Episode 118 - ADHD, Perimenopause, and the Good Girl Trap with Jenny Hobbs
Parenting and relationships can take on a unique dynamic when neurodivergence is part of your life—whether it's your own diagnosis or that of your partner or kids. Today, you’ll hear my conversation with Jenny Hobbs, a physician and a life coach who works with women navigating ADHD and autism in themselves or their families. We explore what ADHD looks like for women, why it often goes undiagnosed until adulthood, and the range of resources available to help. Here’s what we cover:
Why there tends to be an overlap between ADHD and autism diagnoses
How good girl programming affects the way neurodivergence shows up in women
Masking techniques make ADHD in women harder to recognize
Specific signs and patterns that may indicate ADHD
The link between ADHD diagnoses and perimenopause
Practical strategies for managing ADHD regardless of your financial situation
I can’t wait for you to listen.
Mentioned resources:
https://getcoached.jennyhobbsmd.com/adhdtoolkit
https://www.meganannaneff.com/
Taking Charge of Adult ADHD by Russell Barkley
Dr. Jenny Hobbs is a life coach and practicing physician who specializes in supporting working moms in neurodivergent families. Diagnosed with ADHD as an adult and raising an autistic/ADHD family of her own, she brings both personal insight and professional expertise to her work. Dr. Hobbs helps overwhelmed, burned-out moms navigate the unique challenges of parenting and marriage in neurodivergent households—so they can stop feeling like they're failing and start enjoying their family again.
Find Jenny here:
https://www.instagram.com/jennyhobbsmd/
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Transcript
Sara Bybee Fisk 01:00
Jenny Hobbs is on the podcast today and I'm so excited because, oh my gosh, this perimenopause ADHD roller coaster that I've been on, that so many of my clients have been on is just such a trip and there's like not like stop the ride I want to get off. There's not that option at this point yet. So I'm really, really glad, Jenny, that you agreed to have this conversation because not only are you a physician and a mom and someone who has ADHD, but this is a population you work with. So I'm so glad you're here.
Jenny Hobbs 01:30
Me too. This is one of my favorite topics. I can talk about it for hours. So I will try to pull myself back. But yes, I'm Jenny Hobbs. I am a doctor. I work as a hospital based doctor, actually what's called a nocturness. So I only work nights in the hospital. It's kind of a funny job title. And I also am a certified life coach. And I work with working moms who have neurodivergent families. So I love working with moms who either have ADHD or autism themselves, or maybe their kids or their spouse has ADHD or autism. And I find that these women, which I can relate to, because I was diagnosed with ADHD as an adult, and I have two kids who have autism and ADHD, these moms who are like me are often really burned out and exhausted and overwhelmed. And parenting and marriage is really uniquely different when you have neurodivergence in yourself or your family members. So, I work as a life coach with those women as well as doing my nights in the hospital. And I am based in Seattle, Washington. I have two kids who are now eight and a half and 11, which is crazy. And I've been married for 20 years. My husband is a stay-at-home dad. That's actually another type of woman that I often work with is women who are the primary earner and their husband is staying at home with the kids, which is also a unique dynamic, but one that works really well for our family. So that's neat.
Sara Bybee Fisk 02:54
Why is everything changing? Why is it like? I mean, one of the questions that I've kind of had about myself is, did I always have ADHD and just not know it? Was I able to just cope in different ways? Like, why is it so late in life that so many of us are finding this out? Either ADHD or autism or AU, ADHD, is that the term? Let's tell me that term. So we get it right.
Jenny Hobbs 03:25
Yeah, I think they've started calling it odd DHD now. So autism and ADHD. So they're two separate diagnoses. But there does tend to be some overlap.And also kind of a lot of overlap in family like tends to be we call them neuro divergent people. So people with autism ADHD, and a few other less common disorders, neuro divergent people, whether it's autism or ADHD, they tend to kind of flock together to find each other. And they also are very genetic. So some of us we kind of say we have an odd DHD family, right? So a lot of overlap.
Sara Bybee Fisk 04:02
Do we know why there is so much overlap between autism and ADHD?
Jenny Hobbs 04:08
Yeah, you know, it's really interesting. There's a woman, we can put some of the show notes, there's a woman, Megan Anna Neff is her name. And she is a neuropsychologist who was diagnosed with autism and ADHD. And she has talked about how when you look at the genes, there actually do seem to be some like in your genetic material, autism and ADHD do seem to be sort of like associated near one another. So, they do think there is some genetic basis for that. I don't know the details of it. But I think it makes a lot of sense based on what we see when we actually, you know, look at groups of families and things like that.
Sara Bybee Fisk 04:43
One of the reasons that I wanted to have this conversation is I find a lot of relevance to like, you know, I come at this from like the good girl paradigm, like trying to break out of patterns that keep us, you know, small and not asking for what we need. And, and I have a couple of, you know, points of view on that, but I'm wondering for you and what you see in just, you know, your client population and in maybe just your patient population, why do you, what do you think is the relevance of the way we were programmed to be good girls and how our autism or ADHD or both manifest?
Jenny Hobbs 05:21
Oh, yeah, it's so interesting. So when you think about neurodivergent types, so autism, ADHD, those are patterns and ways of interacting with the world that are different from sort of the standard middle norm, right? If you think of us all on a continuum, they kind of fall further to the edges of that continuum, right? And I think, as you and I've talked about before, what is normal is a good question. So there is definitely, you know, a wide range. But when we do studies of certain traits, people who have autism and or ADHD can kind of fall further on those edges. So when you're a child, right, and you're interacting with the world differently, but you're told that a good girl does this, a good girl sits quietly, a good girl listens, a good girl always has her homework turned in one time, right? All these things, a good girl doesn't ever get too angry or have to, you know, let her emotions get the best of her, all those things can be harder to do when you are a person who is not sort of in the middle part of that continuum, right? And so if you have ADHD or autism, both of those disorders are really like disorder is a question really, right? Both of those neurotypes have a harder time managing their emotion, right? So their executive functions, the frontal part of their brain that says, okay, we need to be quiet now, we need to listen, we need to get organized, those executive functions are not as well developed when you have ADHD or autism, right? So now if you're in a world, a society that wants you to be a good girl, and a good girl is defined as being organized and calm and quiet and all of those things, that's gonna be so much harder to do, just if you're naturally wired a little bit differently. I like that language, some people use you're just differently wired. And so it's gonna be that much more challenging to fit into the good girl paradigm.
Sara Bybee Fisk 07:12
I look back on how many masking or techniques or little shortcuts that I had created for myself that were so important in keeping me on track, keeping me organized, keeping me performing and doing what I want. Funny story, I actually had to get a new phone and I didn't do the backup right, so it didn't restore all of my 500 alarms that I had already programmed into my phone, so I got my new phone. I didn't have any alarms. I used to set alarms constantly for myself to keep myself on track, and I was so devastated that I had to go back and redo all my alarms. What do you see in your adult women in terms of those type of techniques or masking or just like all the ways that they try to make themselves conform to what is expected of them?
Jenny Hobbs 08:07
Oh, yeah, it is so interesting. And I think this is one reason it is so difficult to diagnose ADHD. I had the most experience with ADHD. I think it's one of the reasons it's so difficult to diagnose in women is because many of us have gotten so good at compensating for our natural difficulty, right? And I say when I was diagnosed, I remember the person doing the evaluation asked me a question like, do you have to keep, you know, your keys and whatever in like the exact same place where you lose them? And I was like, I mean, doesn't everyone have to do that? That's like just good sense, right? And I have like a million strategies like this, timers and planners. I think if you look at people who are, like, really obsessed with planners and organizing and their schedule, right, and to-do list and checking them off a lot of times, those are strategies someone who's wired with ADHD has developed because they know if they don't, they will forget and the consequences of forgetting have often been really severe, right? You know, problems in school, problems with your parents. And so if you are raised with this idea that like a good girl always does everything on time and pays her taxes, then, you know, all these things and checks off all the boxes, right? And it's hard for you to do, you're gonna be that much more rigidly clinging to those external systems, right? And it's harder to let go of them. And so what's really interesting is that a great example would be being on time, I would say the average person who has ADHD has a hard time getting to places, you know, right on time. But some people have been so strictly taught that it is a moral failing to be late, right? So if you have ADHD wiring, you don't know it, and your family teaches you that like, only horrible people are ever late, right? And they always make you get everywhere early, you might actually be extra early everywhere all the time, because you've like overcompensated. Does that make sense? And you might be actually more anxious than another person about making sure because maybe you're, you know, you're gonna forget all these things. And it's so much harder for you to get it together. And so it adds to what you see is a lot of anxiety and overcompensating. And sometimes that can really mask the symptom of ADHD that you would otherwise see. Does that make sense? And each person has such different strategy that can be hard to take out.
Sara Bybee Fisk 10:24
I'm thinking of a friend who meets that description perfectly, right? It's literally a moral failing. She was really punished, you know, for being late, told how inconsiderate she was. And so she's early everywhere, but always has this anxiety when there's time to go. And so if she's filling out, you know, a signs, signs of ADHD symptom, you know, form, she's not going to check chronically late.
Jenny Hobbs 10:47
because she's not. Exactly, yeah. And I think they've done, this is one of the really interesting things. There are some people who've done a lot of work on diagnosing ADHD in adults because it really presents differently than in children. And so there are actually some lists of symptoms that are more helpful and useful for diagnosis in adults. And so I think it does include being chronically late, but it also includes some other things, right? And you don't have to have all of the things. So that's not, for example, the only thing. And another example of this would be many people with ADHD, they may not be chronically late, but they may have this experience that if they have an appointment at two o'clock, right? They're not quite sure how long everything's gonna take before they get there, right? And so they may feel like they kinda are like sitting around all day having difficulty planning and organizing and doing anything because of this looming appointment that they don't wanna be late for. And so if you think about that, it actually kinda touches more on what ADHD is really about, which is like difficulty planning and organizing and structuring without getting really overwhelmed. Does that make sense? So it's less about whether you're on time or not and more about how difficult it is for you to manage the flow of your day because of that difficulty with time.
Sara Bybee Fisk 12:06
It makes so much sense. I read this somewhere and I just, it almost, well, it did make me tear up because it's like, that's me. It's like for me in time, there's either right now or everything in the future. I just have a really hard time like judging. It's like if I have 15 minutes, I literally think I have time to make myself a sandwich, go brush my hair, clean out my purse before I go to the doctor, download the podcast that I want it. And then all of a sudden, I'm like, damn it. I have to be there in two minutes, and it's a 15-minute drive. There's really something that's been frustrating. And I think the sad things, or if you're listening to this and you're like, ah, I really feel that I think the saddest thing that I see, and I'm sure you do too as well, is that what happens is a constant inner monologue of criticism and judgment and self-doubt where the inability of this prefrontal cortex executive function to happen the way it should become something that is wrong with us. So not only are we now late, but we're beating ourselves up for the 15-minute drive, apologizing profusely when we get there, feeling shame, feeling, you know, scared or anxious. It's not just the executive dysfunction. It's all of the criticism and the judgment that a lot of us live with as well when this isn't going the way it should go.
Jenny Hobbs 13:33
And there's so many interesting things with this. One is that, you know, obviously pretty much all humans and particularly more women and people of color and things like that grow up with a lot of negative messaging, right? And that inner critic, that's where that voice comes from. But when you have ADHD, right, studies show you get a lot more negative messaging than another child, right? And so it does build up, and you have more and more of that over time and more and more of that to overcome. And if you're a woman, you're less likely to get diagnosed as a child. And so to your point, you don't have an explanation. And another thing that Megan Anna Neff says, it's just so great is when you don't have an accurate narrative for what's going on, you will revert to a personal narrative. And I might've got that quote slightly wrong, but you will revert to a narrative that like something is wrong with me if you don't have an accurate explanation, right? And so like you said, that's the experience of so many women who get diagnosed as an adult is literally tearing up because you're like, oh, this makes sense. And you feel seen and you have that accurate narrative and it's really amazing how powerful that is.
Sara Bybee Fisk 14:45
It is. So, we've talked a lot about time specifically. What are some other signs and symptoms that adult women who are wondering, you know, could this be me, be looking for?
Jenny Hobbs 14:58
Great question. So one of the things that's interesting about ADHD is that our understanding of it has changed a lot over the past 30 to 40 years. And even the diagnostic criteria that we use and the picture that we have in our minds is not really fully up to date. Okay, so I'll just kind of fast-forward to the current understanding. And the current understanding of ADHD is, as I mentioned, this executive function disorder, but it's also related strongly to dopamine, right? So your dopamine is like your pleasure reward center chemical, right? So you don't have enough of that. And so basically, you are a person who is kind of more likely to need dopamine to be effective, right? So you're going to need something that's exciting or interesting or challenging. So you might wait till the last minute till you have a deadline, we talked about time, you also might be a person who can be really motivated and really awesome at one thing because you think it's interesting. But if you think something's not interesting, you can't motivate yourself to do it at all. Right? So very, you'll notice inconsistency. Another big thing that comes up a big hallmark of ADHD is emotional dysregulation. And this is- honestly I maybe should have just led with this because emotional dysregulation is one of the core consistent features that is seen in people with ADHD throughout their life. And it's not in our diagnostic criteria. So I cannot tell you how many people I know whose kids seem to have these like really big emotions and all this stuff. And they think it's a behavioral issue. And often, it's actually undiagnosed ADHD. But because they don't picture, they don't look like that picture of like a hyperactive kid, but maybe they're just like a big emotions kid, it's not recognized very easily. So for adult women, do you have a hard time in relationships? Do you have a hard time getting really angry? Do you have big mood swings? Do you, this is an interesting one, do you have trouble getting a lot of traffic tickets? This is one that was for me really interesting. It's one of the main nine criteria for adults is speeding a lot. And I had no idea about that. And after I got diagnosed, I started remembering all like the times I've been speeding and getting tickets and all this crazy stuff, the traffic issues, workplace issues, difficulty keeping a job, difficulty, maybe in your marriage or other relationships, inconsistency, I think I mentioned that. But you know, like, people might think, Oh, you're like, you're just lazy, because you can do things when you want to, if you like it, and you can't do it if you don't like it. But that's actually a big part of ADHD is it's your inconsistent, you're when you're interested, and you're excited, you're feeling great, you can do a lot of stuff. And then when you're not, you literally do nothing. So all or nothing, I think I could go on and on. But I think that maybe gives you a pretty good list.
Sara Bybee Fisk 17:47
Yeah. So, I know that I was diagnosed when I took my son to be diagnosed. He was having trouble in school and he had a lot of the more classic ADHD signs, not able to pay attention, you know, that you've mentioned. And we kind of touched on this in the beginning of the podcast, but what is the link between ADHD diagnoses and perimenopause?
Jenny Hobbs 18:13
So glad you mentioned that. And I was thinking about this earlier when you were talking about women who have ADHD and all their compensatory strategies that they have, right? And you notice like at the beginning, you said like, what's changing? All these things that we're working from, you aren't working anymore. So what happens is if you're a person with ADHD and you're a female, okay, you have added inconsistency because of your hormones, okay? So estrogen improves attention, and you need estrogen to access your working memory. So when you're trying to keep track of, like, organize your schedule for the day, what you need to get done before you get somewhere, all your kids' school stuff, family dinners, you know, you name it, right? As a mom, we got a lot of working memory. You're a working mom, your working memory is busy. You need estrogen to access that effectively and to maintain attention, okay? Obviously, in ADHD, those are the exact things you're already having trouble with, right? When you head into perimenopause, your estrogen levels start to slowly decline. So as a woman, even if you didn't have ADHD, you'd have more difficulty with attention and working memory and emotional regulation and all these things, just as part of your natural process of aging and going to perimenopause. But if you have ADHD, it's gonna be even more significant. And along with that, during your menstrual cycles, your amounts of estrogen are changing too, right? So, even from week to week or day to day, a woman might have different levels of symptoms. So this gets back to another reason why it's so hard to diagnose ADHD in women because, do you meet the criteria on one day and not another or one week and not another or at a different, you know, before puberty, after puberty? And I will say just the caveat is a lot of this, it's very difficult to study. And there is a lack of research on women and people of color when it comes to ADHD. Almost all of the studies we have were done on young white hyperactive boys. So a lot of this, we're just beginning to really unravel. But the take-home point, you know, I'm not an OBGYN, I'm an internal medicine doctor. So I always say like, I don't know a lot about this. What I know is that in menopause and perimenopause, your estrogen levels start to go down, right? And throughout your cycle, your estrogen levels change. And what that means is that your ADHD symptoms, if you have ADHD, are going to correlate with that, right? So there'll be worse in menopause and worse at parts of your cycle. And most likely women who don't have ADHD are seeing a bit of that too. The thing that's really interesting is that what we see is in your late 30s to early 40s, there is a spike in new diagnoses of ADHD among women. And it's kind of the perfect storm of all of these things coming together. So if you think about it, perhaps you had ADHD as a child, but your parents were super strict. You were pretty smart. You were a girl.
Jenny Hobbs 21:13
So it was naturally easier for you maybe to sit down in class and you were more affected by all these social expectations. So you were, you know, girls, little girls are such nice as badasses, right? You think you're like, I got a problem, I will solve it. I got my strategies. I got my planner. I got, you know, all my stuff. You did great. But then you got into your 20s and 30s. You had a couple of kids who most likely have some form of executive dysfunction because it's genetic, right? Maybe you married somebody who's got executive dysfunction because we lock together. Now you've got not only yourself to handle, but you also have two or three or four other people who need you to help them with their executive function, right? And you're hitting your 30s and 40s and your estrogen levels are dipping down, right? And so the way we say this is like the wheels come off. All of those strategies and things that seem to be working just fine and beautifully are not enough to overcome all of the added expectations of the added executive function you need to handle your life with less estrogen helping you out, right? And so there's this line of life. It's happened to me. It sounds like it happened to you. When everything falls apart, you don't know what's going on. And then many of those women who come into that situation are ultimately found to have ADHD and they had no idea.
Sara Bybee Fisk 22:37
Um, the wheels coming off is that's how it felt. It's like, I just couldn't, and it felt for me like almost from one day to the next, it felt pretty dramatic. Like all of a sudden I, yeah, I just couldn't juggle all the balls and was dropping them and I was overwhelmed emotionally, just feeling frazzled all the time. So, what I'm noticing is that we've touched on a couple of things that seem to keep women from getting accurately diagnosed. Like number one, the fact that we do come up with so many masking strategies and right, the wheels just haven't come off for them yet. They, they have all the alarms, they have the planners, they have all the, the ways that they kind of keep themselves on track and their symptoms are changing. Like some days they're like, oh, actually, no, I can remember things just fine. I, this isn't an issue for me. I want to add, and then I'm interested in just kind of what you would add to this list, I think there is a narrative for women about suffering, right? That it is just there, a certain amount of pain is what we're just supposed to deal with a certain amount of, you know, aging just means that things are going to shit and you just can't do anything to stop it. And so thanks patriarchy, because I think that the narrative that we have about what it means to be a woman aging also keeps women seeking and, and getting the help that they need, throw on top of that. It's selfish, it's self-centered to use time and resources for yourself when it's not like, quote, that big a deal. It's not cancer, right? It's not a lump in your breasts, which we would all, you know, go right down. I hope to everybody, you better be doing those breast checks where we would go right and get that taken care of. But I mean, the fact that I just can't remember words like I used to, it's not that bad and that's what aging is. What else do you think really keeps women from getting diagnosed the way they need to be?
Jenny Hobbs 24:34
I definitely think a lot of it is what you said, this idea that it's not that big of a deal. We definitely tend to downplay pain and difficulty. And like I said, we're bad assets. We're used to handling a lot. You know, what's that? There's that quote that's like, just because you carry it well doesn't mean it's not heavy, right? That I feel like that's like women, right? You know, so many of us women working moms, so you're carrying it all, you're doing it, and you're like, it's okay, I got this, I got this. I also think definitely putting others before ourselves. So many of us, you know, we will spend this time, I've talked to a lot of women who are, it's easier for them to pay for money for coaching and therapy and treatment for their children with ADHD. Yes, even if they know they have ADHD, they'll not want to invest in coaching for themselves for ADHD. And they'll say, you know, well, it's one of them even told me, I realized it's kind of funny that I would totally pay this money if it was coaching for my son, but I won't do it for me. Right? So that is definitely big. I think also, it is legitimately challenging to find a good provider who understands a little ADHD and how it presents and can give you a thoughtful valuation, it does take some time, you know, there can be a cost involved in that, you know, so I think there's just some practical considerations as well. And I think, I'm glad you brought up that concept of, you know, it's not breast cancer, or things like that. I think another reason people don't get diagnosed is this misconception that it's not a big deal. So it's quite interesting, actually, there's pretty good data that people with ADHD have a shorter lifespan. So, there's actually a mortality effect of ADHD over time. It's on average, right? It's associated with loss of income, because there's a lot of job loss, it can be associated with divorce, which is extremely expensive, right? It also can lead to some undiagnosed trauma and anxiety and secondary psychiatric disorders, which are, again, are, you know, have their own toll and their own costs. It's pretty impressive if you look at the studies of kids with ADHD, the number of them that don't get treated early on that then go on to have problems with substance use and other problems related to the impulsivity. So it actually is a big deal. It's actually a big health cost to this disorder. But I honestly think the vast majority of people, including many physicians, don't know that. And so I think that lack of information kind of makes people downplay it maybe more than we should sometimes.
Sara Bybee Fisk 26:57
All right, so let's talk about some things that can be done about it. And here's where I just want to recognize, you know, the privilege that is kind of inherent in this, because resources, financial resources, kind of open up a whole other category of, of solutions for you. So I'd love to talk about, you know, some resources that can be low cost or no cost, and then some that might have a cost involved.
Jenny Hobbs 27:24
I think that is a really good point. So I did mention there can definitely be a cost to some of the things that we do for this. Obviously ADHD is a well-recognized disorder, so evaluation and treatment, if you do have insurance or even on a number of the medical plans that are associated with state insurance and things like that, should be covered, at least to some degree. So there is that. So, there are ways to at least start the evaluation with your primary care provider. Certainly, if you have a primary care provider who is comfortable with adult ADHD or can refer you to someone that they know that's a great place to start. And part of the evaluation for ADHD does include checking for other things, like perimenopause and things like that, that can overlap with it. So that's a wonderful place to start. There are also really great free resources available. One book that I love is called Taking Charge of Adult ADHD by Russell Barkley. Wonderful book. It's really nice to have the physical copy like this, but I'll tell you, I listen to it on audio. So I literally got it from Libby, you know, if you have a library card, Libby, you can download it. I listened to the audio while I was driving to work and then I liked it enough and I do enough of this in my own work that I got the physical copy. So you can get that from the library. And this is a wonderful resource. And Russell Barkley also has a lot of YouTube videos available. He's one of the big names who has really worked hard to articulate the characteristics of adult ADHD versus kids. So look for his free resources. I will also I made a PDF download for just for you guys for this podcast. And so I will include in there a list of the nine characteristics that we look for for adult ADHD that's taken from his book and lots of links in there to podcasts and information that I have. That's free as well. But lots of good stuff. That's free. So here are the nine things that they found are more useful for diagnosing ADHD and adults. So specific to adults, not as much for kids. So, do you often easily get distracted by extraneous stimuli or irrelevant thoughts? Do you often make decisions impulsively? A lot of difficulty stopping activities or behavior when you should do so. Start a project or task without reading or listening to directions carefully. Fail to follow through on promises or commitments you make to others. Have trouble doing things in their proper order or sequence. As I'm listening to these, I'm thinking of so many examples. Drive much faster than others. Or if you don't drive, have difficulty engaging in leisure activities or doing fun things quietly. Have difficulty sustaining attention in tasks or recreational activities. Or have difficulty organizing tasks and activities. So you don't have to have all of those nine. So, this will be in the toolkit that I'm going to send you. And it's also in Dr. Barkley's book. But those are kind of the nine things. And if you have four to six of those things, then you might want to be thinking about ADHD. So it's interesting being on time is not on there.
Jenny Hobbs 30:28
Hyperactivity is another big one that we don't see as much in adults. Although I will add that one of the reasons girls often don't get diagnosed is because they tend to have more inattentive type and less hyperactive type. And when you are hyperactive, so I have hyperactive type, if you've noticed, it's verbal hyperactivity is how women and girls tend to present.
Sara Bybee Fisk 30:49
Yeah, that's so interesting. Yeah, if I have my like ADHD bingo card, I'm close to blackout.
Jenny Hobbs 30:57
It's really, so I think that when people say everyone has a little ADHD, you know, I think he talks about this in his book, but when they ask these questions of people with and without ADHD, it's a very, like, it's very clear who falls into that and who doesn't. And I think, you know, like, there's a lot of people I know who just don't have their, they don't understand why I have trouble with these things. So yeah.
Sara Bybee Fisk 31:18
Yeah, the verbal hyperactivity is really helpful for me to hear as well because I think that probably describes me and maybe some other people I know. So thank you for reading those.
Jenny Hobbs 31:28
Yeah. The other thing I like about his book is that it really drives home what it takes to get a good evaluation for ADHD. So what to look for in a provider, where to find someone, what questions they should be asking. And if you've been listening to this, sometimes people are kind of like, well, isn't everyone a little ADHD? And how do you know, he really breaks down, you know, it needs to be something that's present in these areas of life for this length of time, you know, from childhood. So you can really get a sense of it's not just like everyone who's a little distracted, has ADHD, but it really nicely illustrates all of that and even talks about, you know, if you get an evaluation, you don't agree with it, how to think about that. So there's lots of great books about ADHD out there. But I really like how fact-based this is in terms of the diagnostic piece. If you don't have the opportunity to get in to see someone, it's a really nice place to start thinking about for yourself. His book also has strategies for ADHD, which is great. And then that was the other thing I was going to say is that whether or not you actually get a formal diagnosis and start on medications and things like that, which all of which does cost some degree of money, many strategies for ADHD are free and helpful. So things like sleep, we know improving your sleep can improve ADHD symptoms by 30%. In some studies, exercise is probably second only to medication in terms of treating ADHD symptoms, doesn't have to be a ton, nutrition. And then, you know, this does cost some money, typically, but coaching is excellent for ADHD. That's obviously a big part of what I do. And there's tons of ADHD trained coaches available, also therapists who do kind of a mix of therapy and coaching. And one of the reasons I really wanted to bring that up, and one of the reasons I like being a coach for ADHD is that whether or not you go on medications or get a diagnosis, the strategies that help the most are a lot of what we've been talking about here. So just accepting that this is who you are, this is how you're wired, giving yourself that accurate narrative, and building the skills of trusting yourself, loving yourself, letting go of all these rules and expectations and restrictions, the inner critic, all of that work that Sara does, and her people pleasing and that I do, is really effective. And you don't necessarily need to go to a doctor and get on medication to start working on all of that. So sorry, that was a really long answer, Sara.
Sara Bybee Fisk 33:51
No, that was great. I just want to make sure also that we touch on for perimenopausal women that you can replace that estrogen, right? That is one of the most, I mean, there's a night and day difference that I feel and that women, my friends, feel when we have that estrogen on board in a way that can really be helpful. What should someone who is in that perimenopausal range be aware of?
Jenny Hobbs 34:23
I do think perimenopause is a really interesting topic to talk about alongside this because and I actually recently went to a Mayo Clinic CME a few months ago and there was a talk on ADHD and a talk on perimenopause. So I was really excited, excited, all these facts in my mind ready to go. And there's actually a lot of overlap, which is kind of cool. So perimenopause is also very poorly understood, just like ADHD, right? But we do have some pretty good studies now that show that perimenopausal symptoms can start a lot earlier than you might think. So the average age for menopause is around 52, okay? But it can start anytime after 45 is considered normal.
Sara Bybee Fisk 35:06
And I just want to note it's different for different populations. Women of color, black women have a different perimenopausal kind of median age than white women than it can be. But 50s between 50 and 55 kind of covers it.
Jenny Hobbs 35:20
That's a great yeah, that's a great point. And I, again, I'm not an OBGYN. So this is definitely not my main area of expertise. I really mostly understand it as it overlaps with ADHD and things like that. So that's a really good point. I did not know that about people of color, but it totally makes sense. And I think the important point here, though, is that prior to menopause, there's this sort of what they call perimenopause or menopause transition, and then they have something even before that that they call the late reproductive stage. So that's what the OBGYNs call it. Okay. And the bottom line is that big studies show that the symptoms that we think of being menopausal symptoms can start as much as 10 plus years before you actually go into menopause. So they've done studies where they surveyed women starting at age 35. And basically what they found was this, I think the cohort was 35 to 55 or something like that. Basically, what they found was that they had just as many symptoms at 35 as at 50. Like you couldn't really make a huge difference. The only symptom that was really different based on age was hot flashes. So, hot flashes were definitely worse when you were older. But the rest of the things we think of, so sleep problems, brain fog, mood changes, even like musculoskeletal pain, weight gain, you know, vaginal dryness, urinary symptoms, all of that stuff, they couldn't find a difference, whether you were 35 or 45 or 50 on average, which so that means a lot of the stuff that we are just thinking, like you said, oh, this is just, you know, aging, it could be very early signs of menopause, even if you're in your late 30s, potentially, right? I think it is more common as you get older, but I think that, for me was really eye-opening.
Sara Bybee Fisk 37:10
I started perimenopause at 38. Yeah, just based on what was going on with, for me at the time, medical issues I was having, I started perimenopause and nobody told me that that's what it was. Like you said, I really love that perimenopause is having the moment it deserves, and I hope it's a lot more than a moment, because there is so much to it, and I know that I spent a lot of years just watching myself decline and wondering what was wrong, not feeling like there was anything I could do about it. And so I'm really grateful that we've had this discussion because I hope what it opens up, a couple of things, like number one, if you're experiencing some of these things, there's nothing morally wrong with you. It might be time to download the Libby app and listen to Russell Barkley's book, or see a provider, make sure that you're getting one that understands how adult ADHD really manifest differently in adults and specifically in women. Because what I really hope is that women can just ease up on themselves, and that we can get ourselves the resources that we need. So we're not just on the edge of that like overwhelm burnout edge all the time, which I felt like that's just where I lived for such a long time. So I'm really grateful. Is there anything that you didn't get to say so far in our conversation that you wanna make sure that you add?
Jenny Hobbs 38:39
Yeah, I just wanted to, I think along the lines of the perimenopause evaluation and question, so one thing that's really interesting is that if you think about it, these symptoms that we're talking about start so early that hormone testing, like doing the labs to see what your hormone levels are, is really not that helpful in terms of diagnosing. So I think often, you know, again, as in our culture, we all want the black and white answer, we want to go to the doctor and get the lab test that proves that we have this or that we have menopause, and we want to know we want a right answer, we want is this perimenopause, or is this ADHD, you know, we want it all to be perfect. And I don't want to downplay that. Because as Sara said, people can feel so much better when they get the correct diagnosis, and there are treatments that work. So, hormone therapy can be extremely effective. It's very safe. That's another area where there's a lot of misconceptions about it. So with a really smart medical provider, it doesn't have to be an OBGYN, it can be an internal medicine doctor who does or a family practice doctor who does a lot of outpatient women's medicine, talk to them about the risks and benefits, but it can be extremely helpful to get on hormone therapy for that, and helpful to get a diagnosis. But the diagnosis is more of what we would say in medicine, a clinical diagnosis, it's less dependent on those lab values. So go in, ask the question, go in armed with the information that it can start earlier, and for all those reasons. And I think the other thing that's interesting about perimenopause is whether or not you decide to do the hormone therapy is, again, it was fascinating at this talk that I went to, the slides about how to treat your menopausal symptoms, and the slides about how to treat your ADHD, right? After you got past the medication, so either hormone therapy for menopause or stimulants and things like that for ADHD, once you got past that, the list was basically the same. It was sleep, exercise, nutrition, and then a lot of mindset stuff like we talked about, accepting yourself and working on those emotional regulation strategies and all that stuff. So what I love about that is that you can go to your doctor and you should and get evaluated because why not make your life easier by treating the actual problem. But if you don't get the answer you're looking for, or it doesn't feel clear cut, that can also be okay, because you can look at it as an opportunity to tune up your lifestyle and to start working on these strategies of self-acceptance and love and confidence and all of these things, which you can start doing whatever happens with the diagnosis. And honestly, all women can benefit from improving their self-acceptance and love and confidence and their ability to handle their emotions.
Jenny Hobbs 41:22
There's no downside to working on all that while you're doing this. Does that make sense? If anything, it's like a great opportunity to justify it to yourself because there is real benefit to it. Sometimes, like you said, we think things aren't important, but now that we know these things are so important and we're starting to have symptoms that are causing big enough problems that they're affecting our life, we can use that as motivation to prioritize ourselves and what matters. So I know that's kind of like my positive spin I like to take on it with my ADHD folks is like, this is a gift because everyone could use my favorite example is everyone could be better at emotional regulation. Everyone at your work is having trouble regulating their emotions, and they're just covering it up better than you do. And so while it may seem like you're the problem, this is also you get to get really good at this skill that other people are ignoring and you will benefit from that for the rest of your life once you have that intact. And I think that goes for good girls too, right?
Sara Bybee Fisk 42:21
100%. I'm really grateful for the toolkit that you've created. We will link to that. A link to the Libby app too because that's a great free resource for reading that book. And Jenny, just thank you so much for being here.
Jenny Hobbs 42:35
Yeah, thank you. I loved chatting with you. I love your podcast. I just resonate so much with you and the women you work with. So thank you for being the voice of all of us ex-good girls. It's, it's awesome.
Sara Bybee Fisk 42:47
Absolutely. And if people want to find out more about you and your work, where would you like them to go?
Jenny Hobbs 42:52
So, um, you can find me at Jenny Hobbs, MD, like medical doctor. Someone's asked me, does that mean you're from Maryland? No, jennyhobbsmd.com. And I'm also on Instagram, same thing. I believe I was going to change it at one point, but I think it's still the same. Jenny Hobbs, MD on Instagram. I'm also on Facebook. I also have a podcast called Rethink Your Rules, which is just talking to women. You know, all the rules that the good girls were supposed to follow and we're just rethinking them and I specifically say, I always say, it's not that we're going to necessarily rewrite them. We might rewrite them. We're just going to pause and rethink them and decide if they work for us now that we've learned what, how we're wired. And so, so those are good places to find me and I, uh, you know, check out the toolkit that I created, feel free to set up a console anytime. If you want to talk this over, honestly, it's pretty common for women to come to me because they're in that late thirties, early forties, got a kid or two that's diagnosed with ADHD and they're questioning, is this perimenopause? Is this ADHD, and you know, where do I start? And so I love to be able to sort of work with people and guide them as they're talking to their doctor. And I can be a really nice sort of a physician sounding board who's not actually doing the medical diagnosing and treating, but I can help them with the strategies and the mindset and give them an outside perspective as they're going through all of that. So if you want to do a consult and you just chat about where you are and where you want to go, I'm happy to do it.
Sara Bybee Fisk 44:19
Thank you so much.
