diagnosed us. And thankfully, it's just grown and grown and it's three and a half million downloads, the book's come from it. And the most important thing, a community has grown and I know that thousands of women have been helped because they need this advocacy and they need this information so they can then go and speak to their GPs and ask for the help and the support that they deserve.

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Dr Louise Newson: [00:05:02] Which is so brilliant because a lot of my work is empowering people with information so they make choices that is right for them and we're all different. ADHD affects people in very different ways, I mean it varies so much and one of the things is that people still don't understand I think what it is and they think that everybody is the same, you know, but I've never met two people the same who've got ADHD And there's a lot of people I've met who do have ADHD, but don't know it, but that's fine. I'm very against labelling people, unless the label comes with an explanation, reassurance, information, and choices regarding treatment or not treatment. In medicine, we, as clinicians, I think are very bad at making a diagnosis, putting people in a guideline pathway, and then giving them all the same treatment. And that's not appropriate, I don't think when it comes to ADHD. [00:05:59][56.7]
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Kate Moryoussef: [00:06:00] Yeah 100% and that is it. It's, you know, ADHD stands for attention deficit hyperactivity disorder. And those two words, the deficit and the disorder are very, very negative and they automatically feed into the low self-esteem that we've already got. The attention often we don't, it's not, we have it in abundance. We have too much attention, too much hyperfocus, too much interest, but often in the things that we just really care about that really matter to us and that really interests us. Which is why a lot of kids at school struggle because they may be fascinated by science or geography or art. But the other stuff, it's just not part of their, they're just not interested.  [00:06:40][40.2]
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Dr Louise Newson: [00:06:40] It's noise in their head.  [00:06:41][0.8]
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Kate Moryoussef: [00:06:42] Yeah. And so this is that it feeds into the criticism and it feeds in to them thinking that they're not good enough, they are not doing enough, that they should be better, they should be more. And that is really, really difficult. And then the hyperactivity we often see externalised both in women and men. Again, in more of the female side, we can see it externalised in foot tapping, hair twirling, skin picking, cuticle biting. We can see it in needing to be busy the whole time, not being able to rest, feeling like we've got this internalised motor that will just never stop until something physically stops. It's like an injury, like an illness, like an autoimmune condition. We have this sort of adrenaline dominant profile that just just keeps going, which is amazing when you want to advocate and you've got justice sensitivity and you got a big fight, but we also need to know our bandwidth and many of us don't know about this. We haven't got the language and so many women, unfortunately I speak to, have gone through cycles of burnout because of this hyperactivity, that stuff that they care about, work that they're passionate about, people that they want to look after and help and support, but it comes at a cost. And I would say that I don't think I've met one ADHD, I'm going to say woman here, who hasn't suffered in some way with burnout, some form of chronic fatigue, autoimmune, gut issue, hormonal difficulties. It really does present physically for many of us, chronic pain, migraines. It really does. The list goes on and I call it this Venn diagram because it's never just, oh, I'm a bit scatty or I'm a bit forgetful or I struggle with planning or I am a bit messy. That's just the very tip of the surface. A lot of it is this profile of very difficult mental health, physical health challenges alongside things like family dysfunction, addiction, and It can be so, so difficult to live with, undiagnosed. However, like you say, when we get this awareness, this understanding, I don't call it a label, it's just for me, it's like a door opening, it's a chapter of going, this has not all been in your head. This has not been something that you are mistaken. This is you being validated, you being understood, and let's work with this now. Now that we know what's going on, how can we help ourselves? And that is what my community is about. I really want to empower and advocate for women who have had a really, really difficult time, like seriously difficult, and they've gone through trauma from all of this and so many mental health problems that they've seen throughout their families, the generations. And I want this to be a moment in time where this generational pain can stop and women get supported. Their mental health gets supported, their hormonal challenges are listened to, and they can empower themselves with better understanding. And that is why I'm so passionate about it.  [00:09:37][174.9]
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Dr Louise Newson: [00:09:38] It's so important because it has such an impact on so many people and, you know, I'm very interested in the way our brain works and functions. I'm very interested in neurophysiology, so I'm very interested the role of our neurotransmitters. And obviously we, of course, we're different. Everyone has different personalities. So the brains are going to be different in people and they react to different things as well. And I'm very interested in the role of changes. And how they impact on symptoms, but also health as well. And when we look at people with ADHD, like you say, I think the Venn diagram is a really good description because there are a lot of people who also have other conditions as well, such as premenstrual dysphoric disorder, PMDD, or they might have some, like you said, autoimmune diseases, or they may have, some people have PCOS, polycystic ovarian syndrome when they're younger, or endometriosis, and or they might have Ehlers-Danlos syndrome, this sort of hyper laxicity of joints. But everything is treated almost as separate circles when you go and see a doctor. But when you bring it together, one of the things that's in the middle are hormones. And people have always thought hormones are just related to our periods and whether we're fertile or infertile, but actually it's far more than that. And it's the balance of those hormones. And If we look at ADHD, often it becomes more apparent when people are teenagers, there's lots of hormones going through their brains and bodies, but also in perimenopause and menopause. But a lot of women, when you talk to them and get a really clear history, they say that things are more tricky before their periods because their brain is just not processing in the same way, it's not thinking in the way, they catastrophise more, everything is, just becomes too much and then maybe their period comes. They feel better for maybe a few days, a couple of weeks, three weeks, maybe. And then it happens again. But again, they're thinking about the periods and they're not sitting back and thinking. And some people, when they take contraceptives, they think they're taking hormones, but they're not, they are taking a chemical, which will can block your natural hormones. So a lot of people I've spoken to have been given something like progestogen only pill or an implant, which people think will smooth their hormones, give them hormones back. But it can make it a lot worse, but they're not thinking about the connection. So I think the way that, you know, your book talks in lots of different ways is so important. And I'm particularly interested in it because I see and hear so many women who clearly are struggling with their hormones, but when you go under the surface, they're also struggling with symptoms related to ADHD. But once they're on that conveyor belt of an ADHD diagnosis, no one's thinking about hormones, they're just thinking about do you need an amphetamine based drug, yes or no. And it's like, hang on, even if you're not thinking about hormones, there's loads of other things we can do to help our brain function rather than just being medicalised.  [00:12:44][185.9]
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Kate Moryoussef: [00:12:46] 100%. And I think, listen, I am for any type of medication if it works and it helps and there's no severe adverse effect. And I'm very pro-choice with the medication. However, I'm going to speak personally here. I'll explain my story. I've always been very, very hormonally sensitive. Any type of birth control, the Mirena coil, any contraception, just did not agree with me. Anything synthetic. And that's been in my whole life. Anything's synthetic, sort of, I'm very holistic. And I've really, really struggled with that. Um, and I then started HRT at the age of 40. I was very lucky to have a brilliant clinician who understood the ADHD side. And, you know, I have that privilege of being on the podcast and meeting lots of interesting doctors. However, I had severe, I would call it PTSD, of thinking that the progesterone of the HRT was going to send me crazy because I'd had such an impact from the Mirena coil. I then had so much education around the fact that that was a progestin, and this was a body identical progesterone. Long story short, I have found that it was the progesterone as part of the HRT that's helped me beyond words. The estrogen, yes, it's been great, but I've kept it a very minimum, two dose, two squirts, two pumps. That's never increased. But I'm on a higher dose progesterone and I take it and listen, you're the doctor, but, I take this every day and it has been miraculous for me because I was struggling with my sleep was sending me into just like a spiral couldn't sleep, the most terrible debilitating anxiety, catastrophising, restlessness. My ADHD was flared up to another level and it was the progesterone that has helped me so much and it's kept me, normally around ovulation, before HRT, it would be horrendous. I'd be having a marriage breakdown, rage, crying, emotional dysregulation. I couldn't work, I couldn't parent. It was really, really, really hard and then I've got my progestorone which feels balanced right now. And if I feel like a different person, my ADHD is still there. It's there, my cupboards are open, my keys are left in the door, my desk is a mess, but I manage it, it's not taking over me. I see it, it's like an annoying friend that's always there, but it's not this weight that would hold me down, that would impact my mental health and this is why I'm so passionate about talking about it because the amount of women that I have spoken to and again I wanted to mention I also had fibroids, I had lots of hysteroscopies, heavy bleeding to the point where I was very low on iron, I couldn't get out of bed, I would bleed through my clothes and since taking the progesterone it's been completely different. I was like this is like a period, three days of sort of like a normal pad and a tampon. It's beyond words for me, but the mental health, the sleep side has been the most, you know, groundbreaking. So the ADHD is there, but I don't take medication for it. I do all wellbeing things, you know. But it's for me the hormonal balance was that big thing for the ADHD. Also, sadly, I had a miscarriage. I also had what I would say is not, I would, say it was probably some postnatal depression, but it was more postnatal anxiety. I didn't have any of the words. I didn't know that perhaps there was low progesterone. And unfortunately, in my family, there's been a lot of women in my family historically who have really suffered with their mental health around menopause, who have had marriage breakdown, mental health breakdowns, insomnia. They've all been on sleeping pills. And I do believe that it's down to a progesterone deficiency going on in my family, and there's been ADHD as well. So I'm just trying to paint a picture of my own family, but I know that it's making sense to a lot of other women as well. And I want more clinicians to know about this.  [00:16:54][248.0]
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Dr Louise Newson: [00:16:56] Yeah, it's so important because progesterone is a really forgotten, often, hormone. And a lot of people think it's just for the womb, actually. And if people take HRT, they only need it if they still have their womb. One of my patients had a hysterectomy for fibroids recently, and I reviewed her in the clinic this week, and she said, oh, my gynaecologist said, of course, you can stop your progestorone now. You've had a hysterectomy. And she said I quietly smirked to myself and thought, no, actually, I like sleeping. And, but progesterone is a very important hormone in our brain. It really does help reduce inflammation. It helps the synapses, the connections of the nerves to fire and work properly and effectively. And it's a very calming hormone as well. And. I mean, I'm to blame as much as lots of other doctors, because no-one taught me, but I didn't prescribe progesterone in the same way. And I also thought that all progesterones were the same, because the mini pill used to be called the progesterone only pill. And of course it's the progestogen only pill, it's a synthetic chemical. So a lot of people who actually react quite badly to synthetic progestrogens, get on really well with progestorone and often a higher dose. And that's either a higher oral dose or a vaginal or rectal pessary of progesterone. And so some people will use this as a suppository. And it can be quite hard to say to a patient, look, I know you haven't gone on very well before, or they might just take a low dose or standard dose of the micronised progestorone orally and we're saying, no, have a higher dose vaginally. And they're like, hang on, no because I might feel worse. And often they do feel a lot better. And it's really important. One lady contacted me a couple of weeks ago and she's been a patient in the clinic, had seen another doctor and she was okay on her HRT. She thought she was doing well, but then she got some bleeding. There's no underlying sort of cause for the bleeding. So the doctor said, just increase your progesterone. So she said, I went from 100 to 200 and I started to feel amazing so I myself went up to 300mg and I can't tell you the difference. My brain is calmer. I'm sleeping well, I'm more thought ordered, like this is incredible. I'd just like to thank that doctor for doing this and, and I think, gosh, isn't this interesting and there are a lot of women who, as you say, who are progesterone deficient for quite a few years, we see them as they're older in the clinic, but they've often had multiple miscarriages, they've been mislabeled as PCOS, they have often had irregular periods and giving them progesterone, like you say can help periods become lighter, it can improve fertility, it's such a forgotten hormone, but when we think about women with ADHD, it can make the brain a lot calmer. So you can make sense of chaos and the same with testosterone actually. Testosterone is a very good hormone in the brain and there's not much research because sadly no-one does research into this, but even with men, testosterone can be very beneficial if they've got ADHD and you know, there's no studies that I'm aware of giving progesterone to men, but progesterone is a male hormone too, but certainly testosterone in men and a lot of what I notice is testosterone in women, with progesterone, can really make a difference for some of the symptoms related to ADHD.  [00:20:14][198.3]
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Kate Moryoussef: [00:20:16] Yeah, I mean, it's interesting what you say because I'm reading this book called this actually right in front of me called Adrenaline Dominance by a doctor in America, I think he's retired. And he talks about progesterone and talks about progesterone for men as well and how it does help reduce adrenaline that I mean I'll give you an example. I didn't have my prescription, I had to pick it up and I ended up not having my progesterone that night and it was a bit of a... I guess it was me just trying to test it out to see if it really is helping. I woke up at two o'clock in the morning, like someone had shot an adrenaline, you know, like injection in me. My heart was racing, I couldn't stop my brain going, my palpitations. I literally must have lay there for about three hours. It was horrendous and I started panicking. And I remember it was like a flashback of how I was just before I started my HRT. And that was every single day, every single night. I wasn't coping... [00:21:14][57.5]
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Dr Louise Newson: [00:21:14] It's horrid, isn't it? [00:21:15][0.5]
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Kate Moryoussef: [00:21:16] Yeah. It's horrendous. And it made me realise that this adrenaline dominance has been part of my life because anxiety has always been there. And before menopause came, my perimenopausal symptoms came, I was managing it just about, just about. The skin of my teeth through exercise, through wellbeing stuff, through calming things. I didn't have any more resources left. So interestingly, I also do take testosterone. I don't know if I notice any help specifically with my ADHD, but what I do notice is that my resilience has gone up, my ability to just keep moving forwards, despite it being with, you know, it's been a very challenging few years for us and I've managed to get up in the morning and try and have this positive perspective and I do wonder if it is the testosterone that's given me that extra scaffolding that I'm not sure I would have had otherwise. Because ADHD really does, if you don't have that help and that support and the hormones, it really can just crush you and crush you and crush you, especially for women. And I speak to so many women in my community who are only just finding out their 50s and their 60s, and they've had marriage breakdowns. They have really suffered and I don't want women to be suffering like this anymore. They shouldn't.  [00:22:36][80.4]
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Dr Louise Newson: [00:22:37] It's not, it's hard enough. Life is hard enough when we've got enough stuff going on to deal with. But the other thing, there's this balance, as you I'm sure know, with progesterone and cortisol, our stress hormone, and, you know, one of the doctors who did a lot of work in progesterone in the 50s and 60s, Katharina Dalton, wrote a lot about this and about how if we have low progesterone, it increases our cortisol and our stress, so balancing it can make a huge difference. And It's all very well saying to women, you have to be calm, you have to sleep, you to practise meditation. If you've got all this on, it's really, really difficult. So having those tools, but having hormones definitely, and I know myself that having those hormones really just helps me become less emotional. Like I've been dealing with some, all sorts of difficult things, personally, professionally, with my family, one of my daughters being very ill. And I've got this ability to just take stock. Breathe it, do a bit of like, breathe breath work and think, all I can do is one thing at a time. Because I used to be catastrophising and then thinking, oh my God, I've got 28,000 emails and now I've gotta catch a train to London and then I've gonna do this tomorrow and that tomorrow. And it's like, then you end up doing nothing because your brain is in overdrive. And I'm sure, like, I mean, I do a lot of yoga and that helps me but having the hormones has just helped me to just like, hang on Louise. You're in the present, you know, you're doing this podcast now, concentrate on that, and then you can do XYZ. And it's quite subtle and it's quite difficult to explain to people. But you know I take hormones for future health, I'm really scared of osteoporosis, so I'm not taking them just for one thing. And I think there has been this big push, but um, that people, this misunderstanding that people only take them for a hot flush and they forget that they have a role in the brain and the body and elsewhere.  [00:24:33][115.8]
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Kate Moryoussef: [00:24:34] The hot flushes for me were also awful and I'm very grateful that the estrogen definitely helped with that. But for me, the hormones are there for that. Like you say, I do yoga and I walk my dog and I work really hard and I have a big... I really, really do want to help a lot of people. There's no way I could have done any of that without this hormonal support. That has been the foundation. I'm also very aware that some women can't take hormones or don't want to take hormones, and that's their personal choice. And I don't women to think that if they don't take hormones at ADHD, they're going to be, you know, everything's terrible. I do think there's other ways that we can help ourselves, and I speak to amazing psychiatrists all the time who see incredible things with medication for ADHD, and I really don't wanna belittle that and think that it's all about hormones, but I think if it is something that you have seen in your family and your children and all sorts. It's like, if you can try it and you can get that support, I really do think, because we see how ADHD shows up at these big moments in our life, like puberty, postnatally, every month cyclically, you know, with PMDD. But also, like you say, PCOS and endometriosis, it is peppered throughout our lives as women. If we can get more support around that, our ADHD doesn't feel like it's taking over our whole life.  [00:26:05][91.1]
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Dr Louise Newson: [00:26:07] I totally agree and you know, lots of people are told they can't have hormones, whereas they're thinking just about one hormone, usually estrogen, not thinking about the power of progesterone or testosterone and, and, or they've taken contraception and no one's blinked an eyelid, but it's not just hormones. We have to be thinking, and for a lot of us doing exercise, meditation, what we eat, you know all those things make a difference, but we just need to have more information and we're doing some research that I'll talk about soon once we get it in a better shape to publish. But some of the data that we're seeing is really interesting about the role of ADHD and hormones in women. And so we've got a lot to do, but the, you know, the best thing is having conversation talking, women can work a lot out for themselves as well, but I'm very grateful for you coming on and sharing your story as well, and talking about your children too. So before we end, I always ask for three take home tips. So, if someone's listening and thinking, Oh, I think I've got ADHD. What are the three things that you would recommend for those people to do?  [00:27:10][63.9]
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Kate Moryoussef: [00:27:13] I would probably find some help, some support, a community. Really, I definitely see the power in community and a like-mindedness of women asking each other questions. We're very resourceful women, I think, neurodivergent women. Once we figure something out, we'll go down a whole rabbit hole. So lean on other women, find people in the community, but also do that research yourself, take it to your GP, print out the research, the papers. Additude Magazine is a fantastic resource. My podcast, I've tried to interview as many people and I'd love you to come on the podcast, really to try and pick apart the very nuances of how ADHD shows up in women. So you can then present it to your doctor who, you know, to no fault of their own, probably hasn't done the same amount of research that you have or I have and they do need a bit of help. I would definitely say, please advocate for yourself. Please don't be dismissed. No one wants ADHD really, you know, we're not going to make it up. It's very likely that there's going to be some form of neurodivergence there if you are relating to this kind of conversation and other conversations as well.  [00:28:23][69.7]
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Dr Louise Newson: [00:28:23] I think the other thing is making, you know, decisions that are right for you. I'm 99% sure I've got ADHD, but I don't really need to have an official diagnosis. It's not going to help me because I have the tools to manage it and work through. But it's useful for others to know there are reasons why I don't read all my emails properly or I make mistakes, a bit scatty, and it's just talking, I think, and educating others is so important. Trying to reduce the stigma because just having disorder is not really a disorder. I think it's a superpower. If I didn't, if my brain didn't work as it did, I couldn't do nearly as much.  [00:28:58][35.2]
Kate Moryoussef: [00:28:59] It is a superpower, but it's a superpower with limitations if we don't look after ourselves and we don't know our bandwidth and our boundaries and we don't prevent burnout and we really look after ourself. I see us as like very sensitive beings who can do a lot more than many other people, but we really do have to do it, you know, pace ourselves. So say you have a day where you're just back to back with meetings, I would suggest can you have a day of decompression after? Or, you know, really help manage so you can do those big, you know, spurts of energy and then pull back, rest, recharge, recalibrate and protect yourself because many of us have got big jobs that we want to do in this world, but we have to do not do it at the expense of our health or relationships or children, all of that, because I know that so much of that does matter to us as well.  [00:29:52][52.2]
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Dr Louise Newson: [00:29:53] So such great advice and there's plenty more advice in your book, the ADHD Women's Wellbeing Toolkit. So thank you so much for coming on my podcast. I've really enjoyed it.  [00:29:53][0.0]