Hello, and welcome back to the Pause, Purpose, Play podcast with me, your host, Michaela Thomas, your clinical psychologist and expert on all things ADHD, compassion, and perfectionism. And today, we have a fantastic guest called Dr. Helen Wall, who has lots of wisdom for us around the hormonal fluctuations of menopause or perimenopause for especially also ADHD women.
So we talk a lot about, how menopause is a feminist issue when there isn't enough research and evidence yet around how ADHD women experience perimenopause, and not enough guidance around how we can, , treat hormonal challenges, when to seek ADHD assessment, how to speak to your, your GP about it if you want support with your hormones or a referral for ADHD, and much, much more.
So this is a really, really good one, and I would encourage you to stay to the end of this episode even though it's a longer one, because not only will you get a little bit of a science lesson around dopamine, serotonin, but also understand more about, , the fluctuations around estrogen and progesterone in an evidence-based way that makes you feel like you're in safe hands.
So let me introduce you to my guest. Dr. Helen Wall is a GP partner, BMS registered menopause specialist, TV broadcaster, and bestselling author of the book Menopause and ADHD, which we mention in this interview today. She's the resident doctor for BBC Breakfast, and a trusted media voice on women's health, regularly translating complex medical issues into practical evidence-based advice for the public.
A passionate advocate for women's health and ADHD in midlife, Dr. Wall has a particular interest in the intersection between female hormones and brain health. Her work focuses on helping women understand how hormonal changes throughout life can influence cognition, mood, well-being, and neurodiversity, particularly during the perimenopause and menopause transition.
So you will hear more about this book in the chat today
. So welcome to the podcast, Helen. It's such an honor to speak to you after I've been listening to your amazing book on audio.
And we talked about how, yes, ADHDers can struggle to read a book, so it's great that it's also been read in on audiobook. So welcome to the show.
[00:02:29] Dr Helen Wall: Thanks so much for having me here. It's lovely to be here.
[00:02:32] Michaela: You've got some big things going on, , talking about menopause. So today, we're gonna try to make this accessible, but I am gonna ask you some questions of things that I get asked in my clinic all the time.
Things like, " is this ADHD, or is it just brain fog?" Or, "How do I know if it's one or the other, or is it both? , why am I going insane? Do I have dementia?" And other joyous questions. So let's, let's maybe start there, because I know so many people experience that brain fog, and in your book, you talk about that cognition being impacted.
Why is that, that that gets so impacted in perimenopause, and why especially for ADHDers?
[00:03:13] Dr Helen Wall: Yeah. I- you're absolutely right. It can impact any, any woman at all during that perimenopausal, menopausal time. The reason for that is a reason that we don't really talk about very much with women, I don't think, and we certainly don't talk about it enough as clinicians.
, but it's really to do with the effect of the female sex hormones on our brain chemical messenger systems. So we have, , trillions of neurons in our brain. I'll try not to make this into a science lesson. , and the messages going between those, , neurons are carried by chemical messengers. So some people may have heard of a few of these.
One of the commonest ones that we talk about with ADHD is dopamine. , we also, , y- may have heard of things like serotonin, , noradrenaline, , and a few others. So they're really important, not just for the things that people might know them for. So often people know dopamine as sort of that reward ho- hormone.
, they might know serotonin as the happy, in happy pills, , to be really glib about it. But actually, the chemical brain messengers and the way they signal and fire are, are responsible for so many things that we do on a day-to-day basis that we take for granted. So our attention, our memory, our ability to focus and concentrate, , our emotional regulation, and our executive brain function.
So how we think through a problem, how we plan, how we process that information, how we retain it, recall it, and, and so on and so on. So the job of those chemical messengers is huge, and that's happening all the time in our brains without us even realizing it really quickly. And what happens is in, in, , perimenopause, you see great swings in the estrogen levels of women.
So, the-- one day, you know, your estrogen might be really high, the next day it might be low. It's not a stable position. So in menopause, the sex hormones drop to a low, stable level, but in that run-up to that period, perimenopause, it can be quite volatile, so the hormones are not stable. And the key is that estrogen in particular has a, a stabilizing effect on those chemical messengers.
So, uh, you know, you've got these chemical messengers that need to fire and signal and work, , really hard to, to do all those things in our brain, in our neurons, and then you've got the hormones that are impacting on that and, and impacting positively on it when they're nice and stable and, and, , at good levels and predictable.
, obviously, that then means that if they're not stable and predictable, you have a, a negative effect on those chemical brain messengers, and that's when we start to see things like brain fog, memory changes, word-finding difficulties, emotional dysregulation or inability to sort of feel like your mood is stable.
And, . in women with ADHD, that is almost like a double whammy because we know that the brains of people with ADHD already have signaling receptor difficulties often in those chemical brain messengers, particularly dopamine, but also serotonin, noradrenaline, and the others. So, , you've got almost this double whammy situation of a brain that might already be finding those, , signaling a-and the ability of those chemical messengers to function well difficult, and then you add in, , a massive change in, in the, , estrogen and to a lesser extent progesterone, but still important extent.
And yeah, you just get a, you know, a real difficulty , in brain function for many women qui- and often quite early on than we might see it in, in our neurotypical peers.
[00:06:28] Michaela: Hmm. I mean, as, as early as in our late 30s or e- even earlier than that?
[00:06:33] Dr Helen Wall: Yeah. So we, , there's been some studies done on this and, and I often get asked, you know, "Do, do women who are neurodivergent, , do they go through menopause earlier?"
And I think the, the, the feeling that we all have now , from the studies that have been done so far is that actually we've got no evidence that women who are neurodivergent go through actual menopause early. Now, menopause- Hmm ... is defined as periods actually stopping for 12 months and, you know, your ovaries essentially shutting down because they've, they've done their, their life's work.
But what we think is happening is that often the brains of those women who are neurodivergent are hormonally sensitive, they might start to recognize very early perimenopause changes. So it might-- those changes in hormones may well be happening for your neurotypical peers or friends or family-
[00:07:19] Michaela: Hmm
[00:07:20] Dr Helen Wall: but they may not be as sensitive in their brains to those changes, and they may therefore not present so early with perimenopausal symptoms. So we absolutely do start to see women in their late 30s, early 40s who are experiencing, , what we think are perimenopausal, symptoms, often earlier than, than perhaps other people might expect.
[00:07:41] Michaela: So it's a sensitivity- So, so- ... to the fluctuations that, that is really about, rather than- Yes ... it's the onset of symptoms being earlier as actually other people might have a, a slow kind of, um, uphill sort of trickle- Yeah ... with it. So what you're describing there is life, life with ADHD is hard, and then it gets harder when you're- Yes
coming into perimenopause.
[00:08:01] Dr Helen Wall: Which I think is a running theme, isn't it, with ADHD, particularly women with ADHD, because it feels like everything often feels like everything's conspiring against them. You know, the system doesn't recognize them. They h- they've got the hormone changes. , it's the, the-- we're just not-- we've got so many barriers in the way to keeping these women well and helping them to thrive rather than survive.
, and, you know, yeah, absolutely. It's -- that's where the thinking is right now. You know, that may change. I think I have to caveat everything I'm gonna say today with the fact that we have a real sparsity of research and studies in women with ADHD, particularly women with ADHD and their hormones. So a lot of the work I do is based on, , neurobiological theory.
So we know the science behind how the brain works, and we know the science behind what hormones do to those chemical messengers, et cetera. We don't have studies that say, you know, "If we give this woman with ADHD HRT, this is the outcome." We don't have those real-life studies by and large. Yeah. And if we do have studies, they're often quite small numbers.
They're often not, , gold standard randomized control trials, placebo, , et cetera, et cetera. So a lot of it is lived experience. A lot of it is clinical experience from people like myself who are seeing these women day in, day out, and- Hmm, hmm ... all based and hung on sort of that underlying theory , that we know to be true
[00:09:20] Michaela: ,
It's very similar to what I see when I do ADHD assessments as well, of how hard it can be to sit with a diagnosis when we don't always have that clear-cut history of having struggled before age 12. We're actually, we're seeing the hormonal impact, , of not only coming to perimenopause, but also living in a modern-day society, which was much harder than for our mothers when they came into their 40s.
It's all differently hard, I should say. So it's contextual as well, right? But it's, I think it's great that we acknowledge that with integrity, that we just don't know so many things, and the research is emerging, but it's not there yet, and that's, that must be hard for, for you as an evidence-based practitioner, you know, , as a clinical doctor.
I feel the same as a psychologist. How do you sit with that, of how you then support the women in your clinic when the, the research isn't there yet?
[00:10:12] Dr Helen Wall: Do you know, I think a lot of, of women, they want to be heard and they want to be listened to. And I sit with it by sharing exactly what we do know and exactly what we don't know with every patient I see.
, I work as a jobbing GP as well as my clinic where I see many women in this space, and that's how I've always practiced. , I think we just have to be really transparent, really open and honest. I'm not going to go and do something wildly off-piste because, , I think it might, might work.
I always base it on theory or experience or, some- Mm-hmm ... I base it on something, you know, what I'm, what I'm trying to do with women. It's not wild and, and out there, you know? But I think- Yeah ... a lot of, a lot of what women need in this space is being, is having the dots joined together. I see so many women where they've been back and forth, they've seen different clinicians, and this is not a, a crit- critique of any, any one clinician or, or anything.
You know, it's a system issue. ... and they've just been passed from pillar to post. They've got different answers from different people. Every condition, every issue they've had has been seen in silo often, that nobody's joined the dots of that woman's mental health, that woman's, focus, that woman's menstrual history, how she's responded to previous contraceptives or previous hormones.
There's nobody has actually joined all that together and said, "Look, , this is where I think we are, and I think this is what's going on for you as an individual." And that's a, that is a system issue because we just don't have the time, and that's, that's aside from whether we've got the training or the experience as GPs because we do need to know so much about so many different things we need to know about, so it's really hard to have any great depth in, in, in certain areas.
, but that's how I sit with it. I just share it. I'm just open and honest and, you know, we make a shared decision based on something that is, ... based in reality. , and, you know, we don't go and do anything dangerous. We make small changes, and we review, and we reassess. And, most, many women say, "I just feel better because I feel like somebody's looking at the whole picture and able to validate that picture really," and then we can move forward from there.
There's no quick fix with any of this. I'm sure you feel like, you know, you see- Yeah ... exactly the same.
[00:12:32] Michaela: Yeah, I do. And there's that sense of, you know, watching an Instagram reel about a quick ADHD hack. That's not it, because it's such a body and mind experience. It's a full body, full brain experience of thinking about the inflammation, thinking about allergies, histamine, that there's so much to this picture.
And I guess for anyone who also then has a brain that gets easily overwhelmed, it's really difficult to figure out where do I go? And pursuing referrals, asking for the help, like the very thing that we need support with is also w- part of the barriers for why we don't get it. Even if the system was flawless, we would still be able to struggle to access it because that's the nature of the beast,
[00:13:11] Dr Helen Wall: right?
It's exhausting, isn't it? Yeah. And it's exhausting being a woman with ADHD, then hormones kicking in. There's all the different things that you've mentioned that we have going on often. , this hits us in midlife when we've got teenage children who may be going through their own hormonal challenges, neurodiverge- you know, neurodivergence assessments, et cetera, elderly relatives, senior roles at work, leadership positions, businesses,
relationships changing as, as you, as your life changes. , it is all , very overwhelming. And at that point in time is often when women need help, and-
[00:13:43] Michaela: Mm ...
[00:13:44] Dr Helen Wall: they then get hit with a system that isn't open and accessible often to them, and they have to- Mm ... keep going back and grabbing 10 minutes here and 10 minutes there, and being told, just one problem, and actually there might be several issues that are all interlinked.
So, so I'm not- Mm ... I don't take for granted the fact that I have a real luxury when I see women in my private clinic, that I get an hour to sit down- yeah ... and go through with them all of that, so I'm not here to, to criticize GPs, because I work as a, as an NHS GP two days a week too, and I, and I have to flip between those two roles where it, it- they're very different systems to work in.
[00:14:23] Michaela: Mm, and you talk about this- Mm ... in your book as well, about how to, how to speak to your GP about your challenges. W- do you have anything you can kinda summarize to the listeners who may not be able to have the funds to see someone like you privately and are reliant on their NHS GP?
[00:14:38] Dr Helen Wall: Yeah, I think, , it's about getting prepared and again, that can be really difficult when you're exhausted and overwhelmed and you're struggling to focus and your mood's all over the place.
So I don't take that advice lightly, you know, don't give it lightly, should I say. , but externalize it. So I think the thing that always makes it difficult is when somebody comes into that assessment room and they're trying to hold it all in their mind what they're going to say, and they've been rehearsing it and they've been sat in the waiting room and the nerves that go in and they're expecting to be, , dismissed or, you know, find it difficult.
, just put it all on paper, get it out onto paper, externalize it. Bring someone with you who understands or who knows the challenges you're having, if that's gonna help you. , you know, no GP should ever have a problem with someone coming into the consultation room with you if you consent to that, unless they come in, really aggressive or, or, you know- Yeah, of course
to be difficult. But if somebody's to come in to support you is absolutely fine. Writing it down, doing a screening assessment first if, if you, , want to sort of keep yourself on focus. So there's, there's freely available ADHD screening tools, , online. You know, they don't give you the whole answer.
They're not a diagnostic tool by any manner of means, but it just gives you some direction in that appointment. And I think going in with that one problem to talk about that. Mm-hmm. I think the thing where sometimes This consultation falls down is when women start with the now and just talk about the now.
So we see so many women who start by saying, " I'm really struggling now. I've forgotten everything. I can't function at work. My mood's all over the place." But actually, to make that in a 10-minute consultation, you need to try and go back through life and try and make the GP see that this is not a now, just a now problem.
, there will be things throughout your life where you start to think, "Actually, that's why that happened. That, that might be why I looked at that like that. That might be why I made that decision or, or why I always struggled at school or et cetera, et cetera." Because ADHD is, is a neurodevelopmental condition as, as we know, and it- it's lifelong.
So if you go in in a really short snippet of time and in 10 minutes just very much focus on the now, you're going to very likely end up with a now diagnosis, which is likely to be this is perimenopause, this is menopause, it's anxiety, it's depression, it's stress. You need to try and capture in that 10 minutes how this has impacted you throughout life and what the hidden costs have been for you as well.
Because there's so many women who have had, to all intents and purposes, absolutely fantastic lives. They've got great jobs. They've been to university. They've got, family life that they, , they're going on holidays. They're having a great life externally, but often there is an in- an internal hidden cost to that, and I think trying to get that across can also be quite, , revealing as well.
And finally, I would say, ask for what you want. Be really direct. , in, in a nice way, you can say, "I'm wondering if this is ADHD, and that's what's impacting me right now. Could I be referred for assessment?" And if the answer's no, I would ask, "Why not?" you've got a right to ask why, what the reason is behind that.
Mm-hmm.
[00:17:47] Michaela: Mm-hmm. Absolutely. And it must be difficult to know what end to start in. , am I asking for ADHD assessment? Am I asking for a way of looking at my, my hormonal health and conditions there? Where would you say that people start, or is that difficult to say? As, unless it's kind of looked at individually.
Do we thinking about adjusting and supporting the hormones first, or do we try to think about getting an understanding of the neurodivergence, or do we look at the mental health, or, yeah, 'cause all of it
[00:18:14] Dr Helen Wall: interacts Yeah. I mean, you're
[00:18:14] Michaela: asking
[00:18:14] Dr Helen Wall: all, all, you're asking all the key questions that I get asked, , on repeat, so I know this is what women are getting confused with.
And I think you're absolutely right. It is, it's always an individual answer that, but I, just to give some guidance to the listeners, it's, for me, it's about, , thinking what's changed now. So if you are at this point and you think you have always struggled with focus, mood regulation, , hyperactivity, be it whether that's internalized and been mis- misdiagnosed as anxiety, et cetera, , then you may want to go down the ADHD route because it might be that you need support for that, and that's what's going to make the biggest difference to you.
, I think if you have by and large managed and masked well and, and coped well up to the point of your hormones changing, , albeit there are obvious things there that have been a struggle, , then you may want to look at trying to stabilize, hormones or some kind of hormonal support because that's clearly the, the final thing that made the wheels fall off.
I think you raise a really important point that none of these things are, , mutually exclusive. , often there is an element of mental health, , going on with this because it's actually, it really is quite anxiety-provoking and depressing to be trapped in this loop of, work, to do, do, do, burnout, , not knowing what's going on, feeling like the wheels are falling off.
It's absolutely understandable that these women do often turn up with, , co- comorbid anxiety, depression, stress. , so I think it is an individual thing, and I think it's always a jigsaw, so I don't, I never suggest somebody just goes down one route. I think all the different routes are important, but I guess what you're asking is where would you go first.
Yeah. And I think the difficulty in, in the NHS is that, , both can be hard to access for women, so hormonal support and ADHD support and assessments can be hard to access. But if I had to pick one, I would say ADHD assessments are the, the by far the hardest to access in a timely fashion- Oh, for women in, in the NHS because we know that women can wait years for that
[00:20:20] Michaela: Yeah, they can.
And obviously, again, it's difficult when we have this sort of private hat- Mm-hmm ... as well as having worked in the NHS, or currently work in the NHS because the need and demand is so high. Mm-hmm. And then it becomes a, a, a question of privilege as well, which is really difficult, which is, side note- Yeah
why I'm trying to build a social enterprise as well, so I can help people without them having to s- self-fund. But, , it takes time, right?
[00:20:44] Dr Helen Wall: Yeah. I to- I totally agree with you. I always said I'll never work private. You know, my husband's, , in healthcare. He, he's in dental healthcare. He went private a long time ago, and we always had this, , him and me debate that I wouldn't go private.
I was NHS through and through. Mm-hmm. And, you know, I don't think I'll ever leave the NHS because I do love s- I do love... As hard as it is and as many barriers as there are, there are core parts of the NHS that I do hold very close to my heart- Mm-hmm ... and I'm very true to. , but I realized When I got really into this work that it becomes hard.
The more you learn and the more patients you see and the more experienced you become in a really specialist area- Mm ... the harder it is to do a good job in a short amount of time because you just can't unsee things. You know, I can't- Yeah ... not deal with something because I've only got 10 minutes. I can't not see something because I've only got 10 minutes.
So it becomes harder and harder to do a good job and to give those patients what they need. So I have basically set up this private clinic, and what I try and do in that is I try and make it so that women come to see me for one appointment and, , I try and, and send the- them and their GP, you know, it can be up to like a four or five-page letter joining those dots, talking right through their hormone- Mm.
Mm ... life, right through their mental health, , through all the different things that have happened to them, and what I think the proposed plan should be moving forward. And my hope is that those women, yes, they've had to pay for a first appointment, but my hope is that many of those women will then be able to go back into that NHS system and be supported by their own GP and have that proposed plan.
And, you know, when I started doing it, I was a bit like, "A GP's just gonna be really annoyed with me because they might think, you know, I'm interfering, and I sh- I'm telling them what to do." But actually, as time's gone on, I, I think, you know, I've realized that many GPs actually feel quite relieved that this- Mm.
Mm ... this lady who is quite complex for them and is, you know ... And, and often they really do want to help, but they just don't know where to start because it's so- Yeah ... complex and time-pressured to actually have it all on a paper what, what joining the dots and a really clear plan. I would say 95% of those GPs have, have run with that and have, have, have started to action those.
And of course, women can come back and see me if that doesn't happen, and they can come back and, you know, have a review appointment if, if they want to. But it's really important to me that we don't try, you know, that we don't create this divide where only women- Mm. Mm ... who can afford to repeatedly pay for private healthcare can get help for these things because it shouldn't be this way.
It sh- it, it, it's really upsetting that we are where we are in 2026
[00:23:23] Michaela: Absolutely, and I agree with that around giving that guidance because not only do you validate the person who's seeking these answers, but propping them with, with the power of knowledge and the language to, to use in starting that dialogue with their GP, plus it's been documented by, you know, by a qualified health professional that this is what they need.
That's how I, my own HRT was s- was subscribe- , prescribed that way. Yeah. Saw a private clinician, and then the GP has, has taken it over no problem and has been very supportive. Not everyone has that luck, but it's also about thinking about who is the best fit for you within your own GP surgery as well.
Is there a women's health specialist in there who takes more of an interest in it? , but I've also had a question from the listeners about what blood tests do you ask your GP to, to pres- to do for you? What can you-- how do you arm yourself with that knowledge of asking for what deficiencies to look for, et cetera?
[00:24:16] Dr Helen Wall: Yeah, brilliant question because actually when these women often go to their GP, they're often given a hormone blood test, which actually doesn't tell us very much at all. So- Mm ... , the NICE guidance states that from 45 onwards, perimenopause is a clinical diagnosis, and actually we shouldn't be looking to check for hormones.
Now below 45, we, you know, we may well do hormone tests, but that's really to see if someone is in early menopause or premature menopause. It doesn't tell us whether someone's in perimenopause because perimenopause, the hormones, as we've already, , said earlier on, that are swinging wildly. They may be high, they may be low, they're changeable.
It's only a snapshot in time, and it doesn't tell us anything concrete. So I think it's really important that women are aware that they can't hang their hat on whether they're in perimenopause or not based on hormone blood tests. More importantly for me is that they are checking that there's nothing adding into these hormonal changes, so exactly what you mentioned, those deficiencies.
Mm-hmm. You know, ferritin is a huge one for me, particularly women with ADHD, and again, we're going back to theory rather than research studies here. But we know that ferritin it... and vitamin D actually is really important in the, , in one of the enzymes that helps with the chemical messenger synthesis.
So, , if, if a woman is low in ferritin or vitamin D or even if her thyroid is not, , you know, not functioning well, she's underactive or overactive, that can have an impact on how hormones are cycling. So I think, , there are blood tests we should be looking at, and unfortunately again, on the NHS, we have quite a different view of measuring things like that.
Um, and they're based on, you know, what the NHS was designed to do, which was to keep people well, not optimized, I guess- Yes. Yes ... if we're being really honest. Yeah. So for example, ferritin, many, , NHS labs will say that a ferritin, which is the, a measure of your iron stores, , is normal over 15. Some areas say 30.
, but actually if you look at some of the dermatology, papers that have been written, you know, dermatologists quite often say that you can't, for example, grow new hair or, or repair skin with a ferritin under 70. , and- Wow. Wow ... you know, it's just been... I, I did a post recently, , about, restless leg syndrome.
So we used to give, , people for the first-line treatment for people that came with restless leg syndromes, who instantly are often women in, in that perimenopausal stage of life, we used to give them dopamine, agonists. So we used to give them essentially like pramipexole, whi- which increased dopamine in the brain 'cause we knew that, it was, there was something going on with dopamine synthesis that might be causing or leading to this restless legs.
But now what, now the guidance is changing to say actually the first thing we should do is check somebody's iron store. So we always knew that if somebody had low iron or low ferritin, it might add to restless legs, but it certainly wasn't the first go-to. And I think that's really interesting because the overlap there- Mm.
Mm ... is that actually we're now starting to realize that ferritin is important for dopamine synthesis. And in that guidance where it talks about RLS, I think from memory, don't quote me on this, I think it starts at sort of wanting a ferritin of at least 50. So I, I always say to my ladies when I see them, you know, "When was the last time you had your ferritin checked?"
And sometimes they hit a barrier with that because sometimes the GP says, "Well, your ferritin was normal. We checked it last year. We checked it two years ago. You know, just go away and eat a good diet. Your ferritin was 15. It was okay." but it, that, that measure for me is very much the ferritin level that's going to stop you becoming anemic and ending up really unwell.
It's not the ferritin level that's potentially going to optimize your brain function or how you feel or prevent things like restless leg syndrome. Mm. Mm. So, you know, we do have this bit of a gap in, how we manage things, I think, for health, being keeping well, but also optimizing. So ferritin's a big one.
Vitamin D's another one for me. I think vitamin D needs to be You know, are optimal. , and then, , for things like, , perimenopause and menopause, I always talk about omega-3s, , and, , magnesium. Now, I wouldn't be checking that in people's blood tests, but I'd certainly be encouraging them to have a decent diet to keep those, those hormones in check really.
, but yeah, ferritin and vitamin D for me all day long, and thyroid.
[00:28:36] Michaela: And thyroid. - And I guess it's also really difficult, some of my clients are on, quite a complicated cocktail of an SSRI, as in, , , for a serotonin, so an antidepressant, , on HRT, maybe estrogen and progesterone split out separately so they can also,, titrate up and down across the cycle, , 'cause a lot of my clients also have PMDD, to throw that into the mix.
And then also thinking about stimulant medication for ADHD, for instance, and also trying to take all the supplements. You know, it's, it's wildly overwhelming at the moment, isn't it? Creatine, collagen, you know, what are all the things, magnesium, what are all the things one should be taking? And not just take magnesium, but a particular type of magnesium.
So it is really overwhelming for people who are seeking answers. Mm-hmm. Is there anything we can say to simplify that? You know, if we try to do one thing at a time, creating new habits, where do we start when we have someone who's on such a cocktail of, of things? What, what can we do to help simplify that?
[00:29:32] Dr Helen Wall: Well, I think the medical treatments there, so SSRIs, um, HRT, stimulant medications, you know, that's quite a common mix of, of drugs for these women. And I think, , the ... one of the common questions I get is, "I, I was put on the SSRI," or the antidepressant as they're commonly known, um, "and I think that was a misdiagnosis."
Now, there may, there may well be elements of, we know that many women in their- Mm ... perhaps in their younger years, where treatment-resistant anxiety, depression was rife. They even may have had diagnoses like bipolar disorder, if they were emotionally dysregulated, or borderline personality disorder.
We know those things have been misdiagnosed in many women that then went on to have a diagnosis of ADHD. We also know those things coexist with ADHD. So- Mm ... I think, for me, take the medication as prescribed. That is your core thing really, because that's the thing that we've got evidence for keeping you s- you stable.
Mm ... and , I think many women feel a bit fobbed off when antidepressants come into the chat, , which I totally- Yeah ... understand because of the years that we've often spent being told we're just anxious, just depressed, et cetera. Mm-hmm. But actually, we know that for many of these women- who have, , progesterone intolerance or progesterone sensitivity.
And I'm not just talking about women who are given progesterone contraceptives or progesterone HRT, I'm talking about their own progesterone every month in that luteal phase. The very women that you've just mentioned, those with PMDD, PME, PMS, who every month have that one to two weeks of hell, , they are extremely sensitive to, the progesterone often, and they have these brain changes.
And we know that many of those women also have a dip in their serotonin levels in that luteal phase. And we know that allopregnanolone, which is progest- what progesterone is metabolized to, also when that starts to, , dip in the luteal phase, that can cause issues. And serotonin can be quite smoothing of that.
So it can be quite good at controlling those changes in the al- allopregnanolone when women feel like they're getting PMS or have PMS or PMDD. So I think there are benefits to being on SSRIs and antidepressants. I, , I suppose- Mm ... wouldn't be advocating for women to stop that because they've h- been given stimulants or had an ADHD medication.
My advice is always, follow the prescriber, follow your prescriber's av- , advice. And then I think with everything else, it's about just starting one thing at a time. So add in some iron, get some ferritin. There's different versions. Some people tolerate them better than others. I think you have to be careful that you're not going, , too high because too much iron can be harmful as well.
So just to caveat that, , it's about just, just adding in things on a sort of a, a monthly basis just to see how you feel and just make small changes. 'Cause I think the tendency with, uh, women with ADHD is to go all in to just sort of- Yeah ... really high focus. , you get up one day, you think, "I've had enough of feeling like this.
I'm gonna do my research, and I'm really gonna go all in here and just go on everything and change everything and do everything. I'm gonna stop my antidepressants. I'm gonna change my, , I'm gonna ch- just change how much hormones I'm taking." Just one thing at a time Good. Yeah. , don't go all in, you know Just don't
[00:32:48] Michaela: do that.
Yeah. Yeah.
[00:32:50] Dr Helen Wall: Just, just take little baby steps and, and review and reassess because otherwise you don't know what's helping and what isn't.
[00:32:57] Michaela: You don't. And absolutely, also to reinforce what you said there, do not come off your antidepressant on your own accord without informing your doctor, because you may feel really unwell if you're stopping it quickly.
You might have to slowly titrate that out. , and again, this is not either pro-medication or not taking medication. I am pro supporting people in the best way you can with whatever tools and evidenced measures, , evidence-based measures we have out there. And being someone with ADHD and PMDD myself in perimenopause, I am on that cocktail, and I am not going to stop my antidepressants because it, it does help me.
And it's not because I felt I was depressed beforehand. It is just more about, here's another little building block in my- Yes ... in my toolkit. For sure. Here's another little bit that ups, ups me a little bit to be able ... Like a catalyst that helps me do all the other things that we know are the, the lifestyle changes that we really still need with ADHD.
Looking at our sleep, looking at our nutrition, looking at our movement, looking at our social connection, being with people. All of that is impacted if your ability to initiate things, which it does when you feel low and dep- , and depressed, low dopamine, low serotonin, you're not gonna engage with those things.
You're gonna withdraw from those things and not do those things that we know are healthy habits. So if the antidepressant gets you to go, go for a walk, ring a friend, , eat something healthy for dinner, great. What's not to like? Yeah.
[00:34:23] Dr Helen Wall: It's all bits of the jigsaw, isn't it? There's no one thing- Yeah
that's going to fix this. It's just trying to fit all the bits of the jigsaw together. - Yeah ... and I often get asked, "Well, HRT doesn't, isn't for me. I can't take it. I don't want hormones. I've got medical conditions, that means I can't have it." , I think it, it's some people can't have every bit of that jigsaw, so you have to maximize all the bits you can have.
Mm-hmm ... but absolutely, , some of those, the stimulants, the SSRIs, HRT, if you can have any of those and they work for you, they can then give you that push to do all the other things that you need a bit more motivation for, uh, and a bit more clarity in your mind , to be able to do, like , the exercise and the better diet, et cetera.
[00:35:06] Michaela: Which is also difficult. We, we started this conversation with saying how overwhelming and exhausting it is to be a woman in midlife now with all the pressures we have on our plate, and I'm seeing that literally rippling across Instagram at the moment. All women are saying, "I'm so spent. I'm exhausted, all of the things I'm having to do for my wellbeing."
So I guess there's a difference between, like you said, making sure we come out of illness, , that kind of intervention, , type of support, versus also preventing you to get further into something. How do you think about ... Let me see how I'm gonna phrase this question. Thinking about people who have these types of cocktails put in, , looking at im- improving serotonin, dopamine, all of these things, living as well as they can, and they still have huge amounts of brain fog and struggle to concentrate, and they still have challenges with emotional outbursts- Mm
and emotional dysregulation. What kind of, what is the, an optimal level for a woman in midlife with ADHD? Where is the acceptance piece of, "This is just going to be hard, and I need to be kinder to myself," versus- Yeah ... "There are still pieces of the puzzle missing that I could still improve"?
[00:36:15] Dr Helen Wall: Yeah, definitely.
I think, , yeah, I think very often women don't get 100%, you know, back to where they want to be for many of these things because actually, , just the very process of acknowledging that you're going through this and you may get, , a new diagnosis of ADHD, or you may self-identify, you may recognize ADHD and not, , not have an, a diagnosis, but recognize that is what you struggled with.
I think just that very process changes who you are and how you look at yourself, how you look at your life's journey, and how you move forward on that journey. So many of the women I meet, and I am all for this, you know, that they choose to say, "Actually, , I'm not lazy, I'm not, , dizzy, I'm not disorganized.
I've just got a brain that's different, and I'm gonna work with that brain, not against it, and I'm gonna have some self-compassion to be this person that I'm allowing myself to be." , so I think, , it's almost like a grieving process of giving up that person that you've been fighting to almost like the masked person that you've been fighting to be, and accepting that this is you.
, you've got lots of great qualities and great traits. They might not be the ones that you feel, , fitted into those neurotypical, , education systems, and workplaces, and friendships, and relationships, but actually, you know, everybody's an individual, and that's okay. And you just move forwards and work with the brain that you have, set your boundaries differently.
A lot of women, , set boundaries differently. They don't allow themselves to be dragged into this trying to fight to be, , the all-singing, all-dancing Superwoman , that they've tried to hold up for so long. And they just move forwards with different mindset, and I think a huge part of that, that I see women
The, the women that seem to succeed with that most have one of two things for me. Either they have a really good peer social connection system, so whether that's, , they go to peer support groups, they have great friends who are all, you know, often, you know, ADHD women often attract other ADHD women, and they support each other, and it's
I've seen that so many times. , or they have great family who recognize these, , differences - and support them. Or they seek out some kind of ADHD coaching or psychological support, therapy, et cetera. Mm-hmm. I think, , not saying you have to have either or do either of those two things, but from my experience, the women that actually thrive in this new phase of life where they unmask and they accept and they are validated and they have self-compassion often do well with one of those t- do the best, I think, with one of those two routes.
I don't know what your ex- whether you would agree with that, or not.
[00:39:00] Michaela: Absolutely. 100%. And I think it's that, the balancing act between acceptance and change. So when you fundamentally accept yourself as you are without the judgment and the shame, you can then soften that, you know, soften the self-criticism that's been basically incorporated throughout your entire life, coming from external criticism- Yeah
and your internal criticism. Like, internal, external pressure meeting and becoming a, a, you know, a double whammy of hating on yourself. When you start to loosen that, let go of that, with softening that self-compassion bit that you mentioned, I certainly see that that's when they also have the ability to make the changes, because changes don't come motivated by shame.
They come motivated by acceptance, that I need this. This is non-negotiable for me. Or like I said earlier, the things that ... Lifestyle changes. The way I built my business now is that those things are non-negotiable. You know- Yeah ... my team knows that in order for me to be the CEO, I need to be for my business, I need to have daily walks.
I do need to move daily. I need to go to bed at 9:30 PM. , it's ... That doesn't mean I always do that. Yeah. But there are some non-negotiables that I say, "This is not something I'm doing as another pressure or to-do list. This is something I'm choosing to do because it makes me feel as well as possible."
And I would rather be well than wealthy, so certain things I have to let go of. This is setting those self-boundaries within my business as well of, okay, if I'm doing a big stretchy event this week, maybe I can't speak on stages two times this week. Maybe I need to balance that, and I'm building in the rest and the recovery after I've done something stretchy that I could have coped with when I was, , in my 20s or 30s.
Now I cannot, and I perpetually say, "I just need a bloody good lie down," and then just having a bloody good lie down and just resting- That's good ... that, that nervous system.
[00:40:42] Dr Helen Wall: Perfect. I love that. Yeah.
[00:40:45] Michaela: So, yeah. Absolutely. So that, that's what we do in, i- in all of my coaching, is that really noticing when you also have that- I guess that internalized pressure from society of being optimal, of, okay, I should be as good as I was before.
It's a similar thing of post-motherhood. , I should bounce back. There is no bouncing back. You are, , moving forward. So I think that's part of the acceptance piece. It doesn't mean that you say, "Oh, I, I just accept that I, I will now feel like shit because I'm in midlife." Absolutely not, but there are parts of you, your younger self, that you are having to let go of because the equation just doesn't work anymore Yeah, and
[00:41:21] Dr Helen Wall: actually, if you think really hard about it, are you not able to do that anymore, or are you not able to or willing to carry the hidden costs of that?
That's what I- Yeah ... always think. ? Because, probably many of the women I meet could carry on d- flogging themselves like that, holding everything- Mm ... carrying everything with an absolute push, but the cost becomes so much greater. The exhaustion becomes so much greater. And- Mm ... I think it's that recognition that why should...
, I don't need to do this to myself. I don't need to- No ... to carry this any longer. And I think wh- I think perimenopause and menopause, , for many women, whether you're neurodivergent or neurotypical, I think it's a real changing point in how you see yourself and, , where you are- Mm ... in life and what you're willing to put up with and tolerate.
Um- Mm. Mm ... do you know what, what you feel is acceptable for you to tolerate. So-
[00:42:17] Michaela: Yeah. Yeah. It's the F at 40s. You don't wanna- Yeah ... you don't wanna put up with this anymore. It's just, again, the midlife where you get a lot more reflective. I see, certainly see in my clinic that's also where you start to reflect backwards on old relationships, old traumatic experience might come to the surface.
So it's very much a, like, actually do I want this anymore? And cutting ties with relationships. We know that the, the divorce risk is particularly high at this part of life because there are fewer F's given. I don't want this anymore. Yeah. So that's not a bad thing. That just means that you're finally doing something you, you could have been taught to do 20 years ago.
Mm. But again, some of those equations might have worked when you didn't have children. We've not touched upon that, but how hard it is for a neurodivergent woman in midlife who also has neurodivergent children, and having to fight and advocate for them, it becomes really difficult to then, okay, well, like, I have to ad- advocate for myself and get myself a GP appointment, get myself an assessment, when you're already fighting school and doctors and things for your kids.
That's really hard.
[00:43:15] Dr Helen Wall: Yeah. And it's all the practical stuff that you've just mentioned, and I think it's also the pressure cooker of the home environment. , things that other families may take for granted, , going on holiday, changing routine, , just how you interact and communicate, emotional regulation challenges.
, if you've got more than one person in that home who are battling with those things, there can be a lot of collision and a lot of pressure. And- , I, yeah, I don't think that's given enough, uh, credit at all.
[00:43:47] Michaela: It's really not, and again, thinking about the work I do with couples as well, when you mix and blend the neurotypes, then the- Mm-hmm
sensory needs, the, uh, the need for stimulation versus peace, it's so different, , within the household if you then have, , a couple of grownups , and a few children with everyone having a different neurotype. That is, is, , a chaos course as well, collision. So there's a lot going on there.
But again, we don't wanna simplify. You've given a lot of nuance of basically it depends, , is my favorite psychologist answer. Well, it depends on you, , your entire, , personal history and developmental, , stages you've been through. It really depends, but going to speak to someone about it, trusting your gut if you feel like you identify, uh, ADHD, or whether you identify that your ADHD has worsened coming into- Mm-hmm
you know, midlife, to trust their gut. , what are your thoughts around what people are saying about going off protocol for HRT for, for ADHD women of, maybe we can't have the same level of prescribed HRT, either more or less of, say, estrogen or progesterone? What are your thoughts around that, of going off script?
[00:44:51] Dr Helen Wall: Yeah, I mean, for me, it's got to be safe. That's the bottom line, and I think safe is a very, you know, it's a very broad term because actually, for example, you know, we know many of these women can't tolerate many different progestogens, , because of progestogen incens- , progestogen sensitivity or intolerance.
Equally, you know, I know there's some clinicians out there who would then advocate giving less progestogen than we think is perhaps safe endometrically, , because, , we've got to weigh up the risk of suicide and, and, it... we've got to be really clear that actually, , it's not just people feeling a bit irritable.
People can feel really, really desperate and suicidal every month, , or, , on, on medic- on- Mm-hmm ... certain HRTs. So I think, , I never take it lightly that, that, that is a, an issue for women, and it's a very real issue- . and we need to be mindful of it, you know. I always say, , menstrual health is mental health,
we can't separate out hormones and how somebody's feeling e- emotionally and mentally. But I, yeah, so I do go off-piste on some, , and I don't wanna s- it's not really off-piste, it's sort of off license, but within accepted practice. So for example-
[00:45:56] Michaela: Mm,
[00:45:56] Dr Helen Wall: mm ... We know that, , many women, , feel that calming, , sleep-promoting effect of micronized progesterone.
Some women Want that and are told they can't have it,, because they don't qualify because they've got a marina coil in or they've not got a womb. , they don't need progesterone because technically we use progesterone, in the UK in all our guidance to protect the womb lining from, from cancerous change.
, but I think again, I'm gonna go back to that thing about it needing to be the individual. You know, what's the alternative for that woman? Is she going to end up on sleeping tablets? Is she going to be drinking loads, you know, a bottle of wine every night to try and relax and to sleep? Uh, you know, what's, what's the counter risk to that?
, so there are some things that are non-negotiable for me. , if the counter risk is endometrial cancer, then I think you've got to have enough, , progestogen to protect the endometrial lining. That's a non-negotiable for me. , if the counter risk is, well, it's just not in gu- it's not licensed, but we know it helps, then , that's a different kind of, , going off piece.
Mm-hmm, mm-hmm. You know, , if that makes sense. So I always try and stay within sort of, as I've said, some kind of basis for what I do. , but I always listen to the woman as an individual and try and make a plan that fits her within the realms of being safe,
[00:47:08] Michaela: Mm-hmm,
[00:47:08] Dr Helen Wall: mm-hmm ... and not creating a, a, a bigger problem down the line for her or something that's going to put her at considerable risk.
I think what I see in my clinic is, , what ... This is a typical case of what I see in clinic. So a, a lady goes to a GP. The GP ... She has ADHD, whether it's diagnosed or not, underlying neurodivergence. The GP gives her what is our classic HRT now. So we often opt for a transdermal option of estrogen, be it a patch, a gel, , a spray, and then gives her micronized progesterone because we know that micronized progesterone is natural, it's body identical, it's therefore got potentially less breast tissue risks, et cetera.
So that is often the standard, , HRT that we get. Mm-hmm, mm-hmm. And I see in my clinic that many of those women have a really altered response or a paradoxical response to that micronized progesterone. So rather than it being calming and them feeling sedate on it and being able to sleep and feeling less anxious, we know that about, some studies say about 30 to 40% of women, and this is over-represented in neurodivergent women, , have a paradoxical response.
So rather than that being calming on their GABA receptors, it becomes, , reactive. So they become agitated, anxious. So I see a number of women that come to my clinic and say, "I was given micronized progesterone. It's what my GP said was the safest thing. It's the most natural thing." I went, well, one woman said to me I went completely psycho on it two weeks of every month.
Mm-hmm. And the GP said, "Well, if you can't have that, then HRT's not for you because that's the best HRT." So I think through all of the questions you've asked me, I would say there is no good and bad hormones. , it's what's right. The, the good hormone is the one that suits that woman in front of us and her s- her life situation and individual circumstances at that moment in time, and I think this is why so many women have a bad experience in the NHS system.
, not all. There's some brilliant, brilliant, , you know, NHS, uh, clinicians. , but the difficulty is it's really hard to do an individualized assessment in 10 minutes in an NHS GP appointment. , yeah. That's the crux of it. So whether you've got all the training in the world, you've got all the experience in the world, to see a woman and actually be able to go through her whole life journey with hormones, her mental health history, where she is right now, what, what situation her life is in, what might work or not work, and then make an assessment on that and have a detailed- Mm.
-discussion about the risks and benefits, the pros and cons, the licensing or not licensing, the guidance, is nigh on impossible to do in a 10-minute NHS. So often these women when they do get HRT end up with a, , a protocol of the s- what is the safest, most natural version, and it's sort of a copy and paste, and we cannot copy and paste this care for these women because we need to have time to listen and understand and give them a personalized, um- Mm-hmm, mm-hmm
plan. And that, that's where, that's where most of these things I think fall down.
[00:50:10] Michaela: And that's how I feel when I do the ADHD assessments as well, because the, this one factor we've not really touched upon, and it's not just about the brain fog in the here and now. Historically, working memory having a real impact on how you then tell the story of what you've been through.
Do you ... I don't remember when I first got my period, et cetera. So we know that's, , that historical, , blank patches in memory is a very common thing that I see when I assess, and that makes it really difficult to put, , put the go- the pieces together, and again, is why it's so much more important to also capture young girls now when they are young, and not waiting for them to get to, , th- mid-30s where , the average, , diagnosed age is in the UK , for ADHD in women.
So because then you are living it right then and there and not having to piece together 40 years of history, , and you can't remember it, and neither can your parents who might not even be alive anymore, , or they might struggle with dementia, or they might struggle with the relationship with the person.
So it's too toxic, too complicated to even ask for their, , their input on that history. So again, that's also having to piece together what we've got from the person in front of us, and not guesswork, but really listening intently and taking the extra time to put all the pieces together. So this is why it's really difficult when you have people-pleasing as such a character trait in ADHD women, because we don't want to be uncomfortable.
We don't wanna ask for help. We don't wanna be like, "Oh, I don't wanna take up any of your time, doctor." But that's what's needed, right? We do need to have that time of really letting someone to sit there and put all the pieces together. So it's been really helpful to have you sit with these things and the complexity and nuance of it, because it does get very polarized on, on social media.
And you've got, , an ITVX, documentary I was gonna say. You, you've got stuff coming out on ITVX. Tell me more about that.
[00:51:58] Dr Helen Wall: Yeah. A documentary. So, I'd done some work with ITV. It was initially a local news, piece about the fact that, , essentially we did an FOI, we did a Freedom of Information request to medical schools across the UK to ask them, how much they were teaching medical schools to try and quantify it in terms of menopause and hormonal health.
And, The majority of them said, , an hour, 90 minutes , was quite average. So in, in a five-year course, that's not per year, that's across the five years. And there were lots of caveats to that. , we send them out into placements and they'll come across women there. But I think the difficulty is that when students are out on placements, one, what they come across is entirely down to luck, and two, , they're often being taught by clinicians who don't have a lot of time or don't have a lot of experience or, , aren't passionate about these areas perhaps.
The experiences aren't standardized. They're very difficult to capture, and they're not always great, if we're being really honest. , yeah, I think ... So we've-- So basically that, that was then put into a documentary which is on ITVX. It's called Menopause. So it's called Dismissed: Menopause the Scandal.
It talks a bit about, , ADHD women as well and how hormones-- I talk a bit about how hormones impact their brains and how, you know, women are being, being missed in that aspect as well and late diagnosed. There's a fantastic bit of one of my patients called Nikki who did really, really fab. She was so nervous about speaking to them, but she really gives a really clear lived experience of being- Mm
a late diagnosed woman with ADHD and autism, , and how her hormones impacted her. So, you know, what we're hoping is that this is ... It's been picked-- It, well, it came out on Tuesday, but it's already been picked up by national news. It's been put out on national last night. , and the reporter for that, Mel Barham, you know, is really keen to sort of carry this work on and try and sort of raise the bar for women.
Because essentially we're all struggling and suffering from the consequences of that old adage of hysteria. , women just having wombs that- Yeah ... circulate around their bodies, and everything being put down to us being emotional, overreactive, dramatic, , hysterical beings, and I think I still see that on a daily basis in, , medicine in 2026.
There's a few of us about who are trying to, , shout about that and raise the bar on, on, on what we should be doing for women in 2026.
[00:54:20] Michaela: And we talked about that beforehand, of how hard it is to be one of the pioneers getting into these spaces, because we've, we've-- kind of thinking of the feminist angle on that, how hard it is to talk about women's health issues when there's then pushback.
And I was telling you about how I'd gone on, , LBC Radio last week talking about RSD and then getting a, , barrage of, of stuff coming from, uh, old white men on, on LinkedIn. So how do you personally deal with that? , given, your own neurodivergence or given your own life stages, how do you deal with being so visible fighting this fight when there's also then, trolling and hate coming?
[00:55:00] Dr Helen Wall: Yeah. I mean, I think I deal with it really well now. I, that hasn't always been the case. I, , did a lot of work in COVID. I ran the, , I was the basically run the COVID program for Bolton, , in 2019, , 2020 when the COVID vaccine came out. So I did a lot of media around COVID, and I got absolutely annihilated by the- Mm
, anti-vaxxers and the anti-COVID, , cohort of people. , I got death threats. I got things to my work, sent to my work. I got... , I had to basically go into hiding. I didn't... , you'll notice I never share anything about my children or my family on social media. I keep them well out of it. , and I think I just...
, it was difficult. It w- it really affected me at the time, but I'm so glad it went- I went through it because it's given me now that sort of almost shield to take on anything. So when I now get comments like that, and it is usually either from older men or from even, women. C- some of the most disparaging comments can come from women, often women who've been through menopause or perimenopause without support and don't see why anyone else should have it is my view on that often.
Yeah. Yeah. "I, I got on with it. Why can't we get on with it?" Um, I just take that as evidence that we're not there yet, and I use it as, - I almost, rather than letting my RSD kick in, I let my justice sensitivity kick in. I, I then sort of fuel the justice sensitivity to go, "Right.
This is making me really angry now that people are doing this, and we're gonna push on and actually do more of this. And we're gonna actually fight even harder for this." So that's how I sort of learned to flip it. I think... And I think that came from, , the time that I've spent in media during COVID and, and the, the difficult, , situations we had with that.
So yeah, , I hated it at the time, but I am absolutely... Yeah, I think it was a great... It, it set me in good stead for this work, and I am not stopping. And my daughter has ADHD. , it was her that got me into all of this work. , she really , struggled in puberty when her hormones were changing. I was diagnosed after her, and, you know, I had a terrible perimenopause, early on recognized it.
And I... What drives me is that I will not, I, I will not let my daughter and all the women like her go through all of this and get to perimenopause and menopause and still be in this awful situation, . So you've gotta have a, you've gotta have a why. That's my why.
[00:57:28] Michaela: Yeah, that's your personal mission.
And, , as much as that must have hurt at the time, I've said that to other guests on the podcast o- over six years we're talking about pause, purpose, and play, everyone who has a very strong mission and vision of something they want to change and an impact they wanna have or a legacy they wanna leave behind, that's been paved through pain.
Yeah. Every single one has- Yeah ... said that, "I'm really passionate about doing this because I went through this and-" that hurt, and I've seen other people go through this thing, and it hurts, and I need it to not be that way. And I think that's such a beautiful thing- I really- ... about a neurodivergent brain, isn't it?
That we are, "Nope, not gonna stand for this."
[00:58:03] Dr Helen Wall: The thing about neurodiver- I love working in this community because, not because I, , like I understand they get on with people, but I think they are so good at turning pain into passion. And- .. I do a lot of speaking work, I do a, I go into a lot of organizations virtually or, in person, and I, I talk about all the things that we've talked about today , and so on.
And it's nine times out of 10, the first person that contacts me to do that and then puts me in touch with their seniors or the senior exec team or the leadership or the boss or whoever, is somebody who's had those challenges and has been through that painful experience, and doesn't want others to go through that.
And, , yeah, that's just the great thing , about this community. I'm not saying other people can't do that and don't do that, but we see it so much on repeat, because you have to flip your RSD into just a sensitivity, and then you are unstoppable.
[00:58:56] Michaela: Yeah. Yeah. It's the, , the F it moment. I crumbled.
I feel like you crumble for a bit, you feel the feelings, you let them out, and then you seek support. Then you get angry. You g- And then you get angry. I mean, that's sort of... You work for Bob Gandolfini. Then you get angry. He created Band-Aid because he was angry. So- Yeah ... a lot of these things , can come from that.
That's how change is driven through, and it's, that's never gonna feel smooth. And if you are doing things, pioneering some of these changes, unfortunately people don't like change and people don't like difference. It doesn't mean it's right that you'd experience death threats, and I'm really sorry to hear that.
, but you s- you hear the same thing about, say, Jo Elmore, who's been, , the founder of Pregnant Then Screwed, trying to make changes to, uh, parental leave. Anyone is putting their, head above the parapet like that with anything to do with women's wellbeing, we get knocked down. But then we get up again, right?
That's what we do. Then we get up again. So-
[00:59:47] Dr Helen Wall: We get up taller and stronger, hopefully, and we, we push harder. Yeah.
[00:59:51] Michaela: Yeah. I mean, that's the, , stubbornness or determination , of my neurodivergent brain is like, "I'm not gonna be silenced by, by you, old dude on LinkedIn. And thank you for the engagement, 'cause my post has now gone way further- Yes.
than it would've done without you. So thanks very much. , so it's been a great joy to have you on the show. As I always leave the listeners with a little final gift from you, if there was a permission you wanted to give the listeners or a pressure you wanted to take off them, what would that be?
[01:00:21] Dr Helen Wall: To listen to your gut.
It's not the sys- it's not you, it's the system. So keep fighting and keep advocating for yourself. So many women I see start to believe that they are exaggerating, that they're imagining it, that they're, , all those little voices from their childhood and whatnot come back in, in force, and I want you to silence them and know that you know your own body and your own mind and, , you can advocate for yourself.
[01:00:49] Michaela: That's, again, coming back to self-trust and really turning that inwards and believing in yourself. So thank you so much, Dr.- Yeah ... Dr. Helen Wall. And for anyone who wants to listen or read your book, where would they go to find it?
[01:01:02] Dr Helen Wall: , well, it's on all good bookstores. I have to say that. It is on Amazon, and you can get the Audible version from various places where you would buy your Audible books as well.
, I have a website, , www.drhelenwall.com, and I'm on Instagram and Facebook, just my name. So you can find me there. I, , yeah, I'm usually there every day.
[01:01:22] Michaela: Brilliant. Thank you so much for talking to us.
[01:01:25] Dr Helen Wall: Thank you
[01:01:27] Michaela: thank you for listening to the end of this episode. I know this is a complex, , nuanced, challenging discussion, and there might have been lots of scientific terms in there for you.
However, I do feel that knowledge is power, and it is useful for us to know more about these things so we're not getting fobbed off, and we do find the self-trust and the confidence in ourselves, or the courage maybe rather than the confidence, to ask the right questions to the right professionals around us.
So do stand your ground. Don't take no for an answer. It is okay to take extra time. It is okay to have multiple variables that are impacting on each other. So today's episode, I hope, was inspirational in, in fighting that fight, but also allowing yourself the compassion piece, acceptance piece around being who you are.
I wanted to also say that after we finished recording, I immediately pointed out that I think that she had a dog present. So if you've heard any odd little noises, it was because it was an adorable one-year-old dog in the background, and then we got talking about how actually that's the final thing that tips you over the edge in terms of executive functioning, to add a pet into the picture as well.
So as much as we love dogs and how cute they are, it can be a lot to manage when you're already feeling overstretched with managing children. Anyway, so if you are interested in the type of work that Helen does, you can go onto her website and also connect with her on Instagram, follow her media appearances there, listen to the, , the audiobook, and go and watch the ITVX documentary.
If you want to hear more about the work I do through Burn Bright, the group coaching program, which is for ambitious ADHD women who are either senior leaders in corporate positions and feeling overwhelmed by such, or, , running your own businesses, so trying to juggle that busy brain of yours with the busy body, with the busy life of busy kids, then you need some guidance around how to develop those acceptance pieces to develop your habits sustainably, slowly, , so that you can burn bright without burning out.
The next round of Burn Bright starts in January, and the doors are semi-opening soon. I already have a few people wanting to join the program, and it's only got six spaces. So I tend to just tease it and nudge it a little bit beforehand so that you've got plenty of time to think about whether Burn Bright is the right group coaching program for you.
I'll pop the link to the, the, website in the, show notes as well, so you can go and check out thethomasconnection.co.uk/burn-bright. And until I speak to you next time, do take care of yourself
So we talk a lot about, how menopause is a feminist issue when there isn't enough research and evidence yet around how ADHD women experience perimenopause, and not enough guidance around how we can, , treat hormonal challenges, when to seek ADHD assessment, how to speak to your, your GP about it if you want support with your hormones or a referral for ADHD, and much, much more.
So this is a really, really good one, and I would encourage you to stay to the end of this episode even though it's a longer one, because not only will you get a little bit of a science lesson around dopamine, serotonin, but also understand more about, , the fluctuations around estrogen and progesterone in an evidence-based way that makes you feel like you're in safe hands.
So let me introduce you to my guest. Dr. Helen Wall is a GP partner, BMS registered menopause specialist, TV broadcaster, and bestselling author of the book Menopause and ADHD, which we mention in this interview today. She's the resident doctor for BBC Breakfast, and a trusted media voice on women's health, regularly translating complex medical issues into practical evidence-based advice for the public.
A passionate advocate for women's health and ADHD in midlife, Dr. Wall has a particular interest in the intersection between female hormones and brain health. Her work focuses on helping women understand how hormonal changes throughout life can influence cognition, mood, well-being, and neurodiversity, particularly during the perimenopause and menopause transition.
So you will hear more about this book in the chat today
. So welcome to the podcast, Helen. It's such an honor to speak to you after I've been listening to your amazing book on audio.
And we talked about how, yes, ADHDers can struggle to read a book, so it's great that it's also been read in on audiobook. So welcome to the show.
[00:02:29] Dr Helen Wall: Thanks so much for having me here. It's lovely to be here.
[00:02:32] Michaela: You've got some big things going on, , talking about menopause. So today, we're gonna try to make this accessible, but I am gonna ask you some questions of things that I get asked in my clinic all the time.
Things like, " is this ADHD, or is it just brain fog?" Or, "How do I know if it's one or the other, or is it both? , why am I going insane? Do I have dementia?" And other joyous questions. So let's, let's maybe start there, because I know so many people experience that brain fog, and in your book, you talk about that cognition being impacted.
Why is that, that that gets so impacted in perimenopause, and why especially for ADHDers?
[00:03:13] Dr Helen Wall: Yeah. I- you're absolutely right. It can impact any, any woman at all during that perimenopausal, menopausal time. The reason for that is a reason that we don't really talk about very much with women, I don't think, and we certainly don't talk about it enough as clinicians.
, but it's really to do with the effect of the female sex hormones on our brain chemical messenger systems. So we have, , trillions of neurons in our brain. I'll try not to make this into a science lesson. , and the messages going between those, , neurons are carried by chemical messengers. So some people may have heard of a few of these.
One of the commonest ones that we talk about with ADHD is dopamine. , we also, , y- may have heard of things like serotonin, , noradrenaline, , and a few others. So they're really important, not just for the things that people might know them for. So often people know dopamine as sort of that reward ho- hormone.
, they might know serotonin as the happy, in happy pills, , to be really glib about it. But actually, the chemical brain messengers and the way they signal and fire are, are responsible for so many things that we do on a day-to-day basis that we take for granted. So our attention, our memory, our ability to focus and concentrate, , our emotional regulation, and our executive brain function.
So how we think through a problem, how we plan, how we process that information, how we retain it, recall it, and, and so on and so on. So the job of those chemical messengers is huge, and that's happening all the time in our brains without us even realizing it really quickly. And what happens is in, in, , perimenopause, you see great swings in the estrogen levels of women.
So, the-- one day, you know, your estrogen might be really high, the next day it might be low. It's not a stable position. So in menopause, the sex hormones drop to a low, stable level, but in that run-up to that period, perimenopause, it can be quite volatile, so the hormones are not stable. And the key is that estrogen in particular has a, a stabilizing effect on those chemical messengers.
So, uh, you know, you've got these chemical messengers that need to fire and signal and work, , really hard to, to do all those things in our brain, in our neurons, and then you've got the hormones that are impacting on that and, and impacting positively on it when they're nice and stable and, and, , at good levels and predictable.
, obviously, that then means that if they're not stable and predictable, you have a, a negative effect on those chemical brain messengers, and that's when we start to see things like brain fog, memory changes, word-finding difficulties, emotional dysregulation or inability to sort of feel like your mood is stable.
And, . in women with ADHD, that is almost like a double whammy because we know that the brains of people with ADHD already have signaling receptor difficulties often in those chemical brain messengers, particularly dopamine, but also serotonin, noradrenaline, and the others. So, , you've got almost this double whammy situation of a brain that might already be finding those, , signaling a-and the ability of those chemical messengers to function well difficult, and then you add in, , a massive change in, in the, , estrogen and to a lesser extent progesterone, but still important extent.
And yeah, you just get a, you know, a real difficulty , in brain function for many women qui- and often quite early on than we might see it in, in our neurotypical peers.
[00:06:28] Michaela: Hmm. I mean, as, as early as in our late 30s or e- even earlier than that?
[00:06:33] Dr Helen Wall: Yeah. So we, , there's been some studies done on this and, and I often get asked, you know, "Do, do women who are neurodivergent, , do they go through menopause earlier?"
And I think the, the, the feeling that we all have now , from the studies that have been done so far is that actually we've got no evidence that women who are neurodivergent go through actual menopause early. Now, menopause- Hmm ... is defined as periods actually stopping for 12 months and, you know, your ovaries essentially shutting down because they've, they've done their, their life's work.
But what we think is happening is that often the brains of those women who are neurodivergent are hormonally sensitive, they might start to recognize very early perimenopause changes. So it might-- those changes in hormones may well be happening for your neurotypical peers or friends or family-
[00:07:19] Michaela: Hmm
[00:07:20] Dr Helen Wall: but they may not be as sensitive in their brains to those changes, and they may therefore not present so early with perimenopausal symptoms. So we absolutely do start to see women in their late 30s, early 40s who are experiencing, , what we think are perimenopausal, symptoms, often earlier than, than perhaps other people might expect.
[00:07:41] Michaela: So it's a sensitivity- So, so- ... to the fluctuations that, that is really about, rather than- Yes ... it's the onset of symptoms being earlier as actually other people might have a, a slow kind of, um, uphill sort of trickle- Yeah ... with it. So what you're describing there is life, life with ADHD is hard, and then it gets harder when you're- Yes
coming into perimenopause.
[00:08:01] Dr Helen Wall: Which I think is a running theme, isn't it, with ADHD, particularly women with ADHD, because it feels like everything often feels like everything's conspiring against them. You know, the system doesn't recognize them. They h- they've got the hormone changes. , it's the, the-- we're just not-- we've got so many barriers in the way to keeping these women well and helping them to thrive rather than survive.
, and, you know, yeah, absolutely. It's -- that's where the thinking is right now. You know, that may change. I think I have to caveat everything I'm gonna say today with the fact that we have a real sparsity of research and studies in women with ADHD, particularly women with ADHD and their hormones. So a lot of the work I do is based on, , neurobiological theory.
So we know the science behind how the brain works, and we know the science behind what hormones do to those chemical messengers, et cetera. We don't have studies that say, you know, "If we give this woman with ADHD HRT, this is the outcome." We don't have those real-life studies by and large. Yeah. And if we do have studies, they're often quite small numbers.
They're often not, , gold standard randomized control trials, placebo, , et cetera, et cetera. So a lot of it is lived experience. A lot of it is clinical experience from people like myself who are seeing these women day in, day out, and- Hmm, hmm ... all based and hung on sort of that underlying theory , that we know to be true
[00:09:20] Michaela: ,
It's very similar to what I see when I do ADHD assessments as well, of how hard it can be to sit with a diagnosis when we don't always have that clear-cut history of having struggled before age 12. We're actually, we're seeing the hormonal impact, , of not only coming to perimenopause, but also living in a modern-day society, which was much harder than for our mothers when they came into their 40s.
It's all differently hard, I should say. So it's contextual as well, right? But it's, I think it's great that we acknowledge that with integrity, that we just don't know so many things, and the research is emerging, but it's not there yet, and that's, that must be hard for, for you as an evidence-based practitioner, you know, , as a clinical doctor.
I feel the same as a psychologist. How do you sit with that, of how you then support the women in your clinic when the, the research isn't there yet?
[00:10:12] Dr Helen Wall: Do you know, I think a lot of, of women, they want to be heard and they want to be listened to. And I sit with it by sharing exactly what we do know and exactly what we don't know with every patient I see.
, I work as a jobbing GP as well as my clinic where I see many women in this space, and that's how I've always practiced. , I think we just have to be really transparent, really open and honest. I'm not going to go and do something wildly off-piste because, , I think it might, might work.
I always base it on theory or experience or, some- Mm-hmm ... I base it on something, you know, what I'm, what I'm trying to do with women. It's not wild and, and out there, you know? But I think- Yeah ... a lot of, a lot of what women need in this space is being, is having the dots joined together. I see so many women where they've been back and forth, they've seen different clinicians, and this is not a, a crit- critique of any, any one clinician or, or anything.
You know, it's a system issue. ... and they've just been passed from pillar to post. They've got different answers from different people. Every condition, every issue they've had has been seen in silo often, that nobody's joined the dots of that woman's mental health, that woman's, focus, that woman's menstrual history, how she's responded to previous contraceptives or previous hormones.
There's nobody has actually joined all that together and said, "Look, , this is where I think we are, and I think this is what's going on for you as an individual." And that's a, that is a system issue because we just don't have the time, and that's, that's aside from whether we've got the training or the experience as GPs because we do need to know so much about so many different things we need to know about, so it's really hard to have any great depth in, in, in certain areas.
, but that's how I sit with it. I just share it. I'm just open and honest and, you know, we make a shared decision based on something that is, ... based in reality. , and, you know, we don't go and do anything dangerous. We make small changes, and we review, and we reassess. And, most, many women say, "I just feel better because I feel like somebody's looking at the whole picture and able to validate that picture really," and then we can move forward from there.
There's no quick fix with any of this. I'm sure you feel like, you know, you see- Yeah ... exactly the same.
[00:12:32] Michaela: Yeah, I do. And there's that sense of, you know, watching an Instagram reel about a quick ADHD hack. That's not it, because it's such a body and mind experience. It's a full body, full brain experience of thinking about the inflammation, thinking about allergies, histamine, that there's so much to this picture.
And I guess for anyone who also then has a brain that gets easily overwhelmed, it's really difficult to figure out where do I go? And pursuing referrals, asking for the help, like the very thing that we need support with is also w- part of the barriers for why we don't get it. Even if the system was flawless, we would still be able to struggle to access it because that's the nature of the beast,
[00:13:11] Dr Helen Wall: right?
It's exhausting, isn't it? Yeah. And it's exhausting being a woman with ADHD, then hormones kicking in. There's all the different things that you've mentioned that we have going on often. , this hits us in midlife when we've got teenage children who may be going through their own hormonal challenges, neurodiverge- you know, neurodivergence assessments, et cetera, elderly relatives, senior roles at work, leadership positions, businesses,
relationships changing as, as you, as your life changes. , it is all , very overwhelming. And at that point in time is often when women need help, and-
[00:13:43] Michaela: Mm ...
[00:13:44] Dr Helen Wall: they then get hit with a system that isn't open and accessible often to them, and they have to- Mm ... keep going back and grabbing 10 minutes here and 10 minutes there, and being told, just one problem, and actually there might be several issues that are all interlinked.
So, so I'm not- Mm ... I don't take for granted the fact that I have a real luxury when I see women in my private clinic, that I get an hour to sit down- yeah ... and go through with them all of that, so I'm not here to, to criticize GPs, because I work as a, as an NHS GP two days a week too, and I, and I have to flip between those two roles where it, it- they're very different systems to work in.
[00:14:23] Michaela: Mm, and you talk about this- Mm ... in your book as well, about how to, how to speak to your GP about your challenges. W- do you have anything you can kinda summarize to the listeners who may not be able to have the funds to see someone like you privately and are reliant on their NHS GP?
[00:14:38] Dr Helen Wall: Yeah, I think, , it's about getting prepared and again, that can be really difficult when you're exhausted and overwhelmed and you're struggling to focus and your mood's all over the place.
So I don't take that advice lightly, you know, don't give it lightly, should I say. , but externalize it. So I think the thing that always makes it difficult is when somebody comes into that assessment room and they're trying to hold it all in their mind what they're going to say, and they've been rehearsing it and they've been sat in the waiting room and the nerves that go in and they're expecting to be, , dismissed or, you know, find it difficult.
, just put it all on paper, get it out onto paper, externalize it. Bring someone with you who understands or who knows the challenges you're having, if that's gonna help you. , you know, no GP should ever have a problem with someone coming into the consultation room with you if you consent to that, unless they come in, really aggressive or, or, you know- Yeah, of course
to be difficult. But if somebody's to come in to support you is absolutely fine. Writing it down, doing a screening assessment first if, if you, , want to sort of keep yourself on focus. So there's, there's freely available ADHD screening tools, , online. You know, they don't give you the whole answer.
They're not a diagnostic tool by any manner of means, but it just gives you some direction in that appointment. And I think going in with that one problem to talk about that. Mm-hmm. I think the thing where sometimes This consultation falls down is when women start with the now and just talk about the now.
So we see so many women who start by saying, " I'm really struggling now. I've forgotten everything. I can't function at work. My mood's all over the place." But actually, to make that in a 10-minute consultation, you need to try and go back through life and try and make the GP see that this is not a now, just a now problem.
, there will be things throughout your life where you start to think, "Actually, that's why that happened. That, that might be why I looked at that like that. That might be why I made that decision or, or why I always struggled at school or et cetera, et cetera." Because ADHD is, is a neurodevelopmental condition as, as we know, and it- it's lifelong.
So if you go in in a really short snippet of time and in 10 minutes just very much focus on the now, you're going to very likely end up with a now diagnosis, which is likely to be this is perimenopause, this is menopause, it's anxiety, it's depression, it's stress. You need to try and capture in that 10 minutes how this has impacted you throughout life and what the hidden costs have been for you as well.
Because there's so many women who have had, to all intents and purposes, absolutely fantastic lives. They've got great jobs. They've been to university. They've got, family life that they, , they're going on holidays. They're having a great life externally, but often there is an in- an internal hidden cost to that, and I think trying to get that across can also be quite, , revealing as well.
And finally, I would say, ask for what you want. Be really direct. , in, in a nice way, you can say, "I'm wondering if this is ADHD, and that's what's impacting me right now. Could I be referred for assessment?" And if the answer's no, I would ask, "Why not?" you've got a right to ask why, what the reason is behind that.
Mm-hmm.
[00:17:47] Michaela: Mm-hmm. Absolutely. And it must be difficult to know what end to start in. , am I asking for ADHD assessment? Am I asking for a way of looking at my, my hormonal health and conditions there? Where would you say that people start, or is that difficult to say? As, unless it's kind of looked at individually.
Do we thinking about adjusting and supporting the hormones first, or do we try to think about getting an understanding of the neurodivergence, or do we look at the mental health, or, yeah, 'cause all of it
[00:18:14] Dr Helen Wall: interacts Yeah. I mean, you're
[00:18:14] Michaela: asking
[00:18:14] Dr Helen Wall: all, all, you're asking all the key questions that I get asked, , on repeat, so I know this is what women are getting confused with.
And I think you're absolutely right. It is, it's always an individual answer that, but I, just to give some guidance to the listeners, it's, for me, it's about, , thinking what's changed now. So if you are at this point and you think you have always struggled with focus, mood regulation, , hyperactivity, be it whether that's internalized and been mis- misdiagnosed as anxiety, et cetera, , then you may want to go down the ADHD route because it might be that you need support for that, and that's what's going to make the biggest difference to you.
, I think if you have by and large managed and masked well and, and coped well up to the point of your hormones changing, , albeit there are obvious things there that have been a struggle, , then you may want to look at trying to stabilize, hormones or some kind of hormonal support because that's clearly the, the final thing that made the wheels fall off.
I think you raise a really important point that none of these things are, , mutually exclusive. , often there is an element of mental health, , going on with this because it's actually, it really is quite anxiety-provoking and depressing to be trapped in this loop of, work, to do, do, do, burnout, , not knowing what's going on, feeling like the wheels are falling off.
It's absolutely understandable that these women do often turn up with, , co- comorbid anxiety, depression, stress. , so I think it is an individual thing, and I think it's always a jigsaw, so I don't, I never suggest somebody just goes down one route. I think all the different routes are important, but I guess what you're asking is where would you go first.
Yeah. And I think the difficulty in, in the NHS is that, , both can be hard to access for women, so hormonal support and ADHD support and assessments can be hard to access. But if I had to pick one, I would say ADHD assessments are the, the by far the hardest to access in a timely fashion- Oh, for women in, in the NHS because we know that women can wait years for that
[00:20:20] Michaela: Yeah, they can.
And obviously, again, it's difficult when we have this sort of private hat- Mm-hmm ... as well as having worked in the NHS, or currently work in the NHS because the need and demand is so high. Mm-hmm. And then it becomes a, a, a question of privilege as well, which is really difficult, which is, side note- Yeah
why I'm trying to build a social enterprise as well, so I can help people without them having to s- self-fund. But, , it takes time, right?
[00:20:44] Dr Helen Wall: Yeah. I to- I totally agree with you. I always said I'll never work private. You know, my husband's, , in healthcare. He, he's in dental healthcare. He went private a long time ago, and we always had this, , him and me debate that I wouldn't go private.
I was NHS through and through. Mm-hmm. And, you know, I don't think I'll ever leave the NHS because I do love s- I do love... As hard as it is and as many barriers as there are, there are core parts of the NHS that I do hold very close to my heart- Mm-hmm ... and I'm very true to. , but I realized When I got really into this work that it becomes hard.
The more you learn and the more patients you see and the more experienced you become in a really specialist area- Mm ... the harder it is to do a good job in a short amount of time because you just can't unsee things. You know, I can't- Yeah ... not deal with something because I've only got 10 minutes. I can't not see something because I've only got 10 minutes.
So it becomes harder and harder to do a good job and to give those patients what they need. So I have basically set up this private clinic, and what I try and do in that is I try and make it so that women come to see me for one appointment and, , I try and, and send the- them and their GP, you know, it can be up to like a four or five-page letter joining those dots, talking right through their hormone- Mm.
Mm ... life, right through their mental health, , through all the different things that have happened to them, and what I think the proposed plan should be moving forward. And my hope is that those women, yes, they've had to pay for a first appointment, but my hope is that many of those women will then be able to go back into that NHS system and be supported by their own GP and have that proposed plan.
And, you know, when I started doing it, I was a bit like, "A GP's just gonna be really annoyed with me because they might think, you know, I'm interfering, and I sh- I'm telling them what to do." But actually, as time's gone on, I, I think, you know, I've realized that many GPs actually feel quite relieved that this- Mm.
Mm ... this lady who is quite complex for them and is, you know ... And, and often they really do want to help, but they just don't know where to start because it's so- Yeah ... complex and time-pressured to actually have it all on a paper what, what joining the dots and a really clear plan. I would say 95% of those GPs have, have run with that and have, have, have started to action those.
And of course, women can come back and see me if that doesn't happen, and they can come back and, you know, have a review appointment if, if they want to. But it's really important to me that we don't try, you know, that we don't create this divide where only women- Mm. Mm ... who can afford to repeatedly pay for private healthcare can get help for these things because it shouldn't be this way.
It sh- it, it, it's really upsetting that we are where we are in 2026
[00:23:23] Michaela: Absolutely, and I agree with that around giving that guidance because not only do you validate the person who's seeking these answers, but propping them with, with the power of knowledge and the language to, to use in starting that dialogue with their GP, plus it's been documented by, you know, by a qualified health professional that this is what they need.
That's how I, my own HRT was s- was subscribe- , prescribed that way. Yeah. Saw a private clinician, and then the GP has, has taken it over no problem and has been very supportive. Not everyone has that luck, but it's also about thinking about who is the best fit for you within your own GP surgery as well.
Is there a women's health specialist in there who takes more of an interest in it? , but I've also had a question from the listeners about what blood tests do you ask your GP to, to pres- to do for you? What can you-- how do you arm yourself with that knowledge of asking for what deficiencies to look for, et cetera?
[00:24:16] Dr Helen Wall: Yeah, brilliant question because actually when these women often go to their GP, they're often given a hormone blood test, which actually doesn't tell us very much at all. So- Mm ... , the NICE guidance states that from 45 onwards, perimenopause is a clinical diagnosis, and actually we shouldn't be looking to check for hormones.
Now below 45, we, you know, we may well do hormone tests, but that's really to see if someone is in early menopause or premature menopause. It doesn't tell us whether someone's in perimenopause because perimenopause, the hormones, as we've already, , said earlier on, that are swinging wildly. They may be high, they may be low, they're changeable.
It's only a snapshot in time, and it doesn't tell us anything concrete. So I think it's really important that women are aware that they can't hang their hat on whether they're in perimenopause or not based on hormone blood tests. More importantly for me is that they are checking that there's nothing adding into these hormonal changes, so exactly what you mentioned, those deficiencies.
Mm-hmm. You know, ferritin is a huge one for me, particularly women with ADHD, and again, we're going back to theory rather than research studies here. But we know that ferritin it... and vitamin D actually is really important in the, , in one of the enzymes that helps with the chemical messenger synthesis.
So, , if, if a woman is low in ferritin or vitamin D or even if her thyroid is not, , you know, not functioning well, she's underactive or overactive, that can have an impact on how hormones are cycling. So I think, , there are blood tests we should be looking at, and unfortunately again, on the NHS, we have quite a different view of measuring things like that.
Um, and they're based on, you know, what the NHS was designed to do, which was to keep people well, not optimized, I guess- Yes. Yes ... if we're being really honest. Yeah. So for example, ferritin, many, , NHS labs will say that a ferritin, which is the, a measure of your iron stores, , is normal over 15. Some areas say 30.
, but actually if you look at some of the dermatology, papers that have been written, you know, dermatologists quite often say that you can't, for example, grow new hair or, or repair skin with a ferritin under 70. , and- Wow. Wow ... you know, it's just been... I, I did a post recently, , about, restless leg syndrome.
So we used to give, , people for the first-line treatment for people that came with restless leg syndromes, who instantly are often women in, in that perimenopausal stage of life, we used to give them dopamine, agonists. So we used to give them essentially like pramipexole, whi- which increased dopamine in the brain 'cause we knew that, it was, there was something going on with dopamine synthesis that might be causing or leading to this restless legs.
But now what, now the guidance is changing to say actually the first thing we should do is check somebody's iron store. So we always knew that if somebody had low iron or low ferritin, it might add to restless legs, but it certainly wasn't the first go-to. And I think that's really interesting because the overlap there- Mm.
Mm ... is that actually we're now starting to realize that ferritin is important for dopamine synthesis. And in that guidance where it talks about RLS, I think from memory, don't quote me on this, I think it starts at sort of wanting a ferritin of at least 50. So I, I always say to my ladies when I see them, you know, "When was the last time you had your ferritin checked?"
And sometimes they hit a barrier with that because sometimes the GP says, "Well, your ferritin was normal. We checked it last year. We checked it two years ago. You know, just go away and eat a good diet. Your ferritin was 15. It was okay." but it, that, that measure for me is very much the ferritin level that's going to stop you becoming anemic and ending up really unwell.
It's not the ferritin level that's potentially going to optimize your brain function or how you feel or prevent things like restless leg syndrome. Mm. Mm. So, you know, we do have this bit of a gap in, how we manage things, I think, for health, being keeping well, but also optimizing. So ferritin's a big one.
Vitamin D's another one for me. I think vitamin D needs to be You know, are optimal. , and then, , for things like, , perimenopause and menopause, I always talk about omega-3s, , and, , magnesium. Now, I wouldn't be checking that in people's blood tests, but I'd certainly be encouraging them to have a decent diet to keep those, those hormones in check really.
, but yeah, ferritin and vitamin D for me all day long, and thyroid.
[00:28:36] Michaela: And thyroid. - And I guess it's also really difficult, some of my clients are on, quite a complicated cocktail of an SSRI, as in, , , for a serotonin, so an antidepressant, , on HRT, maybe estrogen and progesterone split out separately so they can also,, titrate up and down across the cycle, , 'cause a lot of my clients also have PMDD, to throw that into the mix.
And then also thinking about stimulant medication for ADHD, for instance, and also trying to take all the supplements. You know, it's, it's wildly overwhelming at the moment, isn't it? Creatine, collagen, you know, what are all the things, magnesium, what are all the things one should be taking? And not just take magnesium, but a particular type of magnesium.
So it is really overwhelming for people who are seeking answers. Mm-hmm. Is there anything we can say to simplify that? You know, if we try to do one thing at a time, creating new habits, where do we start when we have someone who's on such a cocktail of, of things? What, what can we do to help simplify that?
[00:29:32] Dr Helen Wall: Well, I think the medical treatments there, so SSRIs, um, HRT, stimulant medications, you know, that's quite a common mix of, of drugs for these women. And I think, , the ... one of the common questions I get is, "I, I was put on the SSRI," or the antidepressant as they're commonly known, um, "and I think that was a misdiagnosis."
Now, there may, there may well be elements of, we know that many women in their- Mm ... perhaps in their younger years, where treatment-resistant anxiety, depression was rife. They even may have had diagnoses like bipolar disorder, if they were emotionally dysregulated, or borderline personality disorder.
We know those things have been misdiagnosed in many women that then went on to have a diagnosis of ADHD. We also know those things coexist with ADHD. So- Mm ... I think, for me, take the medication as prescribed. That is your core thing really, because that's the thing that we've got evidence for keeping you s- you stable.
Mm ... and , I think many women feel a bit fobbed off when antidepressants come into the chat, , which I totally- Yeah ... understand because of the years that we've often spent being told we're just anxious, just depressed, et cetera. Mm-hmm. But actually, we know that for many of these women- who have, , progesterone intolerance or progesterone sensitivity.
And I'm not just talking about women who are given progesterone contraceptives or progesterone HRT, I'm talking about their own progesterone every month in that luteal phase. The very women that you've just mentioned, those with PMDD, PME, PMS, who every month have that one to two weeks of hell, , they are extremely sensitive to, the progesterone often, and they have these brain changes.
And we know that many of those women also have a dip in their serotonin levels in that luteal phase. And we know that allopregnanolone, which is progest- what progesterone is metabolized to, also when that starts to, , dip in the luteal phase, that can cause issues. And serotonin can be quite smoothing of that.
So it can be quite good at controlling those changes in the al- allopregnanolone when women feel like they're getting PMS or have PMS or PMDD. So I think there are benefits to being on SSRIs and antidepressants. I, , I suppose- Mm ... wouldn't be advocating for women to stop that because they've h- been given stimulants or had an ADHD medication.
My advice is always, follow the prescriber, follow your prescriber's av- , advice. And then I think with everything else, it's about just starting one thing at a time. So add in some iron, get some ferritin. There's different versions. Some people tolerate them better than others. I think you have to be careful that you're not going, , too high because too much iron can be harmful as well.
So just to caveat that, , it's about just, just adding in things on a sort of a, a monthly basis just to see how you feel and just make small changes. 'Cause I think the tendency with, uh, women with ADHD is to go all in to just sort of- Yeah ... really high focus. , you get up one day, you think, "I've had enough of feeling like this.
I'm gonna do my research, and I'm really gonna go all in here and just go on everything and change everything and do everything. I'm gonna stop my antidepressants. I'm gonna change my, , I'm gonna ch- just change how much hormones I'm taking." Just one thing at a time Good. Yeah. , don't go all in, you know Just don't
[00:32:48] Michaela: do that.
Yeah. Yeah.
[00:32:50] Dr Helen Wall: Just, just take little baby steps and, and review and reassess because otherwise you don't know what's helping and what isn't.
[00:32:57] Michaela: You don't. And absolutely, also to reinforce what you said there, do not come off your antidepressant on your own accord without informing your doctor, because you may feel really unwell if you're stopping it quickly.
You might have to slowly titrate that out. , and again, this is not either pro-medication or not taking medication. I am pro supporting people in the best way you can with whatever tools and evidenced measures, , evidence-based measures we have out there. And being someone with ADHD and PMDD myself in perimenopause, I am on that cocktail, and I am not going to stop my antidepressants because it, it does help me.
And it's not because I felt I was depressed beforehand. It is just more about, here's another little building block in my- Yes ... in my toolkit. For sure. Here's another little bit that ups, ups me a little bit to be able ... Like a catalyst that helps me do all the other things that we know are the, the lifestyle changes that we really still need with ADHD.
Looking at our sleep, looking at our nutrition, looking at our movement, looking at our social connection, being with people. All of that is impacted if your ability to initiate things, which it does when you feel low and dep- , and depressed, low dopamine, low serotonin, you're not gonna engage with those things.
You're gonna withdraw from those things and not do those things that we know are healthy habits. So if the antidepressant gets you to go, go for a walk, ring a friend, , eat something healthy for dinner, great. What's not to like? Yeah.
[00:34:23] Dr Helen Wall: It's all bits of the jigsaw, isn't it? There's no one thing- Yeah
that's going to fix this. It's just trying to fit all the bits of the jigsaw together. - Yeah ... and I often get asked, "Well, HRT doesn't, isn't for me. I can't take it. I don't want hormones. I've got medical conditions, that means I can't have it." , I think it, it's some people can't have every bit of that jigsaw, so you have to maximize all the bits you can have.
Mm-hmm ... but absolutely, , some of those, the stimulants, the SSRIs, HRT, if you can have any of those and they work for you, they can then give you that push to do all the other things that you need a bit more motivation for, uh, and a bit more clarity in your mind , to be able to do, like , the exercise and the better diet, et cetera.
[00:35:06] Michaela: Which is also difficult. We, we started this conversation with saying how overwhelming and exhausting it is to be a woman in midlife now with all the pressures we have on our plate, and I'm seeing that literally rippling across Instagram at the moment. All women are saying, "I'm so spent. I'm exhausted, all of the things I'm having to do for my wellbeing."
So I guess there's a difference between, like you said, making sure we come out of illness, , that kind of intervention, , type of support, versus also preventing you to get further into something. How do you think about ... Let me see how I'm gonna phrase this question. Thinking about people who have these types of cocktails put in, , looking at im- improving serotonin, dopamine, all of these things, living as well as they can, and they still have huge amounts of brain fog and struggle to concentrate, and they still have challenges with emotional outbursts- Mm
and emotional dysregulation. What kind of, what is the, an optimal level for a woman in midlife with ADHD? Where is the acceptance piece of, "This is just going to be hard, and I need to be kinder to myself," versus- Yeah ... "There are still pieces of the puzzle missing that I could still improve"?
[00:36:15] Dr Helen Wall: Yeah, definitely.
I think, , yeah, I think very often women don't get 100%, you know, back to where they want to be for many of these things because actually, , just the very process of acknowledging that you're going through this and you may get, , a new diagnosis of ADHD, or you may self-identify, you may recognize ADHD and not, , not have an, a diagnosis, but recognize that is what you struggled with.
I think just that very process changes who you are and how you look at yourself, how you look at your life's journey, and how you move forward on that journey. So many of the women I meet, and I am all for this, you know, that they choose to say, "Actually, , I'm not lazy, I'm not, , dizzy, I'm not disorganized.
I've just got a brain that's different, and I'm gonna work with that brain, not against it, and I'm gonna have some self-compassion to be this person that I'm allowing myself to be." , so I think, , it's almost like a grieving process of giving up that person that you've been fighting to almost like the masked person that you've been fighting to be, and accepting that this is you.
, you've got lots of great qualities and great traits. They might not be the ones that you feel, , fitted into those neurotypical, , education systems, and workplaces, and friendships, and relationships, but actually, you know, everybody's an individual, and that's okay. And you just move forwards and work with the brain that you have, set your boundaries differently.
A lot of women, , set boundaries differently. They don't allow themselves to be dragged into this trying to fight to be, , the all-singing, all-dancing Superwoman , that they've tried to hold up for so long. And they just move forwards with different mindset, and I think a huge part of that, that I see women
The, the women that seem to succeed with that most have one of two things for me. Either they have a really good peer social connection system, so whether that's, , they go to peer support groups, they have great friends who are all, you know, often, you know, ADHD women often attract other ADHD women, and they support each other, and it's
I've seen that so many times. , or they have great family who recognize these, , differences - and support them. Or they seek out some kind of ADHD coaching or psychological support, therapy, et cetera. Mm-hmm. I think, , not saying you have to have either or do either of those two things, but from my experience, the women that actually thrive in this new phase of life where they unmask and they accept and they are validated and they have self-compassion often do well with one of those t- do the best, I think, with one of those two routes.
I don't know what your ex- whether you would agree with that, or not.
[00:39:00] Michaela: Absolutely. 100%. And I think it's that, the balancing act between acceptance and change. So when you fundamentally accept yourself as you are without the judgment and the shame, you can then soften that, you know, soften the self-criticism that's been basically incorporated throughout your entire life, coming from external criticism- Yeah
and your internal criticism. Like, internal, external pressure meeting and becoming a, a, you know, a double whammy of hating on yourself. When you start to loosen that, let go of that, with softening that self-compassion bit that you mentioned, I certainly see that that's when they also have the ability to make the changes, because changes don't come motivated by shame.
They come motivated by acceptance, that I need this. This is non-negotiable for me. Or like I said earlier, the things that ... Lifestyle changes. The way I built my business now is that those things are non-negotiable. You know- Yeah ... my team knows that in order for me to be the CEO, I need to be for my business, I need to have daily walks.
I do need to move daily. I need to go to bed at 9:30 PM. , it's ... That doesn't mean I always do that. Yeah. But there are some non-negotiables that I say, "This is not something I'm doing as another pressure or to-do list. This is something I'm choosing to do because it makes me feel as well as possible."
And I would rather be well than wealthy, so certain things I have to let go of. This is setting those self-boundaries within my business as well of, okay, if I'm doing a big stretchy event this week, maybe I can't speak on stages two times this week. Maybe I need to balance that, and I'm building in the rest and the recovery after I've done something stretchy that I could have coped with when I was, , in my 20s or 30s.
Now I cannot, and I perpetually say, "I just need a bloody good lie down," and then just having a bloody good lie down and just resting- That's good ... that, that nervous system.
[00:40:42] Dr Helen Wall: Perfect. I love that. Yeah.
[00:40:45] Michaela: So, yeah. Absolutely. So that, that's what we do in, i- in all of my coaching, is that really noticing when you also have that- I guess that internalized pressure from society of being optimal, of, okay, I should be as good as I was before.
It's a similar thing of post-motherhood. , I should bounce back. There is no bouncing back. You are, , moving forward. So I think that's part of the acceptance piece. It doesn't mean that you say, "Oh, I, I just accept that I, I will now feel like shit because I'm in midlife." Absolutely not, but there are parts of you, your younger self, that you are having to let go of because the equation just doesn't work anymore Yeah, and
[00:41:21] Dr Helen Wall: actually, if you think really hard about it, are you not able to do that anymore, or are you not able to or willing to carry the hidden costs of that?
That's what I- Yeah ... always think. ? Because, probably many of the women I meet could carry on d- flogging themselves like that, holding everything- Mm ... carrying everything with an absolute push, but the cost becomes so much greater. The exhaustion becomes so much greater. And- Mm ... I think it's that recognition that why should...
, I don't need to do this to myself. I don't need to- No ... to carry this any longer. And I think wh- I think perimenopause and menopause, , for many women, whether you're neurodivergent or neurotypical, I think it's a real changing point in how you see yourself and, , where you are- Mm ... in life and what you're willing to put up with and tolerate.
Um- Mm. Mm ... do you know what, what you feel is acceptable for you to tolerate. So-
[00:42:17] Michaela: Yeah. Yeah. It's the F at 40s. You don't wanna- Yeah ... you don't wanna put up with this anymore. It's just, again, the midlife where you get a lot more reflective. I see, certainly see in my clinic that's also where you start to reflect backwards on old relationships, old traumatic experience might come to the surface.
So it's very much a, like, actually do I want this anymore? And cutting ties with relationships. We know that the, the divorce risk is particularly high at this part of life because there are fewer F's given. I don't want this anymore. Yeah. So that's not a bad thing. That just means that you're finally doing something you, you could have been taught to do 20 years ago.
Mm. But again, some of those equations might have worked when you didn't have children. We've not touched upon that, but how hard it is for a neurodivergent woman in midlife who also has neurodivergent children, and having to fight and advocate for them, it becomes really difficult to then, okay, well, like, I have to ad- advocate for myself and get myself a GP appointment, get myself an assessment, when you're already fighting school and doctors and things for your kids.
That's really hard.
[00:43:15] Dr Helen Wall: Yeah. And it's all the practical stuff that you've just mentioned, and I think it's also the pressure cooker of the home environment. , things that other families may take for granted, , going on holiday, changing routine, , just how you interact and communicate, emotional regulation challenges.
, if you've got more than one person in that home who are battling with those things, there can be a lot of collision and a lot of pressure. And- , I, yeah, I don't think that's given enough, uh, credit at all.
[00:43:47] Michaela: It's really not, and again, thinking about the work I do with couples as well, when you mix and blend the neurotypes, then the- Mm-hmm
sensory needs, the, uh, the need for stimulation versus peace, it's so different, , within the household if you then have, , a couple of grownups , and a few children with everyone having a different neurotype. That is, is, , a chaos course as well, collision. So there's a lot going on there.
But again, we don't wanna simplify. You've given a lot of nuance of basically it depends, , is my favorite psychologist answer. Well, it depends on you, , your entire, , personal history and developmental, , stages you've been through. It really depends, but going to speak to someone about it, trusting your gut if you feel like you identify, uh, ADHD, or whether you identify that your ADHD has worsened coming into- Mm-hmm
you know, midlife, to trust their gut. , what are your thoughts around what people are saying about going off protocol for HRT for, for ADHD women of, maybe we can't have the same level of prescribed HRT, either more or less of, say, estrogen or progesterone? What are your thoughts around that, of going off script?
[00:44:51] Dr Helen Wall: Yeah, I mean, for me, it's got to be safe. That's the bottom line, and I think safe is a very, you know, it's a very broad term because actually, for example, you know, we know many of these women can't tolerate many different progestogens, , because of progestogen incens- , progestogen sensitivity or intolerance.
Equally, you know, I know there's some clinicians out there who would then advocate giving less progestogen than we think is perhaps safe endometrically, , because, , we've got to weigh up the risk of suicide and, and, it... we've got to be really clear that actually, , it's not just people feeling a bit irritable.
People can feel really, really desperate and suicidal every month, , or, , on, on medic- on- Mm-hmm ... certain HRTs. So I think, , I never take it lightly that, that, that is a, an issue for women, and it's a very real issue- . and we need to be mindful of it, you know. I always say, , menstrual health is mental health,
we can't separate out hormones and how somebody's feeling e- emotionally and mentally. But I, yeah, so I do go off-piste on some, , and I don't wanna s- it's not really off-piste, it's sort of off license, but within accepted practice. So for example-
[00:45:56] Michaela: Mm,
[00:45:56] Dr Helen Wall: mm ... We know that, , many women, , feel that calming, , sleep-promoting effect of micronized progesterone.
Some women Want that and are told they can't have it,, because they don't qualify because they've got a marina coil in or they've not got a womb. , they don't need progesterone because technically we use progesterone, in the UK in all our guidance to protect the womb lining from, from cancerous change.
, but I think again, I'm gonna go back to that thing about it needing to be the individual. You know, what's the alternative for that woman? Is she going to end up on sleeping tablets? Is she going to be drinking loads, you know, a bottle of wine every night to try and relax and to sleep? Uh, you know, what's, what's the counter risk to that?
, so there are some things that are non-negotiable for me. , if the counter risk is endometrial cancer, then I think you've got to have enough, , progestogen to protect the endometrial lining. That's a non-negotiable for me. , if the counter risk is, well, it's just not in gu- it's not licensed, but we know it helps, then , that's a different kind of, , going off piece.
Mm-hmm, mm-hmm. You know, , if that makes sense. So I always try and stay within sort of, as I've said, some kind of basis for what I do. , but I always listen to the woman as an individual and try and make a plan that fits her within the realms of being safe,
[00:47:08] Michaela: Mm-hmm,
[00:47:08] Dr Helen Wall: mm-hmm ... and not creating a, a, a bigger problem down the line for her or something that's going to put her at considerable risk.
I think what I see in my clinic is, , what ... This is a typical case of what I see in clinic. So a, a lady goes to a GP. The GP ... She has ADHD, whether it's diagnosed or not, underlying neurodivergence. The GP gives her what is our classic HRT now. So we often opt for a transdermal option of estrogen, be it a patch, a gel, , a spray, and then gives her micronized progesterone because we know that micronized progesterone is natural, it's body identical, it's therefore got potentially less breast tissue risks, et cetera.
So that is often the standard, , HRT that we get. Mm-hmm, mm-hmm. And I see in my clinic that many of those women have a really altered response or a paradoxical response to that micronized progesterone. So rather than it being calming and them feeling sedate on it and being able to sleep and feeling less anxious, we know that about, some studies say about 30 to 40% of women, and this is over-represented in neurodivergent women, , have a paradoxical response.
So rather than that being calming on their GABA receptors, it becomes, , reactive. So they become agitated, anxious. So I see a number of women that come to my clinic and say, "I was given micronized progesterone. It's what my GP said was the safest thing. It's the most natural thing." I went, well, one woman said to me I went completely psycho on it two weeks of every month.
Mm-hmm. And the GP said, "Well, if you can't have that, then HRT's not for you because that's the best HRT." So I think through all of the questions you've asked me, I would say there is no good and bad hormones. , it's what's right. The, the good hormone is the one that suits that woman in front of us and her s- her life situation and individual circumstances at that moment in time, and I think this is why so many women have a bad experience in the NHS system.
, not all. There's some brilliant, brilliant, , you know, NHS, uh, clinicians. , but the difficulty is it's really hard to do an individualized assessment in 10 minutes in an NHS GP appointment. , yeah. That's the crux of it. So whether you've got all the training in the world, you've got all the experience in the world, to see a woman and actually be able to go through her whole life journey with hormones, her mental health history, where she is right now, what, what situation her life is in, what might work or not work, and then make an assessment on that and have a detailed- Mm.
-discussion about the risks and benefits, the pros and cons, the licensing or not licensing, the guidance, is nigh on impossible to do in a 10-minute NHS. So often these women when they do get HRT end up with a, , a protocol of the s- what is the safest, most natural version, and it's sort of a copy and paste, and we cannot copy and paste this care for these women because we need to have time to listen and understand and give them a personalized, um- Mm-hmm, mm-hmm
plan. And that, that's where, that's where most of these things I think fall down.
[00:50:10] Michaela: And that's how I feel when I do the ADHD assessments as well, because the, this one factor we've not really touched upon, and it's not just about the brain fog in the here and now. Historically, working memory having a real impact on how you then tell the story of what you've been through.
Do you ... I don't remember when I first got my period, et cetera. So we know that's, , that historical, , blank patches in memory is a very common thing that I see when I assess, and that makes it really difficult to put, , put the go- the pieces together, and again, is why it's so much more important to also capture young girls now when they are young, and not waiting for them to get to, , th- mid-30s where , the average, , diagnosed age is in the UK , for ADHD in women.
So because then you are living it right then and there and not having to piece together 40 years of history, , and you can't remember it, and neither can your parents who might not even be alive anymore, , or they might struggle with dementia, or they might struggle with the relationship with the person.
So it's too toxic, too complicated to even ask for their, , their input on that history. So again, that's also having to piece together what we've got from the person in front of us, and not guesswork, but really listening intently and taking the extra time to put all the pieces together. So this is why it's really difficult when you have people-pleasing as such a character trait in ADHD women, because we don't want to be uncomfortable.
We don't wanna ask for help. We don't wanna be like, "Oh, I don't wanna take up any of your time, doctor." But that's what's needed, right? We do need to have that time of really letting someone to sit there and put all the pieces together. So it's been really helpful to have you sit with these things and the complexity and nuance of it, because it does get very polarized on, on social media.
And you've got, , an ITVX, documentary I was gonna say. You, you've got stuff coming out on ITVX. Tell me more about that.
[00:51:58] Dr Helen Wall: Yeah. A documentary. So, I'd done some work with ITV. It was initially a local news, piece about the fact that, , essentially we did an FOI, we did a Freedom of Information request to medical schools across the UK to ask them, how much they were teaching medical schools to try and quantify it in terms of menopause and hormonal health.
And, The majority of them said, , an hour, 90 minutes , was quite average. So in, in a five-year course, that's not per year, that's across the five years. And there were lots of caveats to that. , we send them out into placements and they'll come across women there. But I think the difficulty is that when students are out on placements, one, what they come across is entirely down to luck, and two, , they're often being taught by clinicians who don't have a lot of time or don't have a lot of experience or, , aren't passionate about these areas perhaps.
The experiences aren't standardized. They're very difficult to capture, and they're not always great, if we're being really honest. , yeah, I think ... So we've-- So basically that, that was then put into a documentary which is on ITVX. It's called Menopause. So it's called Dismissed: Menopause the Scandal.
It talks a bit about, , ADHD women as well and how hormones-- I talk a bit about how hormones impact their brains and how, you know, women are being, being missed in that aspect as well and late diagnosed. There's a fantastic bit of one of my patients called Nikki who did really, really fab. She was so nervous about speaking to them, but she really gives a really clear lived experience of being- Mm
a late diagnosed woman with ADHD and autism, , and how her hormones impacted her. So, you know, what we're hoping is that this is ... It's been picked-- It, well, it came out on Tuesday, but it's already been picked up by national news. It's been put out on national last night. , and the reporter for that, Mel Barham, you know, is really keen to sort of carry this work on and try and sort of raise the bar for women.
Because essentially we're all struggling and suffering from the consequences of that old adage of hysteria. , women just having wombs that- Yeah ... circulate around their bodies, and everything being put down to us being emotional, overreactive, dramatic, , hysterical beings, and I think I still see that on a daily basis in, , medicine in 2026.
There's a few of us about who are trying to, , shout about that and raise the bar on, on, on what we should be doing for women in 2026.
[00:54:20] Michaela: And we talked about that beforehand, of how hard it is to be one of the pioneers getting into these spaces, because we've, we've-- kind of thinking of the feminist angle on that, how hard it is to talk about women's health issues when there's then pushback.
And I was telling you about how I'd gone on, , LBC Radio last week talking about RSD and then getting a, , barrage of, of stuff coming from, uh, old white men on, on LinkedIn. So how do you personally deal with that? , given, your own neurodivergence or given your own life stages, how do you deal with being so visible fighting this fight when there's also then, trolling and hate coming?
[00:55:00] Dr Helen Wall: Yeah. I mean, I think I deal with it really well now. I, that hasn't always been the case. I, , did a lot of work in COVID. I ran the, , I was the basically run the COVID program for Bolton, , in 2019, , 2020 when the COVID vaccine came out. So I did a lot of media around COVID, and I got absolutely annihilated by the- Mm
, anti-vaxxers and the anti-COVID, , cohort of people. , I got death threats. I got things to my work, sent to my work. I got... , I had to basically go into hiding. I didn't... , you'll notice I never share anything about my children or my family on social media. I keep them well out of it. , and I think I just...
, it was difficult. It w- it really affected me at the time, but I'm so glad it went- I went through it because it's given me now that sort of almost shield to take on anything. So when I now get comments like that, and it is usually either from older men or from even, women. C- some of the most disparaging comments can come from women, often women who've been through menopause or perimenopause without support and don't see why anyone else should have it is my view on that often.
Yeah. Yeah. "I, I got on with it. Why can't we get on with it?" Um, I just take that as evidence that we're not there yet, and I use it as, - I almost, rather than letting my RSD kick in, I let my justice sensitivity kick in. I, I then sort of fuel the justice sensitivity to go, "Right.
This is making me really angry now that people are doing this, and we're gonna push on and actually do more of this. And we're gonna actually fight even harder for this." So that's how I sort of learned to flip it. I think... And I think that came from, , the time that I've spent in media during COVID and, and the, the difficult, , situations we had with that.
So yeah, , I hated it at the time, but I am absolutely... Yeah, I think it was a great... It, it set me in good stead for this work, and I am not stopping. And my daughter has ADHD. , it was her that got me into all of this work. , she really , struggled in puberty when her hormones were changing. I was diagnosed after her, and, you know, I had a terrible perimenopause, early on recognized it.
And I... What drives me is that I will not, I, I will not let my daughter and all the women like her go through all of this and get to perimenopause and menopause and still be in this awful situation, . So you've gotta have a, you've gotta have a why. That's my why.
[00:57:28] Michaela: Yeah, that's your personal mission.
And, , as much as that must have hurt at the time, I've said that to other guests on the podcast o- over six years we're talking about pause, purpose, and play, everyone who has a very strong mission and vision of something they want to change and an impact they wanna have or a legacy they wanna leave behind, that's been paved through pain.
Yeah. Every single one has- Yeah ... said that, "I'm really passionate about doing this because I went through this and-" that hurt, and I've seen other people go through this thing, and it hurts, and I need it to not be that way. And I think that's such a beautiful thing- I really- ... about a neurodivergent brain, isn't it?
That we are, "Nope, not gonna stand for this."
[00:58:03] Dr Helen Wall: The thing about neurodiver- I love working in this community because, not because I, , like I understand they get on with people, but I think they are so good at turning pain into passion. And- .. I do a lot of speaking work, I do a, I go into a lot of organizations virtually or, in person, and I, I talk about all the things that we've talked about today , and so on.
And it's nine times out of 10, the first person that contacts me to do that and then puts me in touch with their seniors or the senior exec team or the leadership or the boss or whoever, is somebody who's had those challenges and has been through that painful experience, and doesn't want others to go through that.
And, , yeah, that's just the great thing , about this community. I'm not saying other people can't do that and don't do that, but we see it so much on repeat, because you have to flip your RSD into just a sensitivity, and then you are unstoppable.
[00:58:56] Michaela: Yeah. Yeah. It's the, , the F it moment. I crumbled.
I feel like you crumble for a bit, you feel the feelings, you let them out, and then you seek support. Then you get angry. You g- And then you get angry. I mean, that's sort of... You work for Bob Gandolfini. Then you get angry. He created Band-Aid because he was angry. So- Yeah ... a lot of these things , can come from that.
That's how change is driven through, and it's, that's never gonna feel smooth. And if you are doing things, pioneering some of these changes, unfortunately people don't like change and people don't like difference. It doesn't mean it's right that you'd experience death threats, and I'm really sorry to hear that.
, but you s- you hear the same thing about, say, Jo Elmore, who's been, , the founder of Pregnant Then Screwed, trying to make changes to, uh, parental leave. Anyone is putting their, head above the parapet like that with anything to do with women's wellbeing, we get knocked down. But then we get up again, right?
That's what we do. Then we get up again. So-
[00:59:47] Dr Helen Wall: We get up taller and stronger, hopefully, and we, we push harder. Yeah.
[00:59:51] Michaela: Yeah. I mean, that's the, , stubbornness or determination , of my neurodivergent brain is like, "I'm not gonna be silenced by, by you, old dude on LinkedIn. And thank you for the engagement, 'cause my post has now gone way further- Yes.
than it would've done without you. So thanks very much. , so it's been a great joy to have you on the show. As I always leave the listeners with a little final gift from you, if there was a permission you wanted to give the listeners or a pressure you wanted to take off them, what would that be?
[01:00:21] Dr Helen Wall: To listen to your gut.
It's not the sys- it's not you, it's the system. So keep fighting and keep advocating for yourself. So many women I see start to believe that they are exaggerating, that they're imagining it, that they're, , all those little voices from their childhood and whatnot come back in, in force, and I want you to silence them and know that you know your own body and your own mind and, , you can advocate for yourself.
[01:00:49] Michaela: That's, again, coming back to self-trust and really turning that inwards and believing in yourself. So thank you so much, Dr.- Yeah ... Dr. Helen Wall. And for anyone who wants to listen or read your book, where would they go to find it?
[01:01:02] Dr Helen Wall: , well, it's on all good bookstores. I have to say that. It is on Amazon, and you can get the Audible version from various places where you would buy your Audible books as well.
, I have a website, , www.drhelenwall.com, and I'm on Instagram and Facebook, just my name. So you can find me there. I, , yeah, I'm usually there every day.
[01:01:22] Michaela: Brilliant. Thank you so much for talking to us.
[01:01:25] Dr Helen Wall: Thank you
[01:01:27] Michaela: thank you for listening to the end of this episode. I know this is a complex, , nuanced, challenging discussion, and there might have been lots of scientific terms in there for you.
However, I do feel that knowledge is power, and it is useful for us to know more about these things so we're not getting fobbed off, and we do find the self-trust and the confidence in ourselves, or the courage maybe rather than the confidence, to ask the right questions to the right professionals around us.
So do stand your ground. Don't take no for an answer. It is okay to take extra time. It is okay to have multiple variables that are impacting on each other. So today's episode, I hope, was inspirational in, in fighting that fight, but also allowing yourself the compassion piece, acceptance piece around being who you are.
I wanted to also say that after we finished recording, I immediately pointed out that I think that she had a dog present. So if you've heard any odd little noises, it was because it was an adorable one-year-old dog in the background, and then we got talking about how actually that's the final thing that tips you over the edge in terms of executive functioning, to add a pet into the picture as well.
So as much as we love dogs and how cute they are, it can be a lot to manage when you're already feeling overstretched with managing children. Anyway, so if you are interested in the type of work that Helen does, you can go onto her website and also connect with her on Instagram, follow her media appearances there, listen to the, , the audiobook, and go and watch the ITVX documentary.
If you want to hear more about the work I do through Burn Bright, the group coaching program, which is for ambitious ADHD women who are either senior leaders in corporate positions and feeling overwhelmed by such, or, , running your own businesses, so trying to juggle that busy brain of yours with the busy body, with the busy life of busy kids, then you need some guidance around how to develop those acceptance pieces to develop your habits sustainably, slowly, , so that you can burn bright without burning out.
The next round of Burn Bright starts in January, and the doors are semi-opening soon. I already have a few people wanting to join the program, and it's only got six spaces. So I tend to just tease it and nudge it a little bit beforehand so that you've got plenty of time to think about whether Burn Bright is the right group coaching program for you.
I'll pop the link to the, the, website in the, show notes as well, so you can go and check out thethomasconnection.co.uk/burn-bright. And until I speak to you next time, do take care of yourself
