The Brain That Changes Every Month with Dr. Jolene Brighten
This week I'm talking with Dr. Jolene Brighten, a naturopathic doctor, women's health educator, and author whose work focuses on hormones, reproductive health, and the ways hormonal changes can affect women across their lifespan. She's the author of Beyond the Pill and Is This Normal?, and her newest work, ADHD and Women, coming out October 6th, explores the intersection of hormones and ADHD in women.
I know hormones and ADHD is a topic we've explored before, but Dr. Brighten was a delight to have on the show, and this conversation went in all kinds of directions. So yes, we talked about how hormonal shifts across your life affect ADHD symptoms, why medication can sometimes feel less effective at different points, and some of the ways those changes may show up differently for women with ADHD.
But we also got into the much more practical question of what you actually do when you know your brain isn't going to perform exactly the same way every day, like externalizing executive function instead of trying to remember harder, building small pleasures into the day, and recognizing that sometimes the best intervention isn't the full protocol, it's finding the smallest lever you can actually pull.
If you'd life to follow along on the show notes page you can find that at HackingYourADHD.com/314
YouTube: https://tinyurl.com/y835cnrk
William Curb: All right. Well, it's so exciting to have you on the podcast, especially to discuss this topic that, as we were saying earlier, is just really resonating with a lot of people. But I guess a great place for us to start would just be to kind of hear a little bit about how you even got into doing this.
Dr. Jolene Brighten: Right. I think because ADHD women deserve so much better. They deserve not to be lying awake every night replaying everything they ever did wrong or perceive that they did wrong since second grade. They deserve to be supported, to be heard, to be listened to, instead of being told like, "Oh, it's anxiety, it's depression, it's getting old, it's that you're a mom. Have you tried losing weight?" like we all hear in women's health. And so it was through my years of making clinical observations of these connections between PMDD and ADHD, PCOS—which was formerly known as PCOS—and ADHD, and seeing that cyclically as things change or as women's life cycles change, like postpartum or perimenopause, their symptoms intensify.
And it wasn't until I was late-diagnosed myself with ADHD that I realized there's no resource for this. There's no place where women can go and get this information. And I, fortunately, am a medical provider who teaches other medical providers all over the world how to prescribe hormones and how to treat women. And so in doing that, I've been able to work with prescribers as well on shifting and changing things and seeing the impact we can make, which is part of what inspired my book, ADHD in Women.
William Curb: Yeah, I mean, it's one of those things where I just keep hearing from people where they're like, "Oh my God, this explains my life experience so much," and it's so important because so many women do get that late diagnosis because they finally are hitting that wall where it's like, "Oh, I can't cope with things anymore." And it is because of—or what I assume is because of—these hormonal changes that are making the ADHD suddenly that much more difficult to manage.
Dr. Jolene Brighten: Mm-hmm. Yeah, it's so very true. And often when we talk about ADHD and women, it's always the focus of estrogen and what estrogen is doing. In the book, I call her the "it girl" because many neurotransmitters are following estrogen along: acetylcholine, which is what helps us know why we went into the room in the first place, what we're saying throughout the entire sentence and not losing words mid-sentence; dopamine and norepinephrine, which we think about as those classic ADHD neurotransmitters; and then there's also serotonin, which everybody thinks about for mood, but it has a lot to do with neuroplasticity, our learning, and the health of our brain overall. But for women, it's so much more complex because every single month they are shifting and altering their brain.
So when the period starts, we enter the follicular phase. There's a whole lot of these rapid changes under the influence of estrogen. We ovulate, we pass ovulation, we are now in the luteal phase. Now the brain has to completely adapt to the rise in progesterone and the change in a new neurotransmitter, which is GABA.
William Curb: Yeah, and it's one of those places where it's both predictable, but kind of unpredictable in how you're going to respond, especially if you aren't used to following ADHD itself, where you're like, "Oh, I'm still learning about ADHD," and then "Oh, this is completely unpredictable how this is working," is often what I hear it described as.
Dr. Jolene Brighten: Yeah. Before it was ever well-documented in the research, women have been reporting what is called premenstrual exacerbation—during that luteal phase, ADHD symptoms get amplified. It was only in the last year that we had a research study validating what women have been saying. Impulsivity can get worse closer to when your period arrives, emotional reactivity can be heightened, and people don't often think of emotional regulation as an executive function. And yet, that's so much because the DSM doesn't have it in the criteria necessarily—and I mean, justifiably so. It's a very hard thing to quantify, and the DSM is trying to capture who fits into this bucket as neatly as possible.
And emotional dysregulation can look different for a lot of people. Rejection sensitive dysphoria could be a form of actual emotional dysregulation that's being classified as RSD. PMDD and having that condition also has an emotional reactivity to it. So it starts to become this question of, okay, is it one condition? Is it another condition? Or is it what we are seeing more plainly in the research: an intersection between hormones, co-occurring conditions, and ADHD?
William Curb: Yeah, and then I would just layer on the idea that even without the hormonal changes being that factor, while I have never experienced a period myself, I have heard they are very unpleasant a lot of the time. And having that in your sensory path, that itself is such a distracting and exacerbating condition.
Dr. Jolene Brighten: Right. Well, and I do want to clarify for people listening: periods shouldn't be so uncomfortable or so painful that you need pain meds and those don't work, or you have extreme bloating or emotional dysregulation. What we see in the ADHD population is that women are three times more likely to have an incredibly severe form of PMS. And when you imagine PMS and then multiply it by a million, that's PMDD. ADHD women are three times more likely to have PMDD-like symptoms. They're also twice as likely to be diagnosed with endometriosis, which is one of the leading causes of secondary period pain. And so it's really important that... I think it's really easy to be like, "Oh yeah, of course periods are uncomfortable."
But we have to ask more questions about that because it may be that "I don't like the sensory issues of having to deal with a period." It can also be too that as hormones change—I see this often—women will report things like sensory sensitivity heightens in their luteal phase. So again, that's the time after ovulation, before your period. Women will have more food aversions, things where they're like, "I can suck it up and handle it at certain times of my cycle, but other parts of my cycle, I just gag. I can't do it." And then society—the wellness community—tells them, "Well, you're a failure 'cause you have to eat 30 plants a week and you have to do this and you have to do that."
But that's what I try to do differently in the book. I think a lot of ADHDers know what they should be doing. That's not helpful. They need to know how to make it accessible for them.
William Curb: Yeah, although I often fall on the side of a lot of ADHDers think they know what they should be doing and just assume that's the course, and then don't... They're like, "Oh yeah, these are all the things you're supposed to do," and then, "I'm a failure." And then they look into it, and it's like, "Oh, actually, I was just assuming the highest bar rather than the lowest bar."
Dr. Jolene Brighten: Oh, isn't that so true though? I mean, this is why we see so many ADHD women who are straight-A students. They're high-achieving, and they say exactly that: "The A was the floor. I wasn't allowed to go below the floor." And I think so many things that you hear about—like sleep, exercise, even how to feed yourself—don't often come from the ADHD lens.
And then the ADHDer tries it, right? They try to have that 37-step morning routine, then they fail, and they think, "Well, I'm the problem. I'm a failure. It's not worth trying again." And the fear of failure can be a real reason why we have such a problem getting started on tasks. Yeah, it will get called things like lazy: "Oh, you're just not motivated." But it might be that you have tried, and it failed, and it sucked, and it hurt. And so what we need to do is shift and change things to make them accessible for the individual. And I agree, we have to individualize things because, in the book, I have an ADHD hormone profile quiz, which is very much about figuring out what hormone is driving your symptom pattern and what you specifically need to address, rather than telling you like, "Hey, we all need to work on eating our cruciferous vegetables every day for estrogen metabolism."
It's looking at what is the smallest lever we can move to get you the biggest results? Because once we do that and you have a win, it's a whole lot easier to keep the momentum.
William Curb: Yeah, and I... Well, so I'm kind of curious here too, since this is such an emerging field: how strong is the evidence here for some of these things? What actually has a lot of clinical or evidence-based backing, and what's more stuff that you're observing from people you've been treating?
Dr. Jolene Brighten: That's such a great question, and I think the reality we have to recognize is that the majority of ADHD research happens in children, right? Because the goal is "How do you get them to sit still?", which is honestly the most detrimental thing that we have ever done to ADHD children because the brain requires movement to be able to generate energy.
And so this is an area where we do have good research. What I will say, though, is with the caveat of understanding that there are many things done in children, and only in the last five years have we really seen an explosion of research around women specifically—adult women with ADHD. A lot of that is going to be observational, but in the field of psychology and even neuroscience, that's a great starting place to actually ask the population, "What is your experience?", to know how to answer those questions. We see too often that research will be done on a male animal model or a male human model, or if they have a female animal model, they'll actually remove their ovaries and make it so that they're not necessarily female in terms of the female experience of hormones, and then try to apply that to women.
So it's a lot of teasing out in the research, but I'll come back to the exercise piece because there's very strong data on this. Now, when we look at the ADHD brain, there are a few hypotheses about poor utilization of glucose. We have the mitochondria in our brain—let's go back to sixth grade science for a minute and remember it's the powerhouse of the cell. It's going to create all the energy for the cell. Now, we use glucose to do that, and an ADHD brain is not as efficient at that. But there's something that I like to call the backup crank generator. So if the powerhouse of the cell is the mitochondria, then the literal crank generator—you gotta move it—is exercise.
There's been so much research to show even just five minutes of movement—breaking up sitting at a desk—can help you lock in and focus more. There's research saying that one of the most detrimental things we do to our brain is sit too long. And then there's research showing 20 minutes of moderate physical activity—doing something you like that gets your heart rate up while you're still able to talk through it—can get you two to three hours of attention, focus, and peak cognitive performance. I think that's pretty exciting when we look at that. Then there's the evidence of increasing BDNF, which is Miracle-Gro for the brain.
There is also good blood perfusion. When it comes to women, it's especially important for our hormonal and immune health that can affect our brain. So with all of that said, you didn't hear me prescribe that you must do one specific type of exercise. The place we start with the ADHDer is: what do you actually enjoy that you can sustain for 20 minutes?
And we also didn't talk at all about wanting your body to look a certain way. I want your brain to perform a certain way, and that's why we talk about exercise. I can certainly talk more about nutrition, hormones, or lifestyle. But I think the exercise component is something that's really accessible to a lot of people.
For people who have a disability, I also include other ways that you can move your body if you have fibromyalgia or POTS, which is very common with ADHDers.
William Curb: Yeah, it's one of those things that I always have to keep coming back to when I'm like, "Oh, I've let exercise slip." It's like, "Oh, I can really tell." It just affects the day.
Dr. Jolene Brighten: Yeah, and for a lot of women, it affects their mood. That's another reason why I like to start with exercise, because that has been shown to be so effective in mood management. That's especially important when we consider that anywhere from 30 to 50% of PMDD women will respond to the standard of care treatment, which is an SSRI.
That's not great numbers when you flip it the other way and say 50 to 70% may not. But we know if you're on an SSRI, that can help with neuroplasticity and the brain. You can couple exercise with that—that's totally safe. Or you might be someone who's like, "That didn't really work." You can talk to your doctor about exercise.
William Curb: Yeah. And again, as you were saying, it's 20 minutes, and maybe that's something that you don't hit today, but you build up to...
Dr. Jolene Brighten: Absolutely. And I think people would be surprised, because you can go for a 20-minute walk—and I'm talking about 20 minutes if you want to focus really well. But I also said you could just do five-minute breaks. I love when ADHD patients say, "I'm gonna stack it with other habits because then my brain gets triggered. After I brush my teeth, I'm gonna go ahead and do 10 squats. While I'm making coffee, I do 10 jumping jacks." There are just different ways that you can work things in. Sometimes people are like, "I'm gonna set an alarm, and every 45 minutes, I get three to five minutes to dance by myself." And that can be so rewarding to couple with: "Okay, I'm gonna get a task done, and as I work on this task, I have a timer. Get this much done in this period of time, and then after that, you get to listen to your favorite song and dance." We can start shifting and changing things so that you're getting actual rewards.
William Curb: Yeah, it's funny how when you do those things, I'm like, "Oh yeah, I just put on this song I like," and that lifted my mood. I didn't really think about it that way before, but lately when I want to do some housework and I put some music on, it makes it that much easier. As long as I'm hitting all of those marks, it's like, "Oh, this is not so hard."
Dr. Jolene Brighten: Yeah, right there it's such an ADHD hack to have playlists—your favorite playlists for your different activities. Paying attention to what helps motivate you when it's time to put clothes away or fold laundry keeps your brain stimulated.
Sometimes people say, "I'm gonna listen to my favorite podcast, do an audiobook, or body double by calling a friend to have a conversation." I think it's really important for ADHDers to reframe away from "I'm a failure when I can't do things consistently," and start to look at "What can I congratulate myself for doing?"
Even as you said before, the bar is sometimes set so high. I will have people make a sticker chart. It is highly effective to externalize the things you are doing well and see it. When it comes to exercise, people might say, "When I exercise for a month consistently, then I'm going to get this reward."
And I say, "Let's go smaller. When I do one day, what reward am I getting? When I do three days, what reward am I getting?" When we say, "Just take the first step, and you deserve to congratulate yourself on that," it can be such a mindset shift that helps you be so much more successful at getting started on the thing you know is going to help you.
William Curb: Yeah. Well, especially when it can be so hard in my head to realize going small is the way to go because I can build momentum off of that. But when I make the goal just to put on my shoes and have clothes ready to go to go on a walk—like, all I have to do is that. If I don't feel like going on a walk after that, I can stop. But 90% of the time if I do that, I will go on a walk.
Dr. Jolene Brighten: Yeah. And the other thing too is I think it's totally okay to go on a walk and go to your favorite coffee shop—to go on a walk with purpose. That's another thing where ADHDers are like, "I'm not gonna just wander the neighborhood. That's so boring."
Assigning yourself a goal like, "Instead of ordering takeout or coffee to be delivered, if I have the means and I live or work somewhere where I can do this, I'm going to walk there, get this item, walk back, and enjoy it."
That leads into another strategy I think is really effective: building micro-pleasures into your day. I call them little pockets of pleasure throughout the day because often the ADHD brain gets to the end of the day—and this is especially true for moms—and the brain doesn't want to go to bed because it says, "I didn't get my time. I didn't get any time to myself. I didn't get any of the little dopamine surges that I wanted to feel today. All I got was checking off tasks I don't even like doing and being there for everyone else." Finding little ways to put pleasure throughout the day can actually make it easier to fall asleep at night.
And if you are struggling to fall asleep at night, 70%-plus of ADHDers have some kind of sleep issue. That could be delayed sleep phase onset, where your melatonin rises closer to midnight or 1:00 AM instead of 9:00 to 10:00 PM. Something you can try is giving your brain a little stimulation, but the right kind of stimulation.
Maybe that's knitting, playing a card game, or reading a book—something that feels like it's just for you and you enjoy, but isn't too stimulating. Someone was just sharing with me that they love online shopping, but when they start at night, they can't go to bed.
Okay, that's not the thing we save for bedtime. Can you allow yourself some time to scroll on your lunch hour? I know we all say eat your meal and don't be on your phone, but maybe you eat your meal and build in five minutes of scroll time to look at items. Whether you actually buy something or just shop is a different story, but that way you build it in earlier in the day instead of denying yourself.
William Curb: Yeah, and I mean, one thing I say is I've never been scrolling on my phone and found something that made me want to go to sleep.
Dr. Jolene Brighten: Yeah, that's so true. That's so well said.
William Curb: If I'm doom-scrolling and pop it open, I'm like, "Ooh, this is a mistake." But at the same time, if you say, "I'm going to do zero of this," I find there is a lot of demand avoidance where I'm like, "Well, now I really want to do it."
Dr. Jolene Brighten: Yeah. I also think we're perpetual toddlers. Everything we thought we stopped doing at two or three—no, we really haven't. We still need a bedtime routine, we still need to move our body, we still need to eat regular meals, we might even need a nap, and we certainly don't like to be told no or that we can't have something. We throw a fit in our brain. We've found a way to "adult" it so it doesn't seem so childlike, yet it still is.
William Curb: Yeah. And sometimes I feel bad dealing with my inner toddler, and I'm like, "Ah, I should be nicer to myself." But no, it really is a toddler.
Dr. Jolene Brighten: Yeah. Well, you wouldn't scream at a toddler or just tell them no. It is important to see that inner child in yourself because there are a lot of ways that we act due to unmet needs. 50 to 75% of women reach adulthood before being diagnosed with ADHD, so we had unmet needs.
Our ADHD wasn't recognized and we had to learn to compensate. That can lead to being an adult and thinking, "I can do what I want now." Maybe what I want isn't always the best choice, but it's because I finally get the chance to treat myself in the way I wish I would have been treated.
William Curb: Yeah. Allowing yourself to have fun in your life can feel so difficult at times. I've been working on scheduling my day recently, and one prompt that keeps coming up is, "When am I scheduling fun in the day or week?"
I'm like, "God, this is hard. I don't like the fact that I don't have any fun scheduled," but I know if I don't schedule it, oftentimes it just doesn't happen.
Dr. Jolene Brighten: That's even true with weekends. We think, "On the weekend I'm going to do something fun," but we don't make a plan because planning requires a lot of executive function, and by the end of the week, it's hard to do all that.
Then you get to the weekend and realize, "I haven't left the couch and it's 2:00 PM. Where did the time go?" It takes executive function to get out and do fun things. Learning to schedule fun is really important.
For some people, time-blocking works. But I always caution people because when they start time-blocking, they usually think, "I'm gonna be so productive. Look at all the things I'm gonna get done." Especially for women who cycle, the brain isn't meant to be in peak productivity the entire menstrual cycle. That's how you are physiologically designed.
It's not a bad thing unless capitalism tries to exploit you and wring every drop from you. When you learn to pull back three to five days before your period and do a little bit less, you actually give yourself more.
You have more ongoing energy, you're less likely to fall into burnout, and you show up for your kids more. Women often report being more productive at work when they decide not to push themselves during that time. Research comparing neurotypical women to ADHD women shows that the luteal phase is a lot harder on ADHD women.
While a neurotypical woman might feel like she isn't performing as well cognitively, objective tests show they perform fine. The ADHD woman, however, genuinely struggles—not because she's dumb, but because her brain is shifting, changing, and doing so much. During the follicular phase, neurons branch out and grow. Then in the luteal phase, that pulls back while GABA receptors come online to deal with progesterone changes.
I stand in awe of what the female brain does. It changes in puberty, after having a baby, during pregnancy, during perimenopause, and post-menopause. You don't see that in the male brain. Thinking you're lazy, dumb, or weak because your brain is biologically programmed to undergo these changes doesn't track with reality.
William Curb: Yeah. We all have so much going on, and it's always ratcheting up. I notice natural cycles for myself where I have a good week and think, "Next week I'm going to do even more." Imagining adding times of the month where my brain isn't working with me on top of that sounds maddening.
Dr. Jolene Brighten: Yeah. Men fall into that trap as well with the honeymoon phase of burnout: getting excited about something, doing it for 10 hours a day, hyper-focusing, and forgetting to walk, eat, go to the bathroom, or sleep.
The body has needs, and the ADHD brain is really good at ignoring those when we fall in love with a task. Short-term exposure to cortisol actually makes dopamine work better in the brain, but chronic cortisol exposure causes all neurotransmitters to struggle. You don't produce or use them as well. After mood and energy changes set in, physical symptoms appear—headaches, muscle aches, and pains. Only at that point do we realize we're on the road to burnout because we forgot our basic needs.
William Curb: Yeah, I'm hearing the story of Icarus here.
Dr. Jolene Brighten: Yes! Oh my God, yes. We were traveling recently and saw wings, and my son said, "I'm pretty sure those are Icarus's wings." I asked, "You know that story?" and he said, "Yes, Mom, I know my limits. Don't fable me now."
William Curb: I love talking with kids when you realize something you've discussed for years has been absorbed so well.
Dr. Jolene Brighten: Yeah.
William Curb: But yeah, I'm always amazed at my own inability to realize my limits, thinking, "This is what I did last week. Why can't I do even more next week?"
Dr. Jolene Brighten: Yeah, we forget that everything has a cost. We think, "I was able to do this much last week," without noticing that maybe we didn't sleep as well, our nutrition wasn't as great, or we spent energy socializing.
Because we see neurotypical people or media portrayals where everything seems fine and nobody talks about recovery time or nervous system regulation, we forget these things have costs. I talk about women with ADHD who have co-occurring conditions like lipedema, endometriosis, adenomyosis, or fibromyalgia. They do one small task in a day and come home exhausted, unable to make dinner. People on the outside wonder what the problem is, but everything has an additive cost that compounds over time.
William Curb: Yeah, we're borrowing from our future self: "I'm hyper-focused today, so I had a great day by borrowing energy from tomorrow."
Dr. Jolene Brighten: Exactly. I tell women to "gift your future self." Set reminders today for your future self. A reminder went off on my phone today for a book series I wanted to read that I set six months ago, and I was so grateful to my past self for setting it up.
Think about other ways you can delegate or set things up. For women with corporate jobs, I often suggest setting an autoresponder for a few days if you're experiencing burnout, in your luteal phase, or having a hard perimenopausal week.
An autoresponder helps people help themselves by listing FAQs and contacts for specific issues. That eliminates decision fatigue from small tasks. You can add, "If this is truly urgent, write 'URGENT' in the subject line." That delegates problem-solving away from you. ADHD women can fall into people-pleasing or always solving crises, so gifting your future self with extra bandwidth is essential.
William Curb: Having kids complicates that too—my kids will go to my wife with a problem when she's busy, even when I'm available. They always choose the busiest person to bother.
Dr. Jolene Brighten: That, or they choose the person most likely to say yes. Yesterday my son asked me while I was working if he could make something in the kitchen. I told him to make sure our nanny supervised him. He was opening a pomegranate, which my husband wouldn't have agreed to because now there's pomegranate everywhere. But my nutrition science brain thought, "Polyphenols are great for supporting ADHD brain and gut health!"
My husband asked, "Did you not consider the mess?" and I said, "He had supervision, we'll deal with the mess later." My son came to me because he knew I'd say yes for nutritional reasons, whereas my husband would focus on the mess. As a teenager with ADHD, my son wiped the counter and thought he was done, missing the mess on the floor and cabinets. It's an opportunity to teach how to break down tasks in manageable ways.
William Curb: I do that with my son when he leaves wrappers on the counter. I'll ask, "Do you want to check that again?" But I do the same thing when cleaning the living room and wondering how there's still stuff on the floor.
Dr. Jolene Brighten: My husband has ADHD too, so my son never stood a chance! My husband gets frustrated with my son for the exact same things he does himself. That's a hard part of parenting—seeing your own struggles mirrored back to you.
William Curb: Yeah, my daughter is a clone of my wife, and I have to remind my wife, "She's doing what you do." It's important to realize our own idiosyncrasies drive us crazy.
Dr. Jolene Brighten: Depending on how you were treated as a child, that can be tough. There's an estimate that ADHDers receive 20,000 more critical messages in childhood than non-ADHDers. Whether that number is exact, the experience feels that way because executive function struggles draw criticism.
Dr. Russell Barkley talked about the maturation lag in ADHD—being about 30% behind in prefrontal cortex development. When people said "act your age" at 13, you were acting your biological age, not your calendar age. The myelin sheath insulating neurons also experiences a maturation lag. Criticism often stems from people not understanding that we weren't being disobedient; some of us have auditory processing disorder or need time to digest information before responding.
When issues come up with my children at school, I sometimes feel intense anger toward teachers before realizing, "This is about my own past experiences and how horrible I was made to feel at school."
William Curb: The worst feeling is saying something to your kid and realizing, "That was said to me and I hated it." Then you have to go apologize and own up to your mistake.
Dr. Jolene Brighten: I interviewed pediatric psychologist Dr. Ann-Louise Lockhart on The Dr. Brighten Show about what happens when a parent dysregulates and says something hurtful. She said the most important part is the repair. Hearing an adult apologize is deeply healing for children because it models that making mistakes is okay and relationships can be repaired.
William Curb: Your options are apologizing or pretending it didn't happen, and we all know how bad the latter feels.
Dr. Jolene Brighten: Very well said.
William Curb: Circling back to cycles, how do people handle changes in medication effectiveness?
Dr. Jolene Brighten: If you notice your medication isn't working as well the week before your period, you are not imagining it. Clinical trials historically never studied how to medicate a cycling female with ADHD.
Estrogen boosts dopamine and norepinephrine. In the luteal phase, progesterone takes over and estrogen takes a back seat, so you don't get the same neurotransmitter stimulation. That doesn't mean your medication is useless. Some women stop taking it that week because it feels jittery due to stress system changes, while other prescribers increase the dose during that week. Always consult your prescriber before making changes.
Women have reported in clinical contexts that standardized saffron supplements help medication work better during the luteal phase. Research in children shows Ritalin works better combined with saffron to alleviate symptoms. While we can't automatically apply child studies to adult women, it warrants further research.
On a mitochondrial level, studies in animal models show Ritalin reduces reactive oxygen species (free radicals) in ADHD brains, helping mitochondria function better and utilize glucose. Interestingly, giving stimulants to non-ADHD animals increased oxidative stress and inflammation.
William Curb: That flies in the face of what people colloquially assume about these medications.
Dr. Jolene Brighten: Online supplement companies claim ADHD medications increase oxidative stress, but research shows ADHD brains inherently have mitochondrial dysfunction and need antioxidants regardless. The medication itself isn't causing the oxidative stress in an ADHD brain.
Eating polyphenol-rich foods like pomegranates, herbs (rosemary, turmeric, oregano, thyme), vitamins C and E, and drinking tea helps manage oxidative stress naturally.
William Curb: Small diet modifications are great. I have my tea here—which is cold now, as many ADHDers experience! I like having a warm, non-caffeinated drink that won't make my heart race.
Looking at lifespan changes beyond monthly cycles, what should people watch out for to discuss with their doctors?
Dr. Jolene Brighten: Research shows ADHDers can enter perimenopause up to 10 years earlier and experience twice the symptom severity. Perimenopause can begin in a woman's 30s rather than her 40s.
Early perimenopause symptoms aren't just hot flashes and night sweats; they include insomnia, rage, emotional dysregulation, irritability, brain fog, and losing words mid-sentence. Women in their 40s often feel like failures when, in reality, hormonal changes are compounding a lifetime of doing too much.
In my book, I cover nutrition, lifestyle, and supplement strategies, along with an entire chapter on hormone replacement therapy (HRT) tailored for the hormonally sensitive ADHD brain. For instance, estrogen therapy can raise histamine levels, causing anxiety and sleep disruptions, while progesterone can occasionally have a paradoxical stimulant effect.
Understanding your body early—especially if you have a history of PMDD—helps tailor HRT safety if you have a uterus. About 25% of unassisted women enter post-menopause with severe ADHD symptoms, but with proper clinical interventions, women don't have to white-knuckle their way through life.
William Curb: That's fantastic. As we wrap up, are there any final thoughts you'd like to leave with the audience?
Dr. Jolene Brighten: Recognize that you are doing so well just as you are. You are likely working harder and keeping more mental tabs open than anyone else. I encourage you to do less and externalize more.
Externalize executive function into the physical world: use sticky notes, keep supplements visible on your nightstand, and stop trying to rely solely on memory. Automate tasks where possible—like coffee makers—or buy pre-boiled eggs if peeling them is a barrier to getting protein. Live your life joyfully rather than striving for perfection, which often means doing less to give yourself more.
William Curb: Awesome. Thank you so much for coming on the show, Dr. Brighten.
Dr. Jolene Brighten: Thanks so much for having me!
This Episode's Top Tips
With ADHD it's often said that we know what to do, but have trouble executing on those ideas. For something like exercise, the best idea is then to work towards making it accessible. Instead of focusing on getting the biggest result, we can look toward what we actually enjoy doing and can sustain, even if for just a little bit, we're going to see far more consistent results.
It's important to remember that everything has a cost, even if we're not noticing it at the moment. These costs can compound when we're not paying attention and lead us to wonder why doing just one simple task can leave us exhausted. This doesn't mean that we necessarily need to be doing less, but it does mean we need to pay extra attention to what something is actually going to cost us.
Our brains are not meant to be at peak productivity all month, and that applies doubly if you experience a cycle. As Dr. Brighten says, "that is [just] how you are physiologically designed." This means that it's important that we're giving ourselves grace and letting ourselves block out time on the calendar for when we're not going to be at our peak (and again, we do not need to be at our peak all the time, or even most of the time; it's called the peak for a reason).