101: Navigating Neurodiversity and Hormonal Health with A/Prof Caroline Gurvich

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Welcome to the Dear Menopause podcast.

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I'm Sona Lovell, your host Now.

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I've been bringing you conversations with amazing menopause experts for over two years now.

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If you have missed any of those conversations, now's the time to go back and listen, and you can always share them with anyone you think needs to hear them.

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This way, more people can find these amazing conversations.

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Hi everybody, today I am being joined by Associate Professor Caroline Grvich.

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Now, caroline is a clinical neuropsychologist and she's going to correct me if I get any of this wrong and she is the Head of Cognition and Hormones Group at the HER Center, which means she works alongside Daremen Menopause favourite guest Professor Jayashree Kulkarni.

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So if you are a fan of Professor Kulkarni's work, you are going to love listening to Caroline and her work in and around neurodiversity, which is what we're going to dive into today.

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So, caroline, welcome to the show.

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Thank you, sonia.

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I'm delighted to be here.

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Thank you so much.

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So why don't we kick off by you giving us a little bit more of an in-depth kind of insight as to what you do, who you are, and maybe a little bit about the Hurst Centre as well?

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Yeah, sure.

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So as you said, I'm a neuropsychologist.

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So for people who don't know what a neuropsychologist is, it's broadly like a brain psychologist, so where neuropsychologists are interested in the relationship between brain and behavior, so anything that can impact brain, so that might be like a disease process or a degenerative process or a neurodevelopmental condition.

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Anything that changes our brain can have a flow on effect to impact our cognition, our psychology, our mental health, our thinking skills.

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So neuropsychologists generally assess that association between brain change and behavior, emotions, cognition, and then we can also work in a capacity where we work with people to help whatever changes they've experienced in their cognition and have some sort of therapeutic role.

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So that's neuropsychology in the clinical setting, which I do.

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And then I also work in the research, setting in, as you said, her Centre.

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So HER stands for Health, education and Research, but it also captures HER, as in women's mental health.

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So that's what we do we work towards better understanding women's mental health and then we try to apply that in terms of education and we keep doing more research, try and learn more about different aspects of women's mental health, and our research is really biopsychosocial, I would say.

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So we do a lot of biological work to understand what's going on at a kind of brain or hormone level, and then we look at the characterization of symptoms and behavior, and then we also look at a lot of novel treatment pathways to try and help people who experience a whole range of different things.

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So you know, very broad way, that's neuropsychology and Her Centre.

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Amazing.

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You are very busy.

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You are doing lots of things wearing many hats.

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One of the things I'm interested to know about is, with your work in neuropsychology, has the intersection between impacts on cognition and the brain and menopause perimenopause is that a recent kind of something that you've noticed has become more researched and more perhaps discussed in a clinical setting as well, as we've elevated this conversation over the last few years, or is it something that's always been a part of your work?

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No, it has not always been a part of my work and I would say, prior to me working in this space and doing research in this space.

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So maybe 10, 15 years ago it wouldn't have crossed my mind.

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I don't think, sadly, if someone presented with cognitive concerns around midlife, I don't think I personally would have thought of menopause.

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So it really was not something that was flagged at all.

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It wasn't something that was included when I was training.

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It wasn't something that was included in our course content at all, so it wasn't really talked about.

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And I feel like, as the conversations have started to emerge over the past decade, more and more people are presenting to me, I guess because that's my area of interest as well so more and more people are presenting who are of menopause, perimenopausal age, with cognitive concerns, and so the questions are now asked.

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You know, is this menopause, is this dementia, is this ADHD, those kind of clinical questions?

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But menopause is part of the diagnostic process now, whereas it never used to be, and so I mean I don't think it's a change in people's presentation, but I think it's a change in both people's conversation, like in the lay community asking about that linking cognitive symptoms to potentially to menopause.

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So it's coming from people with experiences of menopause and cognitive symptoms as from people with experiences of menopause and cognitive symptoms as well as clinicians now having that knowledge that changes can be part of that menopause transition.

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So I think you know both sides are now bringing that menopause piece of the puzzle to that whole assessment process.

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Yeah, yay, that's good, good, good news.

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Yes.

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Good news For anyone out there that is, or has been, struggling with some cognitive changes.

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I guess both sides of the picture are coming together with the same kind of knowledge now and being able to provide support to everybody out in the community.

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So I think a good place to start would be if you can give us a bit of a 101 on neurodivergence what actually is neurodivergence, what does it mean, what are the different types?

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And we'll then maybe dive into a little bit on diagnosis as well.

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Yeah, sure.

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So really broadly we have neurodiversity, which just reflects all the different brain types that people have.

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So it's a broad spectrum and the majority of people are called neurotypical, so it's like the neurotypical brain type, and then there's variance within that neurotypical spectrum.

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But on the outsides of that neurotypical spectrum are what we call neurodivergence, and within neurodivergence there's lots of different things that fall under that bracket, but predominantly ADHD, autism.

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They fall within neurodivergence, as well as other neurodevelopmental conditions.

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So things like dyspraxia, dyslexia they also fall within what we call neurodivergence.

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Okay, and then each of those, from a diagnostic perspective, is often diagnosed on a spectrum as well, isn't it?

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Yes, yeah, that's right.

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So I can talk a little bit more about maybe ADHD.

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What it is, adhd is attention deficit hyperactivity disorder that's what the acronym stands for, and it can be either attention deficit and or hyperactivity.

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So some people present with just the inattentive type symptoms and some people present with just the inattentive type symptoms and some people present with just the hyperactive impulsive symptoms and some people have a combined presentation which is a bit of both.

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Just wanted to touch on actually language, because I use the word like deficit and symptoms and that's very medical and diagnostic and that's what we have to use for our diagnostic processes.

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But when we're talking about neurodiversity, in that neurodiversity affirming framework, the language is a little bit different and we talk about differences and characteristics.

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So there are differences in language depending on whether you're kind of framing things within a medical model and diagnostic terminology or whether you're talking about trying to better understand, for example, adhd and the characteristics that come with that and all the strengths as well as the challenges.

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So I guess I'll kind of sometimes I vacillate between the two, depending on whether we're talking about, yeah, diagnostic and following strictly diagnostic terminology, or whether we're having more of a conversation about you know what is ADHD and how different people present with different characteristics.

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Yeah, I think that that'll be really helpful because I know that there are also a number of clinicians that listen to the podcast as well.

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So I guess perhaps from a diagnostic perspective, they would be more interested in that clinical view of it.

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But I also know that I've had as I mentioned right before we started recording that I've actually had quite a few listeners reach out to me and ask when I would be having a guest on to talk about neurodivergence, particularly probably ADHD.

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So it'd be great to be able to really break it down and talk about everything in a way where it's easily understood from a patient perspective as well.

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So let's then touch on why the menopause transition so perimenopause and menopause and postmenopause becomes a time where we are starting to see or from my perspective it seems like we're starting to see more diagnosis of ADHD or neurodivergence becomes more sensitive to the changes in our hormones.

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So is that what's going on?

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It's definitely going on and we've done some research where we did a big survey of people who already had a diagnosis of ADHD and we asked them about their experiences across different life phases, so across the menstrual cycle.

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So these were females or people assigned female at birth and across menstrual cycle and menopause and I think about 98% of people said that their ADHD symptoms became worse across those perimenopausal years.

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And of our sample, quite a number of people were diagnosed with ADHD around perimenopause.

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So while they said the symptom onset was about the age of seven and eight that was the average age that they kind of tracked their symptoms to starting it obviously didn't impact them enough to seek out help or a diagnosis until they hit those perimenopausal years.

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So yes, there's something definitely going on that is happening around perimenopause that is either exacerbating pre-existing ADHD, if people already have the diagnosis, or prompting people to go and explore whether they might have ADHD.

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So in terms of what's going on, I feel like that's a big question mark still and I think there's different hypotheses about what might be going on.

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So there's certainly obviously the hormonal picture.

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So we know hormones change during perimenopause, and particularly estrogen or estradiol.

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That type of estrogen fluctuates and then drops off or declines.

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And we know at a biological level that estrogen interacts with dopamine and dopamine plays an important role in ADHD.

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So from a biological level it kind of makes sense that oh okay, if you're losing your estrogen, the protective effects of estrogen, that whatever dopamine's doing, is a little bit more obvious perhaps, and so that's kind of one biological reason as to why you might see a more obvious symptom presentation around menopause.

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But I think also some people describe that they've been able to kind of mask their ADHD symptoms throughout their life.

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They've been able to rely on lots of supports and structure and scaffolding and lots of different things to hold it together and to kind of get through.

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And then something happens at menopause and it's just whatever they were doing is no longer enough and they just need I don't know, it's not enough and they can't mask anymore and their symptoms just become more obvious.

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And could people be masking, at a subconscious level as well, not even perhaps realising that they are wired a little bit differently, I guess, to what we know, the typical person whatever that typical person is and although they've never had a formal diagnosis, they've just kind of, like you say, they've created their own personal toolkit of and scaffold around being able to function in a way that makes life manageable for them.

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So is it often that you hear from people that really had no idea that that was actually what was going on and they just put those structures in place subconsciously, as opposed to somebody kind of always having a little niggle in the back of their mind that something isn't going on right here, but I don't know where to go and get help.

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So I think some people are really aware that they're masking and they know that they feel a little bit different and they're trying to fit in and trying to cover up their natural self.

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So some people have that awareness.

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Then there's other people who have it with hindsight so they look back and they say I can see how these different things were completely masking and that wasn't my real self and I was trying so hard but it just wasn't me.

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And then there's another group of people who it's not masking that they describe, but they describe periods of burnout, periods of depression, misdiagnosis even as bipolar depression, where they've had periods that haveactive, impulsive type behaviors, and then periods where they've really burnt out because they've struggled to mask and it's been referred to as burnout or referred to as depression.

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And then after years they look back and they think that that was masking and masking not working anymore, rather than being periods of depression or burnout as it might have been labeled.

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So yeah, I think some people are aware and other people, with hindsight it becomes a bit obvious, more obvious to people.

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Yeah, it must be a really interesting journey for someone to go on to, particularly for somebody that, as you say, perhaps goes through a period of misdiagnosis and I would imagine that being diagnosed with something like a bipolar disorder would be really confronting and something that could perhaps create other hard to manage situations in their lives.

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You know, I would imagine that impacts relationships and ability to work and all that sort of thing.

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So in those cases are they often prescribed an antidepressant or an SSRI or something like that to manage those kind of misdiagnosed situations?

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Yeah, generally if I see someone who is sort of perimenopausal age, they have had different medications prescribed over different periods of their life and none have been particularly effective.

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That tends to be the pattern that people talk about.

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But they often have a long list of things that they've tried at different times and I think, like you said, there can be lots of I guess emotions that when people reflect back.

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I think that's also true of being diagnosed with ADHD.

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Like some people feel a sense of relief.

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Some people describe that but other people there's a sense of grief as well, like I wish I knew I had ADHD.

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I wish it was labeled as that or identified as ADHD earlier in my life so I could have managed things so differently.

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So there can be really mixed emotions.

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Some people feel really satisfied and it's just right and everything makes sense, but for other people there's a bit of that and a bit of grief and a bit of adjusting.

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So there can be a whole lot of emotions around diagnosis when it's later in life as well.

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Yeah, that makes sense.

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I've had conversations with friends that have received ADHD diagnoses around the same time that they've started HRT.

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You know, the description is often like the noise was just turned down in my head and I suddenly had some clarity and I was able to focus where I hadn't been able to focus before and I would imagine that you know when you're getting that recognition in your 40s and perhaps it's something that has been problematic for you since you were in school I can understand why grief would would be a part of that yeah, yeah, lots of emotions so, but overall most people are happy to have received a diagnosis.

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If that's a you know something that people, if they're an ADHD brain type, they want to know they and they want that understanding of their own self and their own way that their brain functions and they want different options for medications or interventions or non-pharmacological interventions.

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So I think overall, diagnosis is a positive process, but in that journey there can be lots of different experiences and emotions.

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Yeah, I can imagine.

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So if somebody is in their perimenopausal phase and they're really starting to notice some cognitive changes, they haven't received a diagnosis before in the past of anything around the neurodiverse conditions that we talked about.

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What changes might they be seeing that would indicate that perhaps there has been something going on that they need to go and seek some help around?

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So I think menopause or perimenopause broadly, you can have cognitive changes regardless of whether you're someone who has ADHD or not ADHD.

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But I think if the cognitive changes are having a negative impact on your life in some way your professional life or social life, then I think that's when you really should seek some sort of professional help or have some conversations, starting perhaps with a GP, or if they're really significant, then I think you know neuropsychology assessment can be really helpful to try and tease apart whether there are any objective cognitive changes and if it's more, that you feel like you've always had something so so if you've always struggled with sort of organising yourself, planning attention if you've always been a bit forgetful, if you've always had trouble time managing and organising yourself so you don't leave things to the last minute, if they've always been present but they've just got a whole lot worse, then you know that might be an indication that maybe this is that's more the inattentive presentation of ADHD, but maybe this is an indication that something's always been there and again might be worth exploring that.

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So I think we see two different things during those perimenopausal years.

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Sometimes we see this completely new onset of executive function problems, so difficulty with those higher order, abilities of organizing, planning, time management and prioritizing, efficiency, and then sometimes, and as well as that forgetfulness, word retrieval.

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Those sorts of cognitive symptoms can be there, and they're only there and haven't been there ever before, but they've just emerged in those perimenopausal years.

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And then we have the other presentation where there's been a bit of something underlying always.

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Sometimes people say I've always felt a bit different, I've never been able to explain what it is or why.

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It's just become a bit more pronounced.

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And then it might be an indication that maybe this is a neurodivergent presentation that's just become a little bit exacerbated or uncovered over those perimenopausal years.

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Okay and so, as you mentioned, first port of call often in this situation would be a GP or seeking out neuropsychologist.

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Neuropsychology or you can see a psychiatrist as well.

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You can see a psychiatrist also if you've got those kind of cognitive symptoms or mood symptoms or any kind of mental health changes.

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Yep, yes, great.

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And the hyperactivity side of ADHD.

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How does that tend to present?

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Yeah, so that can also change a bit from what we stereotypically think of when we think of ADHD, the hyperactive boy bouncing off the walls, that's kind of the picture that comes to mind for a lot of people.

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And you can also have hyperactive girls, but it's less common.

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And then, as people get older, the description that people provide is more like they've got a motor inside of them, there's something driving them.

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It's like a restlessness that they have an urgency.

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They can't sit still, they, they can't stop thinking, they can't stop doing something and they really have.

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People describe difficulty unwinding at the end of the day, difficulty relaxing at any time during the day, because they always have this on-the-go feeling.

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So that tends to be the presentation for, as a generalization, that tends to be the presentation for sort of perimenopausal women who have the hyperactive, impulsive presentation.

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It's just this I can't unwind, I can't, yeah, stop, yeah always on always on yeah, exactly.

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And then from a treatment perspective, I guess from my perspective, my understanding of treatment for ADHD is probably linked to kids and teenagers.

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It's, you know, that kind of Ritalin, I think.

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When my boys were in those years where some of their friends were being diagnosed, that was kind of the drug that they were most, or the medication that they were most likely to be prescribed.

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Obviously, if this is a hormonal imbalance or you know change that is starting to trigger some of these either a new diagnosis or an intensification of symptoms what do you tend to recommend from a treatment perspective?

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Yeah.

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So I should say that I don't prescribe.

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So neuropsychologists, within psychology, we don't prescribe medication but in terms of kind of the guidelines of what's out there at the moment.

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So the first line of medication within that stimulant category, but there are other medications as well for ADHD.

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However, in the space of perimenopause and hormone changes, while we don't have the guidelines or the evidence base to suggest hormone therapy, there are a lot of individuals who do report lots of benefits in terms of their cognition from sort of individualized hormone therapy approaches.

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So I always recommend to people you know, go back to your GP or go back to your psychiatrist and talk about what's going on for you and make sure menopause is part of the treatment process.

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So it's not that ADHD is treated independently of the fact that there's been hormone changes and lots of things can be explored and then people can see how they respond as an individual and what's helpful for them, okay, great.

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So there's lots of options out there that may or may not include HRT, if that is something that your prescribing clinician decides to add into the mix, exactly.

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Yes, exactly.

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And then there's also for ADHD.

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There's lots of non-pharmacological interventions as well.

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So there's lots of strategies that people can put in place and things like CBT, so cognitive behaviour therapy, and ADHD coaching.

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So there's so many options, once people understand themselves, that they can lend on to, to get support and to help themselves to sort of bring themselves back to their their best.

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So I think for people just to know that there's so many different options out there that can be really helpful, with kind of differing levels of evidence base.

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But I think sometimes there's a lack of evidence because we just don't have the research there, rather than evidence that there's a lack of effect.

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So I think that's important for people to keep in mind that we're still building the evidence base, particularly for menopausal women, about what's going to be helpful.

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We just there's really very little research.

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So I think while there isn't the evidence basis, there's lots of potential avenues people can explore to help themselves.

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Great, so it sounds very much like there's an opportunity there to you know, go back to what we were talking about earlier build that toolkit again of different strategies and scaffolds that work for you personally, because I would imagine that this is an individual journey for every person.

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So, yeah, so there's lots of tools that can be popped into that toolkit.

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It's just a matter of finding the right person to talk to that can guide you towards the best option for you.

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Yeah, exactly, and I think also knowing, keep in mind, there's lots of options and everyone's different, so you might try something and it might not work, but it's not the only option in terms of there's lots of pharmacological options, hormone options and non-pharmacological options, lifestyle options.

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So there's lots of pharmacological options, hormone options and non-pharmacological options, lifestyle options.

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So there's so many things that, as you say, you can add to your toolkit and throw out the things that don't work for you as an individual, adding something else.

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it's all trial and error, yeah, and yeah, lots of, and I think that's a good good reminder too, and it's a little bit like when we're talking about people that are seeking support for their perimenopausal or menopausal symptoms.

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It's that if you try something that doesn't work, don't accept that as okay.

00:23:53.505 --> 00:24:10.309
Well, this is just my lot and I now have to just struggle along here and even if you've got a clinician or a healthcare practitioner that's not offering you other alternatives, keep being that squeaky wheel and go out there until you do find somebody that offers a solution that is maybe more suited to you.

00:24:11.053 --> 00:24:17.000
Absolutely, and it's a shame that people have to advocate for themselves and find that energy at a time where sometimes you don't have that energy.

00:24:17.000 --> 00:24:24.286
But you know, if you can convert that thought process to hope and know that there's so many options and there's hope and you haven't found the right thing, but keep trying.

00:24:24.286 --> 00:24:27.778
Yeah, hopefully everyone gets to a point where they can optimise everything for themselves options and there's hope and you haven't found the right thing, but keep trying.

00:24:27.778 --> 00:24:33.451
Um, yeah, hopefully everyone gets to a point where they can optimize everything for themselves I like that.

00:24:33.511 --> 00:24:37.172
It's a great great spin on um keeping hope at the forefront.

00:24:37.252 --> 00:24:47.508
I think that's really good well, that's in psychology we do a lot of that kind of we call it positive reframing because you've got to reframe things all the time and it's such an important skill and but it's really hard to do.

00:24:47.508 --> 00:24:53.780
If you're feeling depressed, for example, it's really hard to flip things and positively reframe things.

00:24:53.780 --> 00:25:05.442
But that's why sometimes you need to work with a psychologist or someone to help you positively reframe things and so that sometimes can give you enough energy to keep going and to find solutions.

00:25:05.604 --> 00:25:07.209
Yeah, yeah, great, I like that.

00:25:07.209 --> 00:25:08.131
We had that little segue.

00:25:08.131 --> 00:25:30.808
One of the other areas that I wanted to kind of touch on with you and this is off the back of a guest that I actually had on the podcast recently, which Julie Dutton, who was speaking about her lived experience and when she was able to look back retrospectively and join a lot of dots she'd experienced quite bad PMT, which she thinks was probably PMDD.

00:25:30.808 --> 00:25:32.290
That was just undiagnosed.

00:25:32.290 --> 00:25:41.484
She then experienced perinatal depression and then got an ADHD diagnosis at about the time she started going through her perimenopause.

00:25:41.484 --> 00:25:58.987
The link between some of those different disorders or conditions that you know they don't sound like something I would expect to be a neurodivergence, like a PMDD or a PND, but there is a link, isn't there between people that are more likely to be diagnosed with those.

00:25:59.714 --> 00:26:08.058
Yeah, absolutely, and again, we're still learning so much about this area, but certainly the few studies that have been done have shown a few things.

00:26:08.058 --> 00:26:19.166
So there is a crossover of some sort between PMDD so premenstrual dysphoric disorder, which is the technical name, but like, say, a premenstrual depression and ADHD.

00:26:19.166 --> 00:26:28.276
So there's people with ADHD are more likely to have PMDD and the flip side, people with PMDD are also more likely to have ADHD.

00:26:28.276 --> 00:26:34.509
So there is a link in the literature in terms of like a statistical prevalence type link.

00:26:34.509 --> 00:27:03.202
And then there's also some biological research as well that shows that neurodivergent people have an increased hormonal sensitivity, so not a difference in the actual hormone fluctuation levels, but they're more sensitive to the natural hormone fluctuations that might happen, for example, across the menstrual cycle or the quite significant hormone changes that might happen across the pregnancy and postnatal timeframes.

00:27:03.202 --> 00:27:06.930
So yeah, we're still learning more about that.

00:27:07.055 --> 00:27:26.582
People also talk about their ADHD symptoms becoming more obvious in that premenstrual phase of their menstrual cycle, and so more ADHD symptoms, more mood symptoms that can happen in that phase, and also that some of their stimulant medications are less effective during that phase of their menstrual cycle.

00:27:26.582 --> 00:27:36.550
So there's a few different factors that are probably at play that just make people who are neurodivergent more sensitive to hormone changes.

00:27:36.550 --> 00:27:45.584
And there's also a little bit of research not much that shows that people who are autistic as well as ADHDers are more likely to experience more menopause symptoms.

00:27:45.584 --> 00:27:56.701
So not just an exacerbation of their ADHD or autism, but other menopause symptoms are greater or experienced to a greater severity for neurodivergent people as well.

00:27:56.701 --> 00:28:01.979
So there's certainly something going on, but we don't completely know what that is.

00:28:02.641 --> 00:28:14.442
I want to jump into research with you in a minute, but I just want to wrap up here so, as we are obviously anecdotally learning a lot of this stuff, right now, if the research isn't in place, then a lot of this is probably more anecdotal.

00:28:14.481 --> 00:28:40.106
learning at the moment and looking at patients like Jules, who talked about what her lived experience has been, and being able to retrospectively look at that Does that put us in a position now where we can start raising conversations with the younger generations that are perhaps experiencing PMDD or have a prenatal depression or postnatal depression, that we can kind of like give them a little bit of a hey?

00:28:40.106 --> 00:28:47.307
When you get to perimenopause, it's likely that you may experience heightened symptoms there as well.

00:28:48.128 --> 00:28:48.449
I think.

00:28:48.449 --> 00:28:48.609
So.

00:28:48.609 --> 00:28:55.304
I think we can have that conversation in terms of just saying you seem to be someone who's a bit more sensitive to your hormones changing.

00:28:55.304 --> 00:28:59.767
So there is another time point in your life where there's going to be significant hormone changes.

00:28:59.767 --> 00:29:12.267
So, just you know, be prepared and not scared, yeah, of course, but prepared, but just raising that awareness yeah, yeah, and I think that knowledge is powerful and can reduce the fear.

00:29:12.587 --> 00:29:16.289
but I think it's getting the balance right that we don't want to raise alarm unnecessarily.

00:29:16.289 --> 00:29:45.426
But then if people in that situation who would want to be prepared, you would want to know if you're someone who's going to be a bit more vulnerable to depression for, for example, in perimenopause, and so you know if your mood starts to change and you're early at least perhaps, and you might not be thinking of menopause, and so it's good to have that awareness that, okay, I'm someone who's been sensitive to my hormone changes and let's go and have a chat to my doctor or whoever health practitioner about what's going on and what can be done.

00:29:49.855 --> 00:29:50.156
Yeah, yeah, great.

00:29:50.156 --> 00:29:55.259
I think that's such a progression in the work that I guess we're all doing, and one of the benefits I always see is what impact is this going to have on the generations coming through behind us?

00:29:55.259 --> 00:30:18.768
And I think, as you say, the more armed they can be with knowledge and an understanding of their own personal impacts when they're going through getting pregnancy, when those hormones do change, and if they are someone that recognizes they're going through in pregnancy, when those hormones do change, and if they are someone that recognizes they're more sensitive, then we can go, they can be more prepared, whereas we've now got this generation that are just being blindsided yes, yeah, exactly yeah, awesome.

00:30:19.189 --> 00:30:31.805
so research was one of the areas that I wanted us to dive into a little bit because obviously you know you've referred multiple times throughout our conversation we don't have the research where this is only just starting to kind of become a topic to be researched.

00:30:31.805 --> 00:30:36.798
Where do we sit in future research right now on this topic?

00:30:36.919 --> 00:30:50.669
As I've alluded to, a lot more needs to be done and I think, as you know neuropsychologists and any health professionals we're always very evidence-based, so we want the evidence to help us navigate how to help people the best that we can.

00:30:51.289 --> 00:31:14.163
So I think, in terms of neurodivergence and menopause, I think we need to better kind of characterize what's going on, look at different interventions and supports pharmacological, hormonal, non-pharmacological so there needs to be, you know, clinical trials is kind of the gold standard to provide evidence for what's going to be helpful for groups of people.

00:31:14.163 --> 00:31:29.342
But I think the downside of clinical trials sometimes is that you lose the capacity for individualised treatment, which I think is what is helpful for for most people when you can optimize things that are really individual level.

00:31:29.342 --> 00:31:32.698
But we still need that broad evidence base from from clinical trials.

00:31:32.698 --> 00:31:36.978
So I think it's having a look at what interventions are going to help different groups of people.

00:31:36.978 --> 00:31:46.303
And then, yeah, the broader biological research, like what's going on and underneath everything, how are hormones interacting with different neurotransmitter pathways?

00:31:46.303 --> 00:31:48.226
What's underpinning all of this?

00:31:48.226 --> 00:31:56.027
And I think that understanding can help us drive better interventions and treatments and supports to help people do their best.

00:31:57.375 --> 00:32:07.527
And do we have any clinical trials that are actually about to start or underway anywhere, you know, not just in Australia, because obviously we benefit from any global research that's done as well.

00:32:07.527 --> 00:32:10.805
Is that something that's starting to kind of happen?

00:32:10.805 --> 00:32:14.422
As far as I know, not yet, but I'm hoping they will.

00:32:14.623 --> 00:32:31.559
In terms of specifically ADHD in the menopause space, there's a few small studies that aren't clinical trials where people have tried, for example, stimulant medication in menopausal women who don't have ADHD, but they've shown that that can be helpful for some of the cognitive symptoms of ADHD.

00:32:31.820 --> 00:32:46.242
But there haven't been the flip of really good kind of hormone trials that have had a look at those ADHD type symptoms or executive dysfunction and had a look at whether that might be beneficial, although we know at the moment moment there's not enough evidence to show.

00:32:46.242 --> 00:32:52.240
You know, hormones are helpful for cognition at a broad level but can be anecdotally, definitely at an individual level.

00:32:52.240 --> 00:33:13.009
So I think we just need those clinical trials but as far as I know I haven't seen any around the world that are happening and we're about to start some more kind of neuroimaging, cognitive work to have a look at again that group of perimenopausal women across the adhd spectrum.

00:33:13.009 --> 00:33:26.464
So people with diagnoses, people with perhaps some symptoms but not adhd as a diagnosis, and so we're trying to better understand what might be going on from a hormonal and brain and clinical perspective.

00:33:26.644 --> 00:33:33.561
Yeah, clinical trials is something that we needs to also happen down the track, and I think the other downside to them is they're very expensive.

00:33:33.561 --> 00:33:35.026
Aren't they so expensive?

00:33:35.026 --> 00:33:47.015
Yes, yeah, so we need a donor with a lot of gifting or funding capacity who may perhaps is impacted by this topic to absolutely we can do, absolutely, we can do the research, you can do the research.

00:33:47.894 --> 00:33:51.365
But, yes, you're right, we need the funding to support the research.

00:33:51.627 --> 00:33:52.250
Yeah, great.

00:33:52.250 --> 00:33:54.567
Well, I think there's something we can all definitely get behind.

00:33:54.567 --> 00:33:57.943
And it's such a catch-22 because it is a very frustrating conversation to have.

00:33:57.943 --> 00:34:03.979
If we talk very broadly across everything to do with perimenopause and menopause, you know everyone's like well, why isn't there research?

00:34:03.979 --> 00:34:05.582
And it's like it's not that simple.

00:34:05.582 --> 00:34:06.984
It's really not.

00:34:06.984 --> 00:34:12.193
Everyone knows that we need the research, but it's not as simple as just going out and doing the research.

00:34:12.715 --> 00:34:18.168
No, if only people knew how much time researchers spend writing grants that often we don't get.

00:34:18.168 --> 00:34:25.463
It's really sad that we spend a disproportionate amount of time trying to get funding to do the research that we'd like to actually do.

00:34:26.065 --> 00:34:31.518
Yeah, but it's on everyone's radar and that's what's most important, and it is definitely an evolving space.

00:34:31.518 --> 00:34:46.543
So that's fantastic, caroline, if you could leave us with your top three tips for anybody that finds themselves perhaps listening to this conversation today, going hmm, actually, I think there's something here that I could, you know, go away and do something about.

00:34:46.543 --> 00:34:48.666
What are your top three tips for that person?

00:34:48.666 --> 00:34:48.987
I?

00:34:49.007 --> 00:34:51.177
think the first one would be listen to yourself.

00:34:51.177 --> 00:34:57.724
If you're raising questions within yourself that, oh, this might be me, or yes, I've been struggling with something, go and speak to someone.

00:34:57.724 --> 00:35:05.023
Seek help, because there is help out there, and then keep seeking to find the right supports, right treatments.

00:35:05.023 --> 00:35:08.710
And keep seeking to find the right supports, right treatments, right capacity to let your strengths shine.

00:35:08.710 --> 00:35:17.726
So every individual when we're talking about neurodiversity and neurodivergence every individual has so many strengths and challenges and we want to support all the challenges.

00:35:17.726 --> 00:35:24.764
Find someone who can show you what your strengths are or help you identify your strengths and then help you manage every area that you're struggling with.

00:35:24.764 --> 00:35:26.659
That would be another key area.

00:35:26.679 --> 00:35:37.246
So just keep listening to your inner self and seek help and really trust that inner voice as well, you know, when it does feel like something's just not quite right.

00:35:37.246 --> 00:35:44.005
Yes, most of the times you are right, exactly yes, awesome, fantastic.

00:35:44.005 --> 00:35:54.525
Now, this might be a little bit of a segue, but it was something that I wanted to mention because it is something that you, I believe, worked on alongside, perhaps, professor Kulkarni at the Hearst Centre, and that is the MenoD.

00:35:54.525 --> 00:35:57.481
Yeah, yeah, the online questionnaire.

00:35:57.481 --> 00:35:59.586
Could you talk us a little bit through what that is?

00:36:00.434 --> 00:36:05.367
Yeah, sure, so yeah, that was something that J3 initiated quite a few years ago.

00:36:05.367 --> 00:36:10.527
Sure, so yeah, that was something that Jayshree initiated quite a few years ago to develop a questionnaire for perimenopausal depression.

00:36:10.527 --> 00:36:29.541
So, considering that the symptoms sometimes of depression during perimenopause can be a little bit different to a standard clinical depression, she wanted to develop a questionnaire that would help people assess themselves or help clinicians assess patients who might be presenting with depression during perimenopause.

00:36:29.541 --> 00:36:36.945
So it's a really short questionnaire that can be self-report or clinician administered and it's called the MenOD and you can do.

00:36:36.945 --> 00:36:37.626
You have show notes.

00:36:37.626 --> 00:36:38.436
Yeah, yeah, yeah.

00:36:38.496 --> 00:36:39.742
I'll pop a link through my show notes.

00:36:40.396 --> 00:36:47.701
So, yeah, we can have a link there freely available so people can use that, and it's also a good way for people to track how they're going.

00:36:47.701 --> 00:36:56.266
So if you try a new treatment of some sort or if you change something in your lifestyle and you want an objective way of measuring, is this helping my mood?

00:36:56.266 --> 00:37:01.105
It's a really nice way of kind of tracking what's helpful for you over time.

00:37:01.105 --> 00:37:07.648
Sometimes it's hard to reflect and to be an outside observer of your own mood symptoms.

00:37:08.028 --> 00:37:15.606
Yep, I have a coach that used a saying on me many years ago that has stuck in my brain and I always remember it, and that is you can't read the label from inside the jar.

00:37:16.268 --> 00:37:17.994
Yes, exactly that's such a good.

00:37:17.994 --> 00:37:19.679
I think I'll adopt that one too.

00:37:19.679 --> 00:37:20.721
It's a good one, isn't it?

00:37:20.922 --> 00:37:34.563
it's great, yes and it is we really and I think that's such a great tip with the MENOD is coming back and revisiting it over time to actually be able to track any progressions or, if unfortunately that was the case, regressions as well.

00:37:35.146 --> 00:37:43.385
Exactly, and that's even more important, really, because then you need to really be alert to seek help if things are not looking good.

00:37:44.467 --> 00:37:44.889
Amazing.

00:37:44.889 --> 00:37:45.335
Caroline.

00:37:45.335 --> 00:37:46.920
Thank you so much for your time.

00:37:46.920 --> 00:37:53.159
I've loved chatting to you and I'm pretty sure that everybody listening will have had something to take away from today's conversation as well.

00:37:53.961 --> 00:37:54.364
I hope so.

00:37:54.364 --> 00:37:55.681
Thank you so much for having me, Sonia.

101: Navigating Neurodiversity and Hormonal Health with A/Prof Caroline Gurvich

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