April 10, 2025 • 38 mins
The relationship between menopause and neurodivergence remains largely unexplored territory in women's health—until now.
In this groundbreaking conversation, neuropsychologist A/Professor Caroline Gurvich shares fascinating insights into why cognitive symptoms during perimenopause may signal more than just typical hormone fluctuations.
For many women, perimenopause becomes the unexpected moment when long-overlooked neurodivergent traits suddenly demand attention. "About 98% of people said their ADHD symptoms became worse across those perimenopausal years."
Even more revealing, numerous women receive their first ADHD diagnosis during midlife, despite having experienced symptoms since childhood. This raises questions about why these conditions often go unrecognised, particularly in women, until hormonal shifts disrupt longstanding coping mechanisms.
Listen in to learn more about Estrogen's protective effects on dopamine - a neurotransmitter central to ADHD - which diminishes during perimenopause, potentially unmasking symptoms that were previously manageable.
Beyond ADHD, A/Prof Gurvich discusses how autism, dyslexia, and other neurodivergent conditions may present differently during menopause, and the compelling connections between PMDD, perinatal depression, and neurodivergence.
Whether you've wondered about undiagnosed ADHD, experienced increasing cognitive challenges during perimenopause, or simply want to understand the fascinating intersection between hormones and brain function, this episode offers invaluable insights and practical guidance.
Listen now to better understand your changing brain and discover strategies to thrive during this transformative life stage.
Links:
HER Centre
HER Centre - Cognition and Hormones
MENO-D Assessment Scale to detect depression in menopause
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Sonya (00:01):
Welcome to the Dear Menopause podcast.
I'm SonyaLovell, your host Now.
I've been bringing youconversations with amazing
menopause experts for over twoyears now.
If you have missed any of thoseconversations, now's the time
to go back and listen, and youcan always share them with
anyone you think needs to hearthem.
This way, more people can findthese amazing conversations.
(00:25):
Hi everybody, today I am beingjoined by Associate Professor
Caroline Gurvich.
Now, caroline is a clinicalneuropsychologist and she's
going to correct me if I get anyof this wrong and she is the
Head of Cognition and HormonesGroup at the Her Center, which
means she works alongside DearMenopause favourite guest
(00:46):
Professor Jayashri Kulkarni.
So if you are a fan ofProfessor Kulkarni's work, you
are going to love listening toCaroline and her work in and
around neurodiversity, which iswhat we're going to dive into
today.
So, caroline, welcome to theshow.
Thank you, sonya.
I'm delighted to be here.
Thank you so much.
So why don't we kick off by yougiving us a little bit more of
(01:07):
an in-depth kind of insight asto what you do, who you are, and
maybe a little bit about theHer Centre as well?
A/Prof Gurvich (01:14):
Yeah, sure.
So as you said, I'm aneuropsychologist.
So for people who don't knowwhat a neuropsychologist is,
it's broadly like a brainpsychologist, so where
neuropsychologists areinterested in the relationship
between brain and behavior, soanything that can impact brain,
so that might be like a diseaseprocess or a degenerative
process or a neurodevelopmentalcondition.
(01:36):
Anything that changes our braincan have a flow on effect to
impact our cognition, ourpsychology, our mental health,
our thinking skills.
So neuropsychologists generallyassess that association between
brain change and behavior,emotions, cognition, and then we
can also work in a capacitywhere we work with people to
help whatever changes they'veexperienced in their cognition
(01:58):
and have some sort oftherapeutic role.
So that's neuropsychology inthe clinical setting, which I do
.
And then I also work in theresearch, setting in, as you
said, HER Centre.
So HER stands for health,education and research, but it
also captures HER, as in women'smental health.
So that's what we do we worktowards better understanding
women's mental health and thenwe try to apply that in terms of
(02:21):
education and we keep doingmore research, try and learn
more about different aspects ofwomen's mental health, and our
research is reallybiopsychosocial, I would say.
So we do a lot of biologicalwork to understand what's going
on at a kind of brain or hormonelevel, and then we look at the
characterization of symptoms andbehavior, and then we also look
(02:42):
at a lot of novel treatmentpathways to try and help people
who experience a whole range ofdifferent things.
So in a very broad way, that'sneuropsychology and Her Centre.
Sonya (02:53):
Amazing.
You are very busy.
You are doing lots of things.
We're wearing many hats.
One of the things I'minterested to know about is,
with your work inneuropsychology, has the
intersection between impacts oncognition and the brain and
menopause perimenopause is thata recent kind of something that
you've noticed has become moreresearched and more perhaps
(03:17):
discussed in a clinical settingas well, as we've elevated this
conversation over the last fewyears, or is it something that's
always been a part of your work?
A/Prof Gurvich (03:24):
No, it has not always been a part of my work
and I would say, prior to meworking in this space and doing
research in this space.
So maybe 10-15 years ago itwouldn't have crossed my mind.
I don't think, sadly, ifsomeone presented with cognitive
concerns around midlife, Idon't think I personally would
have thought of menopause.
So it really was not somethingthat was flagged at all.
(03:47):
It wasn't something that wasincluded when I was training, it
wasn't something that wasincluded in our course content
at all, so it wasn't reallytalked about.
And I feel like, as theconversations have started to
emerge over the past decade,more and more people are
presenting to me I guess becausethat's my area of interest as
(04:07):
well so more and more people arepresenting who are of menopause
, perimenopausal age, withcognitive concerns, and so the
questions are now asked.
You know, is this menopause, isthis dementia, is this ADHD,
those kind of clinical questions?
But menopause is part of thediagnostic process now, whereas
it never used to be, and so Imean I don't think it's a change
(04:30):
in people's presentation, but Ithink it's a change in both
people's conversation, like inthe lay community, asking about
that linking cognitive symptomsto potentially to menopause.
So it's coming from people withexperiences of menopause and
cognitive symptoms as frompeople with experiences of
menopause and cognitive symptomsas well as clinicians now
having that knowledge thatchanges can be part of that
(04:51):
menopause transition.
So I think you know both sidesare now bringing that menopause
piece of the puzzle to thatwhole assessment process.
Sonya (05:01):
Yeah, yay, that's good, good, good news for anyone out
there that is, or has been,struggling with some cognitive
changes.
I guess both sides of thepicture are coming together with
the same kind of knowledge nowand being able to provide
support to everybody out in thecommunity.
So I think a good place tostart would be if you can give
(05:21):
us a bit of a 101 onneurodivergence what actually is
neurodivergence, what does itmean, what are the different
types and we'll then maybe diveinto a little bit on diagnosis
as well.
Yeah, sure.
A/Prof Gurvich (05:35):
So really broadly we have neurodiversity,
which just reflects all thedifferent brain types that
people have.
So it's a broad spectrum andthe majority of people are
called neurotypical, so it'slike the neurotypical brain type
, and then there's variancewithin that neurotypical
spectrum.
But on the outsides of thatneurotypical spectrum are what
(05:55):
we call neurodivergence, andwithin neurodivergence there's
lots of different things thatfall under that bracket, but
predominantly ADHD, autism.
They fall withinneurodivergence, as well as
other neurodevelopmentalconditions.
So things like dyspraxia,dyslexia they also fall within
what we call neurodivergence.
Sonya (06:16):
Okay, and then each of those, from a diagnostic
perspective, is often diagnosedon a spectrum as well, isn't it?
A/Prof Gurvich (06:25):
Yes, yeah, that's right.
So I can talk a little bit moreabout, maybe, adhd.
What it is.
Adhd is attention deficithyperactivity disorder that's
what the acronym stands for, andit can be either attention
deficit and or hyperactivity.
So some people present withjust the inattentive type
symptoms and some people presentwith just the inattentive type
(06:46):
symptoms and some people presentwith just the hyperactive
impulsive symptoms and somepeople have a combined
presentation which is a bit ofboth.
Just wanted to touch on actuallylanguage, because I use the
word like deficit and symptomsand that's very medical and
diagnostic and that's what wehave to use for our diagnostic
processes.
But when we're talking aboutneurodiversity, in that
(07:07):
neurodiversity affirmingframework, the language is a
little bit different and we talkabout differences and
characteristics.
So there are differences inlanguage depending on whether
you're kind of framing thingswithin a medical model and
diagnostic terminology orwhether you're talking about
trying to better understand, forexample, adhd and the
characteristics that come withthat and all the strengths as
(07:28):
well as the challenges.
So I guess I'll kind ofsometimes I vacillate between
the two, depending on whetherwe're talking about, yeah,
diagnostic and followingstrictly diagnostic terminology,
or whether we're having more ofa conversation about you know
what is ADHD and how differentpeople present with different
characteristics.
Sonya (07:46):
Yeah, I think that that'll be really helpful
because I know that there arealso a number of clinicians that
listen to the podcast as well.
So I guess perhaps from adiagnostic perspective they
would be more interested in thatclinical view of it.
But I also know that I've hadas I mentioned right before we
started recording that I'veactually had quite a few
listeners reach out to me andask when I would be having a
(08:07):
guest on to talk aboutneurodivergence, particularly
probably ADHD.
So it'd be great to be able toreally break it down and talk
about everything in a way whereit's easily understood from a
patient perspective as well.
So let's then touch on why themenopause transition so
perimenopause and menopause andpostmenopause becomes a time
(08:27):
where we are starting to see orfrom my perspective it seems
like we're starting to see morediagnosis of ADHD or
neurodivergence becomes moresensitive to the changes in our
hormones.
So is that what's going on?
A/Prof Gurvich (08:45):
it's definitely going on and we've done some
research where we did a bigsurvey of people who already had
a diagnosis of adhd and weasked them about their
experiences across differentlife phases, so across the
menstrual cycle.
So these were females or peopleassigned female at birth and
across menstrual cycle andmenopause and I think about 98
(09:07):
of people said that their ADHDsymptoms became worse across
those perimenopausal years.
And of our sample, quite anumber of people were diagnosed
with ADHD around perimenopause.
So while they said the symptomonset was about the age of seven
and eight that was the averageage that they kind of tracked
their symptoms to starting itobviously didn't impact them
(09:32):
enough to seek out help or adiagnosis until they hit those
perimenopausal years.
So yes, there's somethingdefinitely going on that is
happening around perimenopausethat is either exacerbating
pre-existing ADHD, if peoplealready have the diagnosis, or
prompting people to go andexplore whether they might have
ADHD.
So in terms of what's going on,I feel like that's a big
(09:55):
question mark still and I thinkthere's different hypotheses
about what might be going on.
So there's certainly obviouslythe hormonal picture.
So we know hormones changeduring perimenopause, and
particularly estrogen orestradiol.
That type of estrogenfluctuates and then drops off or
declines.
And we know at a biologicallevel that estrogen interacts
(10:17):
with dopamine and dopamine playsan important role in ADHD.
So from a biological level itkind of makes sense that oh okay
, if you're losing your estrogen, the protective effects of
estrogen, that whatever dopamineis doing, is a little bit more
obvious perhaps, and so that'skind of one biological reason as
to why you might see a moreobvious symptom presentation
(10:41):
around menopause.
But I think also some peopledescribe that they've been able
to kind of mask their ADHDsymptoms throughout their life.
They've been able to rely ofmask their ADHD symptoms
throughout their life.
They've been able to rely onlots of supports and structure
and scaffolding and lots ofdifferent things to hold it
together and to kind of getthrough.
And then something happens atmenopause and it's just whatever
(11:03):
they were doing is no longerenough and they just need I
don't know, it's not enough andthey can't mask anymore and
their symptoms just become moreobvious.
Sonya (11:12):
And could people be masking, at a subconscious level
as well, like not even perhapsrealising that they are wired a
little bit differently, I guess,to what we know, the typical
person whatever that typicalperson is and although they've
never had a formal diagnosis,they've just kind of, like you
say, they've created their ownpersonal toolkit of and scaffold
around being able to functionin a way that makes life
(11:35):
manageable for them.
So is it often that you hearfrom people that really had no
idea that that was actually whatwas going on and they just put
those structures in placesubconsciously, as opposed to
somebody kind of always having alittle niggle in the back of
their mind that something isn'tgoing on right here, but I don't
know where to go and get help?
A/Prof Gurvich (11:54):
So I think some people are really aware that
they're masking and they knowthat they feel a little bit
different and they're trying tofit in and trying to cover up
their natural self.
So some people have thatawareness.
Then there's other people whohave it with hindsight.
So they look back and they say,oh, I can see how these
(12:15):
different things were completelymasking and that wasn't my real
self and I was trying so hardbut it just wasn't me.
And then there's another groupof people who it's not masking
that they describe, but theydescribe periods of burnout,
periods of depression,misdiagnosis, even as bipolar
depression, where they've hadperiods that have been described
(12:35):
as mania and then periods thathave been described as
depression.
But actually, when they lookback, it's not that.
It's just that they've hadperiods of quite intense sort of
hyperactive, impulsive typebehaviours and then periods
where they've really burnt outbecause they've struggled to
mask and it's been referred toas burnout or referred to as
depression.
And then after years they lookback and they think that that
(12:59):
was masking and masking notworking anymore rather than
being periods of depression orburnout as it might have been
labeled.
So yeah, I think some peopleare aware and other people with
hindsight.
Hindsight it becomes a bitobvious, more obvious to people.
Sonya (13:14):
Yeah, it must be a really interesting journey for someone
to go on to, particularly forsomebody that, as you say,
perhaps goes through a period ofmisdiagnosis and I would
imagine that being diagnosedwith something like a bipolar
disorder would be reallyconfronting and something that
could perhaps create other hardto manage situations in their
lives.
You know, I would imagine thatimpacts relationships and
(13:38):
ability to work and all thatsort of thing.
So in those cases are theyoften prescribed an
antidepressant or an SSRI orsomething like that to manage
those kind of misdiagnosedsituations?
A/Prof Gurvich (13:49):
Yeah, generally if I see someone who is sort of
perimenopausal age, they havehad different medications
prescribed over differentperiods of their life and none
have been particularly effective.
That tends to be the patternthat people talk about.
But they often have a long listof things that they've tried at
different times and I think,like you said, there can be lots
(14:10):
of I guess emotions that whenpeople reflect back.
I think that's also true ofbeing diagnosed with ADHD.
Like some people feel a senseof relief.
Some people describe that butother people there's a sense of
grief as well, like I wish Iknew I had ADHD.
I wish it was labeled as thator identified as ADHD earlier in
(14:31):
my life so I could have managedthings so differently.
So there can be really mixedemotions.
Some people feel reallysatisfied and it's just right
and everything makes sense, butfor other people there's a bit
of that and a bit of grief and abit of adjusting.
So there can be a whole lot ofemotions around diagnosis when
it's later in life as well.
Sonya (14:53):
Yeah, that makes sense.
I've had conversations withfriends that have received ADHD
diagnoses around the same timethat they've started HRT.
You know, the description isoften like the noise was just
turned down in my head and Isuddenly had some clarity and I
was able to focus where I hadn'tbeen able to focus before and I
would imagine that you knowwhen you're getting that
(15:14):
recognition in your 40s andperhaps it's something that has
been problematic for you sinceyou were in school I can
understand why grief would wouldbe a part of that yeah, yeah,
lots of emotions so, but overallmost people are happy to have
received a diagnosis, if that'ssomething that people if they're
(15:34):
an ADHD brain type they want toknow.
A/Prof Gurvich (15:38):
They want that understanding of their own self
and their own way that theirbrain functions and they want
different options formedications or interventions or
non-pharmacologicalinterventions.
So I think overall, diagnosisis a positive process, but in
that journey there can be lotsof different experiences and
emotions.
Sonya (15:58):
Yeah, I can imagine.
So if somebody is in theirperimenopausal phase and they're
really starting to notice somecognitive changes, they haven't
received a diagnosis before inthe past of anything you know
around the neurodiverseconditions that we talked about.
What changes might they beseeing that would indicate that
(16:19):
perhaps there has been somethinggoing on that they need to go
and seek some help around.
A/Prof Gurvich (16:23):
So I think menopause or perimenopause
broadly, you can have cognitivechanges regardless of whether
you're someone who has ADHD ornot ADHD.
But I think if the cognitivechanges are having a negative
impact on your life in some wayyour professional life or social
life, then I think that's whenyou really should seek some sort
of professional help or havesome conversations, starting
(16:47):
perhaps with a GP, or if they'rereally significant, then I
think you know, neuropsychologyassessment can be really helpful
to try and tease apart whetherthere are any objective
cognitive changes.
And if it's more, that you feellike you've always had
something so if you've alwaysstruggled with sort of
(17:08):
organising yourself, planningattention, if you've always
struggled with sort oforganizing yourself, planning
attention, if you've always beena bit forgetful, if you've
always had trouble time managingand organizing yourself so you
don't leave things to the lastminute, if they've always been
present but they've just got awhole lot worse, then that might
be an indication that maybethis is that's more the
inattentive presentation of ADHD, but maybe this is an
(17:30):
indication that something'salways been there and again
might be worth exploring that.
So I think we see two differentthings that during those
perimenopausal years sometimeswe see this completely new onset
of executive function problems,so difficulty with those higher
order abilities of organizing,planning, time management and
(17:51):
prioritizing efficiency.
And then sometimes, and as wellas that forgetfulness, word
retrieval.
Those sorts of cognitivesymptoms can be there, and
they're only there and haven'tbeen there ever before, but
they've just emerged in thoseperimenopausal years.
And then we have the otherpresentation where there's been
a bit of something underlyingalways.
Sometimes people say I'vealways felt a bit different,
(18:13):
I've never been able to explainwhat it is or why it's just
become a bit more pronounced.
And then it might be anindication that maybe this is a
neurodivergent presentationthat's just become a little bit
exacerbated or uncovered overthose perimenopausal years.
Sonya (18:31):
Okay, and so, as you mentioned, first port of call
often in this situation would bea GP or seeking out
neuropsychologists.
A/Prof Gurvich (18:38):
Neuropsychology or you can see a psychiatrist as
well.
You can see a psychiatrist alsoif you've got those kind of
cognitive symptoms or moodsymptoms or any kind of mental
health changes.
Sonya (18:50):
Yep, yep, yes, great, and the hyperactivity side of ADHD.
How does that tend to present?
A/Prof Gurvich (18:57):
Yeah, so that can also change a bit from what
we stereotypically think of.
When we think of ADHD, thehyperactive boy bouncing off the
walls, that's kind of thepicture that comes to mind for a
lot of people.
And you can also havehyperactive girls, but it's it's
less common.
And then, as people get older,it's the description that people
provide is more like they'vegot a motor inside of them,
(19:19):
there's something driving them.
It's like a restlessness thatthey have an urgency.
They can't sit still, theycan't stop thinking, they can't
stop doing something and theyreally have.
People describe difficultyunwinding at the end of the day,
difficulty relaxing at any timeduring the day, because they
always have this on-the-gofeeling.
(19:39):
So that tends to be thepresentation for, as a
generalization, that tends to bethe presentation for sort of
perimenopausal women who havethe hyperactive, impulsive
presentation.
It's just this I can't unwind,I can't stop.
Sonya (19:54):
Yeah, always on.
A/Prof Gurvich (19:56):
Always on.
Sonya (19:56):
Yeah, exactly.
And then from a treatmentperspective, I guess from my
perspective, my understanding oftreatment for ADHD is probably
linked to kids and teenagers.
It's, you know, that kind ofRitalin, I think.
When my boys were in thoseyears where some of their
friends were being diagnosed,that was kind of the drug that
they were most, or themedication that they were most
(20:17):
likely to be prescribed.
Obviously, if this is ahormonal imbalance or you know
change that is starting totrigger some of these either a
new diagnosis or anintensification of symptoms what
do you tend to recommend from atreatment perspective?
A/Prof Gurvich (20:39):
Yeah.
So I should say that I don'tprescribe.
So neuropsychologists, withinpsychology, we don't prescribe
medication but in terms of kindof the guidelines of what's out
there at the moment.
So the first line of medicationwithin that stimulant category,
but there are other medicationsas well for ADHD.
However, in the space ofperimenopause and hormone
(21:00):
changes, while we don't have theguidelines or the evidence base
to suggest hormone therapy,there are a lot of individuals
who do report lots of benefitsin terms of their cognition from
sort of individualized hormonetherapy approaches.
So I always recommend to peopleyou know, go back to your GP or
(21:21):
go back to your psychiatristand talk about what's going on
for you and make sure menopauseis part of the treatment process
.
So it's not that ADHD istreated independently of the
fact that there's been hormonechanges and lots of things can
be explored and then people cansee how they respond as an
individual and what's helpfulfor them, okay, great.
Sonya (21:41):
So there's lots of options out there that may or
may not include HRT, if that issomething that your prescribing
clinician decides to add intothe mix, exactly.
A/Prof Gurvich (21:51):
Yes, exactly.
And then there's also for ADHD.
There's lots ofnon-pharmacological
interventions as well.
So there's lots of strategiesthat people can put in place and
things like CBT, so cognitivebehaviour therapy, and ADHD
coaching.
So there's so many options,once people understand
themselves, that they can lendon to get support and to help
(22:13):
themselves to sort of bringthemselves back to their best.
So I think for people just toknow that there's so many
different options out there,that can be really helpful with
kind of differing levels ofevidence base.
But I think sometimes there's alack of evidence because we
just don't have the researchthere, rather than evidence that
there's a lack of effect.
So I think that's important forpeople to keep in mind that
(22:35):
we're still building theevidence base, particularly for
menopausal women, about what'sgoing to be helpful.
We just there's really verylittle research.
So I think while there isn'tthe evidence basis, there's lots
of potential avenues people canexplore to help themselves.
Sonya (22:49):
Great, so it sounds very much like there's lots of
potential avenues people canexplore to help themselves.
Great, so it sounds very muchlike there's an opportunity
there to go back to what we weretalking about earlier build
that toolkit again of differentstrategies and scaffolds that
work for you personally, becauseI would imagine that this is an
individual journey for everyperson.
So, yeah, so there's lots oftools that can be popped into
that toolkit.
It's just a matter of findingthe right person to talk to that
(23:10):
can guide you towards the bestoption for you.
A/Prof Gurvich (23:13):
Yeah, exactly, and I think also knowing, keep
in mind there's lots of optionsand everyone's different, so you
might try something and itmight not work, but it's not the
only option in terms of there'slots of pharmacological options
, hormone options andnon-pharmacological options,
lifestyle options.
So there's so many things that,as you say, you can add to your
toolkit and throw out thethings that don't work for you
(23:35):
as an individual, addingsomething else.
Sonya (23:37):
It's all trial and error, yeah, and yeah, lots of, and I
think that's a good goodreminder too, and it's a little
bit like when we're talkingabout people that are seeking
support for their perimenopausalor menopausal symptoms.
It's that if you try somethingand it doesn't work, don't
accept that as okay.
Well, this is just my lot and Inow have to just struggle along
here and even if you've got aclinician or a healthcare
(24:00):
practitioner that's not offeringyou other alternatives like
keep being that squeaky wheeland go out there until you do
find somebody that offers asolution that is maybe more
suited to you.
A/Prof Gurvich (24:11):
Absolutely, and it's a shame that people have to
advocate for themselves andfind that energy at a time where
sometimes you don't have thatenergy.
But if you can convert thatthought process to hope and know
that there's so many optionsand there's hope and you haven't
found the right thing, but keeptrying.
Yeah, hopefully everyone getsto a point where they can
(24:31):
optimize everything forthemselves.
Sonya (24:33):
I like that.
It's a great, great spin onkeeping hope at the forefront.
I think that's really good.
A/Prof Gurvich (24:38):
Well, that's in psychology.
We do a lot of that kind of wecall it positive reframing
because you've got to reframethings all the time.
It's such an important skillbut it's really hard to do.
If you're feeling depressed,for example, it's really hard to
flip things and positivelyreframe things.
But that's why sometimes youneed some to work with
psychologist or someone to helpyou positively reframe things
(25:00):
and so that sometimes can giveyou enough energy to keep going
and to find solutions.
Sonya (25:05):
Yeah, yeah, great, I like that.
We had that little segue.
One of the other areas that Iwanted to kind of touch on with
you and this is off the back ofa guest that I actually had on
the podcast recently, julieDutton, who was speaking about
her lived experience and whenshe was able to look back
retrospectively and join a lotof dots she'd experienced quite
(25:26):
bad PMT, which she thinks wasprobably PMDD.
That was just undiagnosed.
She then experienced perinataldepression and then got an ADHD
diagnosis at about the time shestarted going through her
perimenopause.
The link between some of thosedifferent disorders or
conditions that you know theydon't sound like something I
(25:50):
would expect to be aneurodivergence, like a PMDD or
a PND, but there is a link,isn't there, between people that
are more likely to be diagnosedwith those.
A/Prof Gurvich (25:59):
Yeah, absolutely , and again, we're still
learning so much about this area, but certainly the few studies
that have been done have shown afew things.
So there is a crossover of somesort between PMDD so
premenstrual dysphoric disorder,which is the technical name,
but like, say, a premenstrualdysphoric disorder, which is the
technical name, but like, say,a premenstrual depression and
ADHD.
So there's people with ADHD aremore likely to have PMDD and
(26:24):
the flip side, people with PMDDare also more likely to have
ADHD.
So there is a link in theliterature in terms of like a
statistical prevalence type link.
And then there's also somebiological research as well that
shows that neurodivergentpeople have an increased
hormonal sensitivity, so not adifference in the actual hormone
(26:47):
fluctuation levels, but they'remore sensitive to the natural
hormone fluctuations that mighthappen, for example, across the
menstrual cycle or the quitesignificant hormone changes that
might happen across thepregnancy and postnatal
timeframes.
So yeah, we're still learningmore about that.
People also talk about theirADHD symptoms becoming more
(27:11):
obvious in that premenstrualphase of their menstrual cycle.
Becoming more obvious in thatpremenstrual phase of their
menstrual cycle and so more ADHDsymptoms, more mood symptoms
that can happen in that phase,and also that some of their
stimulant medications are lesseffective during that phase of
their menstrual cycle.
So there's a few differentfactors that are probably at
play that just make people whoare neurodivergent more
(27:33):
sensitive to hormone changes.
And there's also a little bitof research not much that shows
that people who areneurodivergent more sensitive to
hormone changes.
And there's also a little bitof research not much that shows
that people who are autistic aswell as ADHDers are more likely
to experience more menopausesymptoms.
So not just an exacerbation oftheir ADHD or autism, but other
menopause symptoms are greateror experienced to a greater
severity for neurodivergentpeople as well.
(27:56):
So there's certainly somethinggoing on, but we don't
completely know what that is.
Sonya (28:02):
I want to jump into research with you in a minute,
but I just want to wrap up here.
So, as we are obviouslyanecdotally learning a lot of
this stuff right now, if theresearch isn't in place, then a
lot of this is probably moreanecdotal learning at the moment
and looking at patients likeJules, who talked about what her
lived experience has been andbeing able to retrospectively
look at that.
Does that put us in a positionnow where we can start raising
(28:26):
conversations with the youngergenerations that are perhaps
experiencing PMDD or, you know,have a prenatal depression or
postnatal depression that we cankind of like give them a little
bit of a hey?
When you get to perimenopause,it's likely that you may
experience heightened symptomsthere as well.
A/Prof Gurvich (28:48):
I think so.
I think we can have thatconversation in terms of just
saying you seem to be someonewho's a bit more sensitive to
your hormones changing.
So there is another time pointin your life where there's going
to be significant hormonechanges.
So, just you know, be preparedand not scared, yeah, of course,
but prepared, but just raisingthat awareness.
Yeah, yeah, and I think thatknowledge is powerful and can
(29:11):
reduce the fear.
But I think it's getting thebalance right that we don't want
to raise alarm, unnecess fear,but I think it's getting the
balance right that we don't wantto raise alarm unnecessarily.
But then if people in thatsituation who would want to be
prepared, you would want to knowif you're someone who's going
to be a bit more vulnerable todepression, for example in
perimenopause, and so you knowif your mood starts to change
and you're early at leastperhaps, and you might not be
(29:31):
thinking menopause, and so it'sgood to have that awareness that
, okay, I'm someone who's beensensitive to my hormone changes
and let's go and have a chat tomy doctor or whoever health
practitioner about what's goingon and what can be done.
Sonya (29:46):
Yeah, yeah, great.
I think that's such aprogression in the work that I
guess we're all doing, and oneof the benefits I always see is
what impact is this going tohave on the generations coming
through behind us?
And I think, as you say, themore armed they can be with
knowledge and an understandingof their own personal impacts
when they're going through theirpregnancy, when those hormones
do change, and if they aresomeone that recognizes they're
(30:09):
more sensitive, then we can go,they can be more prepared,
whereas we've now got thisgeneration that are just being
blindsided.
A/Prof Gurvich (30:16):
Yes, yeah, exactly.
Sonya (30:18):
Yeah, awesome.
So research was one of theareas that I wanted us to dive
into a little bit becauseobviously you know, you've
referred multiple timesthroughout our conversation we
don't have the research wherethis is only just starting to
kind of become a topic to beresearched.
Where do we sit in futureresearch right now on this topic
?
A/Prof Gurvich (30:36):
As I've alluded to, a lot more needs to be done
and I think, as you knowneuropsychologists and any
health professionals we'realways very evidence-based, so
we want the evidence to help usnavigate how to help people the
best that we can.
So I think, in terms ofneurodivergence and menopause, I
think we need to better kind ofcharacterize what's going on,
(30:58):
look at different interventionsand supports pharmacological,
hormonal, non-pharmacological sothere needs to be, you know,
clinical trials is kind of thegold standard to provide
evidence for what's going to behelpful for groups of people.
But I think the downside ofclinical trials sometimes is
that you lose the capacity forindividualized treatment, which
(31:22):
I think is what is helpful formost people when you can
optimize things that are reallyindividual level.
But we still need that broadevidence base from clinical
trials.
So I think it's having a lookat what interventions are going
to help different groups ofpeople.
And then, yeah, the broaderbiological research what's going
on underneath everything?
How are hormones interactingwith different neurotransmitter
(31:45):
pathways?
What's underpinning all of this?
And I think that understandingcan help us drive better
interventions and treatments andsupports to help people do
their best.
Sonya (31:57):
And do we have any clinical trials that are
actually about to start orunderway anywhere, you know, not
just in Australia, becauseobviously we benefit from any
global research that's done aswell.
Is that something that'sstarting to kind of happen?
As far as I know, not yet, butI'm hoping they will.
A/Prof Gurvich (32:14):
In terms of specifically ADHD in the
menopause space there's a fewsmall studies that aren't
clinical trials where peoplehave tried, for example,
stimulant medication inmenopausal women who don't have
ADHD, but they've shown thatthat can be helpful for some of
the cognitive symptoms of ADHD.
But there haven't been the flipof really good kind of hormone
(32:35):
trials that have had a look atthose ADHD type symptoms or
executive dysfunction and had alook at whether that might be
beneficial, although we know atthe moment there's not enough
evidence to show hormones arehelpful for cognition at a broad
level but can be anecdotally,definitely at an individual
level.
So I think we just need thoseclinical trials but as far as I
(32:57):
know I haven't seen any aroundthe world that are happening and
we're about to start some morekind of neuroimaging, cognitive
work to have a look at againthat group of perimenopausal
women across the ADHD spectrum,so people with diagn, people
with perhaps some symptoms butnot ADHD as a diagnosis, and so
(33:20):
we're trying to betterunderstand what might be going
on from a hormonal and brain andclinical perspective.
Sonya (33:26):
Yeah, clinical trials is something that needs to also
happen down the track, and Ithink the other downside to them
is they're very expensive,aren't they so expensive?
Yes, so we need a donor with alot of gifting or funding
capacity, who perhaps isimpacted by this topic to
Absolutely.
A/Prof Gurvich (33:44):
We can do the research, you can do the
research, but, yes, you're right, we need the funding to support
the research.
Sonya (33:51):
Yeah, great.
Well, I think there's somethingwe can all definitely get
behind and it's such a catch-22because it is a very frustrating
conversation to have.
If we talk very broadly acrosseverything to do with
perimenopause and menopause,everyone's like, well, why isn't
there research?
And it's like it's not thatsimple.
It's really not.
Everyone knows that we need theresearch, but it's not as
simple as just going out anddoing the research no, if only
(34:13):
people knew how much timeresearchers spend running grants
that often we don't get.
A/Prof Gurvich (34:18):
And it's really sad that we spend a
disproportionate amount of timetrying to get funding to do the
research that we'd like toactually do.
Sonya (34:26):
Yeah, but it's on everyone's radar and that's
what's most important, and it isdefinitely an evolving space.
So that's fantastic, caroline,if you could leave us with your
top three tips for anybody thatfinds themselves, perhaps
listening to this conversationtoday, going actually, I think
there's something here that Icould go away and do something
(34:46):
about.
What are your top three tipsfor that person?
I?
A/Prof Gurvich (34:49):
think the first one would be listen to yourself.
If you're raising questionswithin yourself that, oh, this
might be me, or yes, I've beenstruggling with something, go
and speak to someone.
Seek help, because there ishelp out there, and then keep
seeking to find the rightsupports, right treatments,
right capacity to let yourstrengths shine.
So every individual when we'retalking about neurodiversity and
(35:12):
neurodivergence everyindividual has so many strengths
and challenges and we want tosupport all the challenges.
Find someone who can show youwhat your strengths are or help
you identify your strengths andthen help you manage every area
that you're struggling with.
That would be another key area.
Sonya (35:26):
So just keep listening to your inner self and seek help
and really trust that innervoice as well, you know, when it
does feel like something's justnot quite right.
Yes, most of the times you areright, exactly.
Yes, that's right, awesome,fantastic.
Now, this might be a little bitof a segue, but it was
(35:47):
something that I wanted tomention because it is something
that you, I believe, worked onalongside, perhaps, professor
Kulkarni at the Hearst Centre,and that is the Meno D.
Yeah, yeah, the onlinequestionnaire.
Could you talk us a little bitthrough what that is?
A/Prof Gurvich (36:00):
Yeah, sure.
So, yeah, that was somethingthat Jayshree initiated quite a
few years ago to develop aquestionnaire for perimenopausal
depression.
So, considering that thesymptoms sometimes of depression
during perimenopause can be alittle bit different to a
standard clinical depression,she wanted to develop a
questionnaire that would helppeople assess themselves or help
(36:24):
clinicians assess patients whomight be presenting with
depression during perimenopause.
So it's a really shortquestionnaire that can be
self-report or clinicianadministered and it's called the
MENOD and you can do you haveshow?
Do you have show?
Sonya (36:38):
notes.
A/Prof Gurvich (36:38):
Yeah, yeah, yeah , I'll pop a link through my
show notes, yeah so, yeah, wecan have a link there freely
available so people can use thatand it's also a good way for
people to track how they'regoing.
So if you try a new treatmentof some sort or if you change
something in your lifestyle andyou want an objective way of
measuring, is this helping mymood?
It's a really nice way of kindof tracking what's helpful for
(37:00):
you over time.
Sometimes it's hard to toreflect and to be an outside
observer of your own moodsymptoms.
Sonya (37:08):
Yep, I have a coach that used a saying on me many years
ago that has stuck in my brainand I always remember it, and
that is you can't read the labelfrom inside the jar.
A/Prof Gurvich (37:16):
Yes, exactly that's such a good.
I think I'll adopt that one too.
It's a good one, isn't it?
It's great, yes.
Sonya (37:22):
And it is we really and I think that's such a great tip
with the Men-OD is coming backand revisiting it over time to
actually be able to track anyprogressions or, if
unfortunately that was the case,regressions as well exactly,
and that's even more important,really, because then you need to
really be alert to seek help,if, yeah, if things are not
(37:42):
looking good amazing.
Caroline, thank you so much foryour time.
I've loved chatting to you andI'm pretty sure that everybody
listening will have hadsomething to take away from
today's conversation as well Ihope so.
A/Prof Gurvich (37:54):
Thank you so much for having me, Sonia.
Welcome to the Dear Menopause podcast.
I'm SonyaLovell, your host Now.
I've been bringing youconversations with amazing
menopause experts for over twoyears now.
If you have missed any of thoseconversations, now's the time
to go back and listen, and youcan always share them with
anyone you think needs to hearthem.
This way, more people can findthese amazing conversations.
(00:25):
Hi everybody, today I am beingjoined by Associate Professor
Caroline Gurvich.
Now, caroline is a clinicalneuropsychologist and she's
going to correct me if I get anyof this wrong and she is the
Head of Cognition and HormonesGroup at the Her Center, which
means she works alongside DearMenopause favourite guest
(00:46):
Professor Jayashri Kulkarni.
So if you are a fan ofProfessor Kulkarni's work, you
are going to love listening toCaroline and her work in and
around neurodiversity, which iswhat we're going to dive into
today.
So, caroline, welcome to theshow.
Thank you, sonya.
I'm delighted to be here.
Thank you so much.
So why don't we kick off by yougiving us a little bit more of
(01:07):
an in-depth kind of insight asto what you do, who you are, and
maybe a little bit about theHer Centre as well?
A/Prof Gurvich (01:14):
Yeah, sure.
So as you said, I'm aneuropsychologist.
So for people who don't knowwhat a neuropsychologist is,
it's broadly like a brainpsychologist, so where
neuropsychologists areinterested in the relationship
between brain and behavior, soanything that can impact brain,
so that might be like a diseaseprocess or a degenerative
process or a neurodevelopmentalcondition.
(01:36):
Anything that changes our braincan have a flow on effect to
impact our cognition, ourpsychology, our mental health,
our thinking skills.
So neuropsychologists generallyassess that association between
brain change and behavior,emotions, cognition, and then we
can also work in a capacitywhere we work with people to
help whatever changes they'veexperienced in their cognition
(01:58):
and have some sort oftherapeutic role.
So that's neuropsychology inthe clinical setting, which I do
.
And then I also work in theresearch, setting in, as you
said, HER Centre.
So HER stands for health,education and research, but it
also captures HER, as in women'smental health.
So that's what we do we worktowards better understanding
women's mental health and thenwe try to apply that in terms of
(02:21):
education and we keep doingmore research, try and learn
more about different aspects ofwomen's mental health, and our
research is reallybiopsychosocial, I would say.
So we do a lot of biologicalwork to understand what's going
on at a kind of brain or hormonelevel, and then we look at the
characterization of symptoms andbehavior, and then we also look
(02:42):
at a lot of novel treatmentpathways to try and help people
who experience a whole range ofdifferent things.
So in a very broad way, that'sneuropsychology and Her Centre.
Sonya (02:53):
Amazing.
You are very busy.
You are doing lots of things.
We're wearing many hats.
One of the things I'minterested to know about is,
with your work inneuropsychology, has the
intersection between impacts oncognition and the brain and
menopause perimenopause is thata recent kind of something that
you've noticed has become moreresearched and more perhaps
(03:17):
discussed in a clinical settingas well, as we've elevated this
conversation over the last fewyears, or is it something that's
always been a part of your work?
A/Prof Gurvich (03:24):
No, it has not always been a part of my work
and I would say, prior to meworking in this space and doing
research in this space.
So maybe 10-15 years ago itwouldn't have crossed my mind.
I don't think, sadly, ifsomeone presented with cognitive
concerns around midlife, Idon't think I personally would
have thought of menopause.
So it really was not somethingthat was flagged at all.
(03:47):
It wasn't something that wasincluded when I was training, it
wasn't something that wasincluded in our course content
at all, so it wasn't reallytalked about.
And I feel like, as theconversations have started to
emerge over the past decade,more and more people are
presenting to me I guess becausethat's my area of interest as
(04:07):
well so more and more people arepresenting who are of menopause
, perimenopausal age, withcognitive concerns, and so the
questions are now asked.
You know, is this menopause, isthis dementia, is this ADHD,
those kind of clinical questions?
But menopause is part of thediagnostic process now, whereas
it never used to be, and so Imean I don't think it's a change
(04:30):
in people's presentation, but Ithink it's a change in both
people's conversation, like inthe lay community, asking about
that linking cognitive symptomsto potentially to menopause.
So it's coming from people withexperiences of menopause and
cognitive symptoms as frompeople with experiences of
menopause and cognitive symptomsas well as clinicians now
having that knowledge thatchanges can be part of that
(04:51):
menopause transition.
So I think you know both sidesare now bringing that menopause
piece of the puzzle to thatwhole assessment process.
Sonya (05:01):
Yeah, yay, that's good, good, good news for anyone out
there that is, or has been,struggling with some cognitive
changes.
I guess both sides of thepicture are coming together with
the same kind of knowledge nowand being able to provide
support to everybody out in thecommunity.
So I think a good place tostart would be if you can give
(05:21):
us a bit of a 101 onneurodivergence what actually is
neurodivergence, what does itmean, what are the different
types and we'll then maybe diveinto a little bit on diagnosis
as well.
Yeah, sure.
A/Prof Gurvich (05:35):
So really broadly we have neurodiversity,
which just reflects all thedifferent brain types that
people have.
So it's a broad spectrum andthe majority of people are
called neurotypical, so it'slike the neurotypical brain type
, and then there's variancewithin that neurotypical
spectrum.
But on the outsides of thatneurotypical spectrum are what
(05:55):
we call neurodivergence, andwithin neurodivergence there's
lots of different things thatfall under that bracket, but
predominantly ADHD, autism.
They fall withinneurodivergence, as well as
other neurodevelopmentalconditions.
So things like dyspraxia,dyslexia they also fall within
what we call neurodivergence.
Sonya (06:16):
Okay, and then each of those, from a diagnostic
perspective, is often diagnosedon a spectrum as well, isn't it?
A/Prof Gurvich (06:25):
Yes, yeah, that's right.
So I can talk a little bit moreabout, maybe, adhd.
What it is.
Adhd is attention deficithyperactivity disorder that's
what the acronym stands for, andit can be either attention
deficit and or hyperactivity.
So some people present withjust the inattentive type
symptoms and some people presentwith just the inattentive type
(06:46):
symptoms and some people presentwith just the hyperactive
impulsive symptoms and somepeople have a combined
presentation which is a bit ofboth.
Just wanted to touch on actuallylanguage, because I use the
word like deficit and symptomsand that's very medical and
diagnostic and that's what wehave to use for our diagnostic
processes.
But when we're talking aboutneurodiversity, in that
(07:07):
neurodiversity affirmingframework, the language is a
little bit different and we talkabout differences and
characteristics.
So there are differences inlanguage depending on whether
you're kind of framing thingswithin a medical model and
diagnostic terminology orwhether you're talking about
trying to better understand, forexample, adhd and the
characteristics that come withthat and all the strengths as
(07:28):
well as the challenges.
So I guess I'll kind ofsometimes I vacillate between
the two, depending on whetherwe're talking about, yeah,
diagnostic and followingstrictly diagnostic terminology,
or whether we're having more ofa conversation about you know
what is ADHD and how differentpeople present with different
characteristics.
Sonya (07:46):
Yeah, I think that that'll be really helpful
because I know that there arealso a number of clinicians that
listen to the podcast as well.
So I guess perhaps from adiagnostic perspective they
would be more interested in thatclinical view of it.
But I also know that I've hadas I mentioned right before we
started recording that I'veactually had quite a few
listeners reach out to me andask when I would be having a
(08:07):
guest on to talk aboutneurodivergence, particularly
probably ADHD.
So it'd be great to be able toreally break it down and talk
about everything in a way whereit's easily understood from a
patient perspective as well.
So let's then touch on why themenopause transition so
perimenopause and menopause andpostmenopause becomes a time
(08:27):
where we are starting to see orfrom my perspective it seems
like we're starting to see morediagnosis of ADHD or
neurodivergence becomes moresensitive to the changes in our
hormones.
So is that what's going on?
A/Prof Gurvich (08:45):
it's definitely going on and we've done some
research where we did a bigsurvey of people who already had
a diagnosis of adhd and weasked them about their
experiences across differentlife phases, so across the
menstrual cycle.
So these were females or peopleassigned female at birth and
across menstrual cycle andmenopause and I think about 98
(09:07):
of people said that their ADHDsymptoms became worse across
those perimenopausal years.
And of our sample, quite anumber of people were diagnosed
with ADHD around perimenopause.
So while they said the symptomonset was about the age of seven
and eight that was the averageage that they kind of tracked
their symptoms to starting itobviously didn't impact them
(09:32):
enough to seek out help or adiagnosis until they hit those
perimenopausal years.
So yes, there's somethingdefinitely going on that is
happening around perimenopausethat is either exacerbating
pre-existing ADHD, if peoplealready have the diagnosis, or
prompting people to go andexplore whether they might have
ADHD.
So in terms of what's going on,I feel like that's a big
(09:55):
question mark still and I thinkthere's different hypotheses
about what might be going on.
So there's certainly obviouslythe hormonal picture.
So we know hormones changeduring perimenopause, and
particularly estrogen orestradiol.
That type of estrogenfluctuates and then drops off or
declines.
And we know at a biologicallevel that estrogen interacts
(10:17):
with dopamine and dopamine playsan important role in ADHD.
So from a biological level itkind of makes sense that oh okay
, if you're losing your estrogen, the protective effects of
estrogen, that whatever dopamineis doing, is a little bit more
obvious perhaps, and so that'skind of one biological reason as
to why you might see a moreobvious symptom presentation
(10:41):
around menopause.
But I think also some peopledescribe that they've been able
to kind of mask their ADHDsymptoms throughout their life.
They've been able to rely ofmask their ADHD symptoms
throughout their life.
They've been able to rely onlots of supports and structure
and scaffolding and lots ofdifferent things to hold it
together and to kind of getthrough.
And then something happens atmenopause and it's just whatever
(11:03):
they were doing is no longerenough and they just need I
don't know, it's not enough andthey can't mask anymore and
their symptoms just become moreobvious.
Sonya (11:12):
And could people be masking, at a subconscious level
as well, like not even perhapsrealising that they are wired a
little bit differently, I guess,to what we know, the typical
person whatever that typicalperson is and although they've
never had a formal diagnosis,they've just kind of, like you
say, they've created their ownpersonal toolkit of and scaffold
around being able to functionin a way that makes life
(11:35):
manageable for them.
So is it often that you hearfrom people that really had no
idea that that was actually whatwas going on and they just put
those structures in placesubconsciously, as opposed to
somebody kind of always having alittle niggle in the back of
their mind that something isn'tgoing on right here, but I don't
know where to go and get help?
A/Prof Gurvich (11:54):
So I think some people are really aware that
they're masking and they knowthat they feel a little bit
different and they're trying tofit in and trying to cover up
their natural self.
So some people have thatawareness.
Then there's other people whohave it with hindsight.
So they look back and they say,oh, I can see how these
(12:15):
different things were completelymasking and that wasn't my real
self and I was trying so hardbut it just wasn't me.
And then there's another groupof people who it's not masking
that they describe, but theydescribe periods of burnout,
periods of depression,misdiagnosis, even as bipolar
depression, where they've hadperiods that have been described
(12:35):
as mania and then periods thathave been described as
depression.
But actually, when they lookback, it's not that.
It's just that they've hadperiods of quite intense sort of
hyperactive, impulsive typebehaviours and then periods
where they've really burnt outbecause they've struggled to
mask and it's been referred toas burnout or referred to as
depression.
And then after years they lookback and they think that that
(12:59):
was masking and masking notworking anymore rather than
being periods of depression orburnout as it might have been
labeled.
So yeah, I think some peopleare aware and other people with
hindsight.
Hindsight it becomes a bitobvious, more obvious to people.
Sonya (13:14):
Yeah, it must be a really interesting journey for someone
to go on to, particularly forsomebody that, as you say,
perhaps goes through a period ofmisdiagnosis and I would
imagine that being diagnosedwith something like a bipolar
disorder would be reallyconfronting and something that
could perhaps create other hardto manage situations in their
lives.
You know, I would imagine thatimpacts relationships and
(13:38):
ability to work and all thatsort of thing.
So in those cases are theyoften prescribed an
antidepressant or an SSRI orsomething like that to manage
those kind of misdiagnosedsituations?
A/Prof Gurvich (13:49):
Yeah, generally if I see someone who is sort of
perimenopausal age, they havehad different medications
prescribed over differentperiods of their life and none
have been particularly effective.
That tends to be the patternthat people talk about.
But they often have a long listof things that they've tried at
different times and I think,like you said, there can be lots
(14:10):
of I guess emotions that whenpeople reflect back.
I think that's also true ofbeing diagnosed with ADHD.
Like some people feel a senseof relief.
Some people describe that butother people there's a sense of
grief as well, like I wish Iknew I had ADHD.
I wish it was labeled as thator identified as ADHD earlier in
(14:31):
my life so I could have managedthings so differently.
So there can be really mixedemotions.
Some people feel reallysatisfied and it's just right
and everything makes sense, butfor other people there's a bit
of that and a bit of grief and abit of adjusting.
So there can be a whole lot ofemotions around diagnosis when
it's later in life as well.
Sonya (14:53):
Yeah, that makes sense.
I've had conversations withfriends that have received ADHD
diagnoses around the same timethat they've started HRT.
You know, the description isoften like the noise was just
turned down in my head and Isuddenly had some clarity and I
was able to focus where I hadn'tbeen able to focus before and I
would imagine that you knowwhen you're getting that
(15:14):
recognition in your 40s andperhaps it's something that has
been problematic for you sinceyou were in school I can
understand why grief would wouldbe a part of that yeah, yeah,
lots of emotions so, but overallmost people are happy to have
received a diagnosis, if that'ssomething that people if they're
(15:34):
an ADHD brain type they want toknow.
A/Prof Gurvich (15:38):
They want that understanding of their own self
and their own way that theirbrain functions and they want
different options formedications or interventions or
non-pharmacologicalinterventions.
So I think overall, diagnosisis a positive process, but in
that journey there can be lotsof different experiences and
emotions.
Sonya (15:58):
Yeah, I can imagine.
So if somebody is in theirperimenopausal phase and they're
really starting to notice somecognitive changes, they haven't
received a diagnosis before inthe past of anything you know
around the neurodiverseconditions that we talked about.
What changes might they beseeing that would indicate that
(16:19):
perhaps there has been somethinggoing on that they need to go
and seek some help around.
A/Prof Gurvich (16:23):
So I think menopause or perimenopause
broadly, you can have cognitivechanges regardless of whether
you're someone who has ADHD ornot ADHD.
But I think if the cognitivechanges are having a negative
impact on your life in some wayyour professional life or social
life, then I think that's whenyou really should seek some sort
of professional help or havesome conversations, starting
(16:47):
perhaps with a GP, or if they'rereally significant, then I
think you know, neuropsychologyassessment can be really helpful
to try and tease apart whetherthere are any objective
cognitive changes.
And if it's more, that you feellike you've always had
something so if you've alwaysstruggled with sort of
(17:08):
organising yourself, planningattention, if you've always
struggled with sort oforganizing yourself, planning
attention, if you've always beena bit forgetful, if you've
always had trouble time managingand organizing yourself so you
don't leave things to the lastminute, if they've always been
present but they've just got awhole lot worse, then that might
be an indication that maybethis is that's more the
inattentive presentation of ADHD, but maybe this is an
(17:30):
indication that something'salways been there and again
might be worth exploring that.
So I think we see two differentthings that during those
perimenopausal years sometimeswe see this completely new onset
of executive function problems,so difficulty with those higher
order abilities of organizing,planning, time management and
(17:51):
prioritizing efficiency.
And then sometimes, and as wellas that forgetfulness, word
retrieval.
Those sorts of cognitivesymptoms can be there, and
they're only there and haven'tbeen there ever before, but
they've just emerged in thoseperimenopausal years.
And then we have the otherpresentation where there's been
a bit of something underlyingalways.
Sometimes people say I'vealways felt a bit different,
(18:13):
I've never been able to explainwhat it is or why it's just
become a bit more pronounced.
And then it might be anindication that maybe this is a
neurodivergent presentationthat's just become a little bit
exacerbated or uncovered overthose perimenopausal years.
Sonya (18:31):
Okay, and so, as you mentioned, first port of call
often in this situation would bea GP or seeking out
neuropsychologists.
A/Prof Gurvich (18:38):
Neuropsychology or you can see a psychiatrist as
well.
You can see a psychiatrist alsoif you've got those kind of
cognitive symptoms or moodsymptoms or any kind of mental
health changes.
Sonya (18:50):
Yep, yep, yes, great, and the hyperactivity side of ADHD.
How does that tend to present?
A/Prof Gurvich (18:57):
Yeah, so that can also change a bit from what
we stereotypically think of.
When we think of ADHD, thehyperactive boy bouncing off the
walls, that's kind of thepicture that comes to mind for a
lot of people.
And you can also havehyperactive girls, but it's it's
less common.
And then, as people get older,it's the description that people
provide is more like they'vegot a motor inside of them,
(19:19):
there's something driving them.
It's like a restlessness thatthey have an urgency.
They can't sit still, theycan't stop thinking, they can't
stop doing something and theyreally have.
People describe difficultyunwinding at the end of the day,
difficulty relaxing at any timeduring the day, because they
always have this on-the-gofeeling.
(19:39):
So that tends to be thepresentation for, as a
generalization, that tends to bethe presentation for sort of
perimenopausal women who havethe hyperactive, impulsive
presentation.
It's just this I can't unwind,I can't stop.
Sonya (19:54):
Yeah, always on.
A/Prof Gurvich (19:56):
Always on.
Sonya (19:56):
Yeah, exactly.
And then from a treatmentperspective, I guess from my
perspective, my understanding oftreatment for ADHD is probably
linked to kids and teenagers.
It's, you know, that kind ofRitalin, I think.
When my boys were in thoseyears where some of their
friends were being diagnosed,that was kind of the drug that
they were most, or themedication that they were most
(20:17):
likely to be prescribed.
Obviously, if this is ahormonal imbalance or you know
change that is starting totrigger some of these either a
new diagnosis or anintensification of symptoms what
do you tend to recommend from atreatment perspective?
A/Prof Gurvich (20:39):
Yeah.
So I should say that I don'tprescribe.
So neuropsychologists, withinpsychology, we don't prescribe
medication but in terms of kindof the guidelines of what's out
there at the moment.
So the first line of medicationwithin that stimulant category,
but there are other medicationsas well for ADHD.
However, in the space ofperimenopause and hormone
(21:00):
changes, while we don't have theguidelines or the evidence base
to suggest hormone therapy,there are a lot of individuals
who do report lots of benefitsin terms of their cognition from
sort of individualized hormonetherapy approaches.
So I always recommend to peopleyou know, go back to your GP or
(21:21):
go back to your psychiatristand talk about what's going on
for you and make sure menopauseis part of the treatment process
.
So it's not that ADHD istreated independently of the
fact that there's been hormonechanges and lots of things can
be explored and then people cansee how they respond as an
individual and what's helpfulfor them, okay, great.
Sonya (21:41):
So there's lots of options out there that may or
may not include HRT, if that issomething that your prescribing
clinician decides to add intothe mix, exactly.
A/Prof Gurvich (21:51):
Yes, exactly.
And then there's also for ADHD.
There's lots ofnon-pharmacological
interventions as well.
So there's lots of strategiesthat people can put in place and
things like CBT, so cognitivebehaviour therapy, and ADHD
coaching.
So there's so many options,once people understand
themselves, that they can lendon to get support and to help
(22:13):
themselves to sort of bringthemselves back to their best.
So I think for people just toknow that there's so many
different options out there,that can be really helpful with
kind of differing levels ofevidence base.
But I think sometimes there's alack of evidence because we
just don't have the researchthere, rather than evidence that
there's a lack of effect.
So I think that's important forpeople to keep in mind that
(22:35):
we're still building theevidence base, particularly for
menopausal women, about what'sgoing to be helpful.
We just there's really verylittle research.
So I think while there isn'tthe evidence basis, there's lots
of potential avenues people canexplore to help themselves.
Sonya (22:49):
Great, so it sounds very much like there's lots of
potential avenues people canexplore to help themselves.
Great, so it sounds very muchlike there's an opportunity
there to go back to what we weretalking about earlier build
that toolkit again of differentstrategies and scaffolds that
work for you personally, becauseI would imagine that this is an
individual journey for everyperson.
So, yeah, so there's lots oftools that can be popped into
that toolkit.
It's just a matter of findingthe right person to talk to that
(23:10):
can guide you towards the bestoption for you.
A/Prof Gurvich (23:13):
Yeah, exactly, and I think also knowing, keep
in mind there's lots of optionsand everyone's different, so you
might try something and itmight not work, but it's not the
only option in terms of there'slots of pharmacological options
, hormone options andnon-pharmacological options,
lifestyle options.
So there's so many things that,as you say, you can add to your
toolkit and throw out thethings that don't work for you
(23:35):
as an individual, addingsomething else.
Sonya (23:37):
It's all trial and error, yeah, and yeah, lots of, and I
think that's a good goodreminder too, and it's a little
bit like when we're talkingabout people that are seeking
support for their perimenopausalor menopausal symptoms.
It's that if you try somethingand it doesn't work, don't
accept that as okay.
Well, this is just my lot and Inow have to just struggle along
here and even if you've got aclinician or a healthcare
(24:00):
practitioner that's not offeringyou other alternatives like
keep being that squeaky wheeland go out there until you do
find somebody that offers asolution that is maybe more
suited to you.
A/Prof Gurvich (24:11):
Absolutely, and it's a shame that people have to
advocate for themselves andfind that energy at a time where
sometimes you don't have thatenergy.
But if you can convert thatthought process to hope and know
that there's so many optionsand there's hope and you haven't
found the right thing, but keeptrying.
Yeah, hopefully everyone getsto a point where they can
(24:31):
optimize everything forthemselves.
Sonya (24:33):
I like that.
It's a great, great spin onkeeping hope at the forefront.
I think that's really good.
A/Prof Gurvich (24:38):
Well, that's in psychology.
We do a lot of that kind of wecall it positive reframing
because you've got to reframethings all the time.
It's such an important skillbut it's really hard to do.
If you're feeling depressed,for example, it's really hard to
flip things and positivelyreframe things.
But that's why sometimes youneed some to work with
psychologist or someone to helpyou positively reframe things
(25:00):
and so that sometimes can giveyou enough energy to keep going
and to find solutions.
Sonya (25:05):
Yeah, yeah, great, I like that.
We had that little segue.
One of the other areas that Iwanted to kind of touch on with
you and this is off the back ofa guest that I actually had on
the podcast recently, julieDutton, who was speaking about
her lived experience and whenshe was able to look back
retrospectively and join a lotof dots she'd experienced quite
(25:26):
bad PMT, which she thinks wasprobably PMDD.
That was just undiagnosed.
She then experienced perinataldepression and then got an ADHD
diagnosis at about the time shestarted going through her
perimenopause.
The link between some of thosedifferent disorders or
conditions that you know theydon't sound like something I
(25:50):
would expect to be aneurodivergence, like a PMDD or
a PND, but there is a link,isn't there, between people that
are more likely to be diagnosedwith those.
A/Prof Gurvich (25:59):
Yeah, absolutely , and again, we're still
learning so much about this area, but certainly the few studies
that have been done have shown afew things.
So there is a crossover of somesort between PMDD so
premenstrual dysphoric disorder,which is the technical name,
but like, say, a premenstrualdysphoric disorder, which is the
technical name, but like, say,a premenstrual depression and
ADHD.
So there's people with ADHD aremore likely to have PMDD and
(26:24):
the flip side, people with PMDDare also more likely to have
ADHD.
So there is a link in theliterature in terms of like a
statistical prevalence type link.
And then there's also somebiological research as well that
shows that neurodivergentpeople have an increased
hormonal sensitivity, so not adifference in the actual hormone
(26:47):
fluctuation levels, but they'remore sensitive to the natural
hormone fluctuations that mighthappen, for example, across the
menstrual cycle or the quitesignificant hormone changes that
might happen across thepregnancy and postnatal
timeframes.
So yeah, we're still learningmore about that.
People also talk about theirADHD symptoms becoming more
(27:11):
obvious in that premenstrualphase of their menstrual cycle.
Becoming more obvious in thatpremenstrual phase of their
menstrual cycle and so more ADHDsymptoms, more mood symptoms
that can happen in that phase,and also that some of their
stimulant medications are lesseffective during that phase of
their menstrual cycle.
So there's a few differentfactors that are probably at
play that just make people whoare neurodivergent more
(27:33):
sensitive to hormone changes.
And there's also a little bitof research not much that shows
that people who areneurodivergent more sensitive to
hormone changes.
And there's also a little bitof research not much that shows
that people who are autistic aswell as ADHDers are more likely
to experience more menopausesymptoms.
So not just an exacerbation oftheir ADHD or autism, but other
menopause symptoms are greateror experienced to a greater
severity for neurodivergentpeople as well.
(27:56):
So there's certainly somethinggoing on, but we don't
completely know what that is.
Sonya (28:02):
I want to jump into research with you in a minute,
but I just want to wrap up here.
So, as we are obviouslyanecdotally learning a lot of
this stuff right now, if theresearch isn't in place, then a
lot of this is probably moreanecdotal learning at the moment
and looking at patients likeJules, who talked about what her
lived experience has been andbeing able to retrospectively
look at that.
Does that put us in a positionnow where we can start raising
(28:26):
conversations with the youngergenerations that are perhaps
experiencing PMDD or, you know,have a prenatal depression or
postnatal depression that we cankind of like give them a little
bit of a hey?
When you get to perimenopause,it's likely that you may
experience heightened symptomsthere as well.
A/Prof Gurvich (28:48):
I think so.
I think we can have thatconversation in terms of just
saying you seem to be someonewho's a bit more sensitive to
your hormones changing.
So there is another time pointin your life where there's going
to be significant hormonechanges.
So, just you know, be preparedand not scared, yeah, of course,
but prepared, but just raisingthat awareness.
Yeah, yeah, and I think thatknowledge is powerful and can
(29:11):
reduce the fear.
But I think it's getting thebalance right that we don't want
to raise alarm, unnecess fear,but I think it's getting the
balance right that we don't wantto raise alarm unnecessarily.
But then if people in thatsituation who would want to be
prepared, you would want to knowif you're someone who's going
to be a bit more vulnerable todepression, for example in
perimenopause, and so you knowif your mood starts to change
and you're early at leastperhaps, and you might not be
(29:31):
thinking menopause, and so it'sgood to have that awareness that
, okay, I'm someone who's beensensitive to my hormone changes
and let's go and have a chat tomy doctor or whoever health
practitioner about what's goingon and what can be done.
Sonya (29:46):
Yeah, yeah, great.
I think that's such aprogression in the work that I
guess we're all doing, and oneof the benefits I always see is
what impact is this going tohave on the generations coming
through behind us?
And I think, as you say, themore armed they can be with
knowledge and an understandingof their own personal impacts
when they're going through theirpregnancy, when those hormones
do change, and if they aresomeone that recognizes they're
(30:09):
more sensitive, then we can go,they can be more prepared,
whereas we've now got thisgeneration that are just being
blindsided.
A/Prof Gurvich (30:16):
Yes, yeah, exactly.
Sonya (30:18):
Yeah, awesome.
So research was one of theareas that I wanted us to dive
into a little bit becauseobviously you know, you've
referred multiple timesthroughout our conversation we
don't have the research wherethis is only just starting to
kind of become a topic to beresearched.
Where do we sit in futureresearch right now on this topic
?
A/Prof Gurvich (30:36):
As I've alluded to, a lot more needs to be done
and I think, as you knowneuropsychologists and any
health professionals we'realways very evidence-based, so
we want the evidence to help usnavigate how to help people the
best that we can.
So I think, in terms ofneurodivergence and menopause, I
think we need to better kind ofcharacterize what's going on,
(30:58):
look at different interventionsand supports pharmacological,
hormonal, non-pharmacological sothere needs to be, you know,
clinical trials is kind of thegold standard to provide
evidence for what's going to behelpful for groups of people.
But I think the downside ofclinical trials sometimes is
that you lose the capacity forindividualized treatment, which
(31:22):
I think is what is helpful formost people when you can
optimize things that are reallyindividual level.
But we still need that broadevidence base from clinical
trials.
So I think it's having a lookat what interventions are going
to help different groups ofpeople.
And then, yeah, the broaderbiological research what's going
on underneath everything?
How are hormones interactingwith different neurotransmitter
(31:45):
pathways?
What's underpinning all of this?
And I think that understandingcan help us drive better
interventions and treatments andsupports to help people do
their best.
Sonya (31:57):
And do we have any clinical trials that are
actually about to start orunderway anywhere, you know, not
just in Australia, becauseobviously we benefit from any
global research that's done aswell.
Is that something that'sstarting to kind of happen?
As far as I know, not yet, butI'm hoping they will.
A/Prof Gurvich (32:14):
In terms of specifically ADHD in the
menopause space there's a fewsmall studies that aren't
clinical trials where peoplehave tried, for example,
stimulant medication inmenopausal women who don't have
ADHD, but they've shown thatthat can be helpful for some of
the cognitive symptoms of ADHD.
But there haven't been the flipof really good kind of hormone
(32:35):
trials that have had a look atthose ADHD type symptoms or
executive dysfunction and had alook at whether that might be
beneficial, although we know atthe moment there's not enough
evidence to show hormones arehelpful for cognition at a broad
level but can be anecdotally,definitely at an individual
level.
So I think we just need thoseclinical trials but as far as I
(32:57):
know I haven't seen any aroundthe world that are happening and
we're about to start some morekind of neuroimaging, cognitive
work to have a look at againthat group of perimenopausal
women across the ADHD spectrum,so people with diagn, people
with perhaps some symptoms butnot ADHD as a diagnosis, and so
(33:20):
we're trying to betterunderstand what might be going
on from a hormonal and brain andclinical perspective.
Sonya (33:26):
Yeah, clinical trials is something that needs to also
happen down the track, and Ithink the other downside to them
is they're very expensive,aren't they so expensive?
Yes, so we need a donor with alot of gifting or funding
capacity, who perhaps isimpacted by this topic to
Absolutely.
A/Prof Gurvich (33:44):
We can do the research, you can do the
research, but, yes, you're right, we need the funding to support
the research.
Sonya (33:51):
Yeah, great.
Well, I think there's somethingwe can all definitely get
behind and it's such a catch-22because it is a very frustrating
conversation to have.
If we talk very broadly acrosseverything to do with
perimenopause and menopause,everyone's like, well, why isn't
there research?
And it's like it's not thatsimple.
It's really not.
Everyone knows that we need theresearch, but it's not as
simple as just going out anddoing the research no, if only
(34:13):
people knew how much timeresearchers spend running grants
that often we don't get.
A/Prof Gurvich (34:18):
And it's really sad that we spend a
disproportionate amount of timetrying to get funding to do the
research that we'd like toactually do.
Sonya (34:26):
Yeah, but it's on everyone's radar and that's
what's most important, and it isdefinitely an evolving space.
So that's fantastic, caroline,if you could leave us with your
top three tips for anybody thatfinds themselves, perhaps
listening to this conversationtoday, going actually, I think
there's something here that Icould go away and do something
(34:46):
about.
What are your top three tipsfor that person?
I?
A/Prof Gurvich (34:49):
think the first one would be listen to yourself.
If you're raising questionswithin yourself that, oh, this
might be me, or yes, I've beenstruggling with something, go
and speak to someone.
Seek help, because there ishelp out there, and then keep
seeking to find the rightsupports, right treatments,
right capacity to let yourstrengths shine.
So every individual when we'retalking about neurodiversity and
(35:12):
neurodivergence everyindividual has so many strengths
and challenges and we want tosupport all the challenges.
Find someone who can show youwhat your strengths are or help
you identify your strengths andthen help you manage every area
that you're struggling with.
That would be another key area.
Sonya (35:26):
So just keep listening to your inner self and seek help
and really trust that innervoice as well, you know, when it
does feel like something's justnot quite right.
Yes, most of the times you areright, exactly.
Yes, that's right, awesome,fantastic.
Now, this might be a little bitof a segue, but it was
(35:47):
something that I wanted tomention because it is something
that you, I believe, worked onalongside, perhaps, professor
Kulkarni at the Hearst Centre,and that is the Meno D.
Yeah, yeah, the onlinequestionnaire.
Could you talk us a little bitthrough what that is?
A/Prof Gurvich (36:00):
Yeah, sure.
So, yeah, that was somethingthat Jayshree initiated quite a
few years ago to develop aquestionnaire for perimenopausal
depression.
So, considering that thesymptoms sometimes of depression
during perimenopause can be alittle bit different to a
standard clinical depression,she wanted to develop a
questionnaire that would helppeople assess themselves or help
(36:24):
clinicians assess patients whomight be presenting with
depression during perimenopause.
So it's a really shortquestionnaire that can be
self-report or clinicianadministered and it's called the
MENOD and you can do you haveshow?
Do you have show?
Sonya (36:38):
notes.
A/Prof Gurvich (36:38):
Yeah, yeah, yeah , I'll pop a link through my
show notes, yeah so, yeah, wecan have a link there freely
available so people can use thatand it's also a good way for
people to track how they'regoing.
So if you try a new treatmentof some sort or if you change
something in your lifestyle andyou want an objective way of
measuring, is this helping mymood?
It's a really nice way of kindof tracking what's helpful for
(37:00):
you over time.
Sometimes it's hard to toreflect and to be an outside
observer of your own moodsymptoms.
Sonya (37:08):
Yep, I have a coach that used a saying on me many years
ago that has stuck in my brainand I always remember it, and
that is you can't read the labelfrom inside the jar.
A/Prof Gurvich (37:16):
Yes, exactly that's such a good.
I think I'll adopt that one too.
It's a good one, isn't it?
It's great, yes.
Sonya (37:22):
And it is we really and I think that's such a great tip
with the Men-OD is coming backand revisiting it over time to
actually be able to track anyprogressions or, if
unfortunately that was the case,regressions as well exactly,
and that's even more important,really, because then you need to
really be alert to seek help,if, yeah, if things are not
(37:42):
looking good amazing.
Caroline, thank you so much foryour time.
I've loved chatting to you andI'm pretty sure that everybody
listening will have hadsomething to take away from
today's conversation as well Ihope so.
A/Prof Gurvich (37:54):
Thank you so much for having me, Sonia.
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