ADHD or Hormones? The Perimenopause Brain

We explore how hormone swings in perimenopause can reshape mental health, from anxiety and low mood to attention changes, and highlight new research that validates women’s lived experience. A Michigan State University study using daily saliva testing offers a path to personalized care and earlier screening.

• why mental health shifts in perimenopause deserve attention
• how estrogen and progesterone fluctuations affect mood and cognition
• what the MSU daily saliva study measures and why it matters
• stress versus biology and why both can be true
• personalization of hormone therapy and symptom tracking
• the case for routine screening beyond depression alone
• practical steps to self-track and start conversations
• hope for better care for current and future generations

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Transcript

Opening And Why This Matters

Speaker 1 0:00

Welcome to The Pause, the Menopause podcast with unfiltered conversations about the symptoms you hate, the changes you didn't see coming, and the hilarious moments midlife can bring. I'm your host, Val Lego, and I've been a dedicated health reporter for 25 years, and I wanted to normalize something that every woman goes through: menopause. Hey friends, Val Lego here. Welcome back to The Pause. I want to talk about an aspect of perimenopause that really concerns me. It's one that hasn't been talked about a whole lot, but one that I know is going to make so many of you listening not only say, that's me, but say, I had no idea that's a symptom of perimenopause. Because let's face it, when we talk about perimenopause, it's all about hot flashes and night sweats and mood swings and all the sexy headline

Anxiety, Estrogen, And Misdiagnosis

Speaker 0:53

stuff. But the hormonal changes during this time can also influence our mental health in much bigger ways. I know previously on The Pause, we've talked about how once I started hormone therapy, my anxiety practically disappeared. And there's a couple of reasons why this made me really sad. Number one, because I had no idea I had anxiety. I had no idea how bad my anxiety was, or that it was increasing because of the drop of estrogen I was experiencing. And number two, it made me just wonder how many women are being treated with anti-anxiety meds or anti-antidepressants or ADHD meds when all they really need is estrogen. As an accredited health reporter with more than 25 years experience who has covered women's health for decades, this just really hits me. We talk about perimetopause. Is this transition time? And yes, it is. But what if the hormones are influencing our brain health in ways that we're really only now starting to understand? So we're not going to just talk about it. We are going to dig right in. What does the science say? What are they learning? And what could this mean for all of us navigating midlife? There is a team of researchers at Michigan State University that received a $3.7 million grant to study how hormonal shifts during perimenopause might be linked to psychosis. And I know psychosis is kind of a scary word, but what it really means is significant changes in perception, thinking, emotional regulation, think anxiety, depression, your ADHD getting worse, those types of things. So here's a quick breakdown on the study. Dr. Kelly Klump, Dr. Kristen Colbert, and Dr. Katie Thacker at MSU are leading this groundbreaking study that follows 750 women between 50 and 60 years old. Everyday participants track their mood and symptoms while giving saliva samples so the team can measure hormones like estrogen and progesterone in real time. And you may ask why daily samples. Because perimenopause isn't just one smooth drop in hormones. We've talked about this on previous episodes of the pause. That's why a blood test isn't a reliable way to tell where your hormones are at. Perimenopause is a roller coaster, a point blank. Some days your estrogen is spiking, other days it's plummeting. This study wants to see how those fluctuations line up with changes in mental health. But this is the kind of research we've needed for decades. Real science is finally, finally catching up with women's lived experiences. I'm going to talk with two of the researchers one-on-one and learn what this means for women like us in midlife. First up is Dr. Kelly Klump, an MSG Research Foundation professor in clinical science and one of the principal investigators of the study. Thank you so much for giving us your time today, Dr. Klump. I really appreciate it.

Speaker 1 3:55

Well, thank you for having me. This is a topic that is near and dear to my science and personal heart. So thank you for having me.

Speaker 4:03

Can you explain a little bit in the simplest of terms what this study is really looking at and why perimenopause is just such a critical time in women's mental health?

The MSU Study And Its Goals

Defining Psychosis And Mood Risks

Speaker 1 4:13

Sure. So we are examining whether perimenopause is associated with increased risk for things like psychosis, mood disorders like depression and bipolar disorder, and related conditions like anxiety. Now, perimenopause is such a critical time for mental health, given the life changes that occur during this time period for women in terms of parenting, caregiving, work, et cetera. But it's also critically important because of the dramatic changes in estrogen and progesterone that you mentioned earlier. Now, we've had decades of studies actually conducted in animals and some in women that have shown that these hormones may contribute to increased risk for mood and other psychiatric symptoms like anxiety and binge eating. Yet, remarkably, very little research had examined whether they impact risk during the perimenopausal period when they are changing so dramatically. And this was a really huge miss in the field. It's also a neglect of women's lived experience that has been trying to tell us, again, for decades, that this period of life can be incredibly difficult for women. And you you really suspect that it's the hormone fluctuations that could be the reason. Exactly. Yes. You know, as I mentioned, clearly, midlife isn't called the midlife squeeze for nothing. So there are a lot of stressors that women experience during midlife. They often are having kids that are in teenage years or beyond, moving on to other stages in their life. They're also frequently caring for elderly parents. And so they're feeling, and they have the work stressors, et cetera. So there are a lot of stressors at midlife. And for a very long time, people have assumed that women's increases in anxiety and depression and even psychotic symptoms might be linked to these stressors. But what we ignored are these basic science studies in animals and again, women, that really showed that fluctuations in hormones like estrogen and progesterone seemed to increase risk for these symptoms during earlier reproductive periods, for example, across the menstrual cycle. So the menstrual cycle is another time where women experience pretty dramatic, not as dramatic, but pretty significant shifts in estrogen and progesterone. And when past studies had looked at the menstrual cycle, they saw that these changes in the hormones were predicting increases in anxiety in women, increases in depression, increases in weird perceptual experiences that seem to be linked to psychosis. But prior to our studies and some other studies that are now happening in the field, thankfully, nobody had thought about perimenopause and how the hormone fluctuations during perimenopause are even greater than what we see during the menstrual cycle. And these hormonal shifts could be contributing to the spike in mood, anxiety, psychotic symptoms that we see in women during midlife. We really just assumed it was all stress and had nothing to do with biology. And as I said, this basic science data really had our research team thinking this could be also about hormonal shifts contributing to this really difficult time for women.

Speaker 7:41

I think what I love the most is that it's it's giving you validation that you're not crazy. It's giving you validation that when you go to your doctor and he's just like, ah, it's all in your head, ah, you'll get through it. Like, no, like something is really not okay. Like I need help. There's what can we do? Um, I love the validation that this study is giving.

Speaker 1 8:02

Exactly. And, you know, sometimes people get worried that if something is due to a biological factor like hormones, or you see this in genetic research, that it means we can't do anything about it and nothing can be farther from the truth. Even if something is caused or partially caused by changes in hormones, that doesn't mean we can't do anything. We can have, we have a lot of tools at our disposal to help deal with those hormonal fluctuations. But one of the key pieces is knowing that these hormonal fluctuations are contributing to those symptoms, both to decrease blame on the part of women and their physicians, and also to be able to identify the most effective treatments.

Meet Dr. Kelly Klump

Speaker 8:42

And you're doing this by taking those saliva samples, which what I've been reading and the research and the people that I've been talking to, like this is like the new normal. Don't get your blood test. Test that saliva on a daily basis so we know where you're at. And I love that this is the basis of the study.

Why Perimenopause Is High Risk

Speaker 1 8:58

Yeah, we really um in our lab here at Michigan State, we've done these daily saliva sample studies for quite some time. This is our first study in perimetopause, but we also do it across the menstrual cycle. We've done a little bit during puberty. So it's really critical because getting one sample on a particular day tells you really nothing about the woman's hormonal milieu. And when I say it tells you nothing, it tells you nothing about her hormonal milieu on that day, that week, that month, et cetera, because these hormones can shift quite significantly across days. And so getting it across multiple days ensures that you're getting the most accurate picture of the hormonal milieu. And from a scientific perspective, it gives you the strongest scientific design possible to be able to see are the changes in the hormones occurring before you see increases in those symptoms? Because you can look at it within a day, but then you can also look across days. Were the fluctuations in hormones on day one, did those predict increases in anxiety, depression, psychotic symptoms on day two? So it's a really, in addition to giving a much more accurate picture of a woman's hormonal milieu, it also gives a really strong study design for being able to show that the hormones are actually preceding and predicting the changes in the symptoms.

Speaker 10:23

And what I also like is that it takes it one step further and it personalizes it because every woman's perimenopausal journey is not like the next. Everybody's individual, what you're experiencing, your life experiences, your your environment that you grew up in, as far as what you were exposed to or how you eat, all of those things are contributing to make it your own unique. So you can't just say, here's what you should take. You need 0.5 estrogen or you need 0.375 estrogen. Uh it it doesn't necessarily always go that way. Um yes. Oh, sorry, I didn't mean to interrupt you. No, you're fine. I just was gonna kind of interject my own experience with my uh, you know, I I went up to the 0.75, but then I realized that that was a little bit too much, but yet I needed something between that, but there wasn't really a dose between that. So I I modify my my patches where two, two, one week I do two of them, one week I do one. So I kind of try to hit that sweet spot, but it's a guessing game, is worked for me. But unfortunately, we have these pre-doses of like, oh, you just go up a dose, and then you figure it out with your progesterone. And then if you've got testosterone, you figure that out too. And so you just feel like you're constantly popping pills, slapping patches, and rubbing cream on yourself. Oh, absolutely.

Stressors Versus Biology

Speaker 1 11:39

And that, well, and that piece about every woman is different. Yeah, I can't underscore that enough. So because we get 35 days worth of hormone values, we can we end up generating an individual hormone plot for every single woman. And what is striking when you look at these individual plots is you'll look at a whole sample of women who are in perimenopause. But what their hormones are doing during perimenopause across 35 days is really different. It's different in terms of how high some women's estrogen spikes are, how low some women's estrogen valleys are, and also how much across weeks and days there is that variability. And that really underscores what you just mentioned because of these really vast individual differences in what a woman's hormones are doing, even if she's in the same phase as another woman, that really does suggest that these personalized, what we think of as personalized medicine approaches in terms of hormone replacement therapy, but also in terms of psychological therapy, being able to know what is this woman's hormone profile doing and how can we best help her is going to be on a very individual basis.

Speaker 12:51

Yeah. And I do love that because that to me is like by design going to help women on individual levels navigate this part of their life so much more. I I wonder, I have one last question for you. Um this is this, do you think this will lead to screening tools? Like this is my hope for the study is that someday it's just kind of like, oh, let's test your saliva. Here's where we need to be at. And you have this host of screening tools that women can use when they are stepping into that phase of perimenopause, maybe when they're like 40 instead of, you know, 50, 55.

Menstrual Cycle Clues To Midlife

Speaker 1 13:27

Exactly. Yes. I mean, we really hope so. We hope that our findings would be able to be used by women and physicians in order to increase understanding about the potential risk for increases in these symptoms and their link with the hormones. So, as a first step, we are hoping and we plan to try and do some dissemination to alert physicians about increased risk with perimenopause and hormones and the need to screen on the front end for psychotic symptoms, mood symptoms, anxiety during perimenopause in all women. I think any woman will know when you, or we've had this experience, when you go to your physician, they often will screen for substance use, maybe a couple questions on depression, but there are no questions on psychosis. There's no questions on how you're doing cognitively in terms of remembering things, forgetting where you put things, et cetera. And certainly very few questions on anxiety. We're hoping our data will show we need to have that as a part of routine clinical care because early screening and identification has been shown to decrease suffering from these symptoms as it hastens appropriate care and provides validation and understanding on the part of the women and the physician. And if you think about it, what we often, when we become aware we should be looking for signs and symptoms of something, it's because our physician is screening for it when we come in. So letting women know you're starting to approach perimenopause, you may experience these symptoms. They are linked to your hormonal fluctuations. If you experience this, come back, let's talk about it. There are treatments and let's identify it early so we can really, really help you with these symptoms because midlife does not have to be a time of suffering for women. And for too long it has been. We really hope our findings will be able to change this and help physicians and women recognize the increased risk during perimetopause and start interventions early so that women can thrive during these critical midlife years.

Speaker 15:30

I'm loving everything that I'm hearing. It makes me so hopeful, not only for the women currently going through this, but for our younger generation. Hopefully, they'll never ever even know what it was like to suffer through perimetopause. Hopefully this research really just opens that door for it to just be a normal transition and they can have a great midlife. That's my hope. I agree. Thank you so much, Kelly, for joining me for the insights. I'm gonna be talking with your colleague, uh, Dr. Kristen Coleman coming up. Um, but I I'm very excited to see where this research goes. And thank you so much for your time.

Speaker 1 16:08

Oh, thank you, and thank you for all that you are doing for women and for this field. Um, it's invaluable and we very much appreciate it, Val.

Validation: You’re Not Imagining It

Speaker 16:16

You know, every time I talk to scientists, I'm reminded how much we still don't know about women's health and how powerful it is when we start to ask the right questions. So if you're listening and you're thinking, hmm, this kind of sounds like me, here's what I want you to know. You're not broken, you are not imagining it, and you are not alone. Hormones can influence our brains in real, measurable ways. Write down what you're noticing. Why am I suddenly so anxious? Why do I feel detached? Why am I more sensitive? Or why is my mind racing? Write these down. Make a note, then bring it up with someone. Talk to someone about it. You can talk to your doctor, your therapist, your friend, your sister, your mom, your neighbor. Every woman is going to be going through this in their lifetime. Every woman deserves to be supported in their journey and talk through it. And that's what I want for you. So if today's episode resonated with you, come join me in our private Facebook group, The Pause Diaries. This is where we keep these conversations going with other women through perimetopause and menopause. And don't forget to follow the pause wherever you listen to podcasts so you don't miss a new episode. Until next time, take good care of your body and your mind, and we'll talk soon. The Pause Podcast is for informational purposes only and not intended as medical advice. Always talk to your healthcare provider about any questions or concerns. Views shared by hosts and guests are their own and don't replace personalized care from a qualified professional.