Hi Holly! I’d like to know if perimenopause truly reveals previously masked ADHD in women or if perimenopause symptoms are just very similar to ADHD symptoms? Thank you for your work
Thanks for asking Fiona — it’s something I’ve been really curious about too. My own perimenopause symptoms often feel so much like ADHD, and it’s made me wonder whether this phase of life actually reveals traits that were previously masked, or if the two simply share such similar patterns that they become almost indistinguishable. Either way, it’s fascinating how much this transition seems to strip away old coping mechanisms and show us what’s been underneath all along.
What do you do about the issues of perimenopause/menopause if HRT is contraindicated? I had hormone sensitive breast cancer in my 20s so will never be able to take hormone replacement and have in fact been in chemical induced menopause for most of the last decade.
I recently started HRT and felt happy with my choice but then I went to a women’s health talk and the nurse practitioner said women who are still having monthly periods should not be on HRT yet. I feel like I got very conflicting views and now I’m
This conversation feels so needed, especially for women navigating both perimenopause and recovery. I’ve noticed how hormonal shifts can quietly stir up old coping mechanisms or emotional patterns — not in the same way as before, but with a kind of tenderness that demands new understanding.
For me, sobriety + sober curious living x hormonal change have both been teachers in presence and learning to be more fully embodied. I’m also curious about the link between hormones, creativity, and regulation. As an artist, I can feel cycles of energy and clarity move through my body like seasons — and I wonder how much of that is hormonal rhythm, and how much is simply being a woman in flux.
I’d love to hear more about supporting hormonal health naturally or holistically (for those of us who may not choose HRT), and how we can reframe aging not as decline, but as deepening embodiment.
These are such rich questions Jocelyn thanks for adding them. I love the artist angle too, especially because I get so personally dysmorphic about my talent/ability career choice like, cyclically :)
Thank you so much for responding, Holly!! One of the most power tools believe it or not in my creative journey the last several years as I navigate healing and the hormonal shifts has been anger! I’ve almost come to anticipate it each month and look forward to seeing what comes up…and I definitely understand the dysmorphia around talent/choices/ability because like you, I am living it! And here we are—another day!
Thank you so much for this thread! I discovered I had terrible PMDD when I quit drinking at 35yo my doctor put me on SSRIs but it barely helped. She then thought about Ritalin due to my absolute lack of motivation during my luteal phases, which was debilitating to the point I could barely motivate myself to get up and go to the toilets. Ritalin helped immediately and I then started to realize that Ive had ADHD all my life but never noticed before. I read that approx. 60% of menstruating people with adhd have pmdd. I would like to know more about that. What are the correlations between adhd, hormones, mental health and substance abuse ?
fantastic to see this and I'd love to add to your great footnote: for some women, HRT is literally life-saving. I wondered if you will be speaking about early menopause and premature ovarian insufficiency/failure (POI/POF)? These are conditions with similar symptoms to perimenopause and menopause but happen to women before the age of 40-45 (I'm one of them, I was diagnosed with POI leading to an early menopause when I was 37 but had symptoms that went undiagnosed for years, its a rare condition and affects about 1 in 100 women). Without HRT, studies show that women with POI/early menopause can be at a higher risk for cognitive decline, heart issues, bone loss, and increased morbidity overall. HRT is akin to a vitamin supplementation for women with POI, replacing the massively imbalanced and declining estrogen and progesterone levels that are not being produced at normal levels for their age (which tends to make the perimenopausal and menopause symptoms much more severe when they occur earlier in POI rather than later/more normal age range - in short, our hormones are responsible for so many of our body systems to function in a basic homeostasis). Of course, everyones choice for HRT is different; it took me years to consider starting HRT while I came out of my denial about my diagnosis (in part confusion caused by medical doctors who 'didnt know what to do with me' and referred me to a specialist who properly diagnosed me). Now looking back, I was wish I had started HRT supplementation way sooner. I wouldn't be able to function without it. From my experience, I am baffled why some people would think HRT is in conflict with sobriety and hope my post conveys this compassionately from a biological perspective. Love the comments here and Julianna's - I can see how I've shifted myself from a 'purity' mindset from this experience too, realizing I couldn't 'fix' or 'fight' POI on my own without actual help and medical support and listening to what the doctors were eventually telling me to do re: HRT. Anyhow, sorry for the rant, its become a bit of a passion of mine to bring POI to the peri/meno/HRT conversation (I work with this as a massage therapist and yoga teacher too). This post popped up on my Substack and I was so happy to see this conversation was happening! Thank you x
Oof, thank you for sharing this. I’m adding your question, but just holding that while I didn’t have your experience, I did put off hrt for far too long until a friend who’d been riding my major ups and downs finally said, you’ve got to look into this. Thanks for all of this.
62 yrs old and 3 months sober. I used to rely on cannibas for a good night's sleep, but now I'm taking magnesium and all the things and have yet had a restful night's sleep.
Hey Anne I had to stop using cannabis for sleep. I’ve had to do a million things and now go to bed fine without (canna does not work for me in my life any longer).
- no caffeine after 10 am and no more than one cup
- keep blood sugar consistent throughout day, including before bedtime (for me I get a spike if I don’t eat before bed)
- before bed: hot bath sometimes with a huge bag of magnesium salt (huge—4 cups), I add different oils (currently: osea vagus nerve oil) OR hot shower OR in a pinch I do cold water on my feet only
- no screens thirty before bed but often much more; I also use a wares color filter on my screens (Apple settings: color filters)
- I take magnesium glycine in morning and at night; I dump 750’GABA under tongue (NOW brand); sometimes melatonin
- right now I am taking 200mg of cbd oil (I use a stupidly expensive kind, nuerogan) in morning and night (this is short term—it’s too expensive)
- before bed, hot tea, usually Bedtime Tea (yogi tea)
- same bed time same wake time
- room is kept cool (55 degrees); I use earplugs and there’s no light pollution
- I don’t sleep with my partner if he’s gonna wake me up — separate beds
- I do a short breath meditation before bed, four strokes in thru nose four strokes out OR long deep breath OR 4-7-8 breath
- if that doesn’t work, I do a body scan until I fall asleep
- lastly: if I can’t fall asleep I stop trying, get up, read book, try again.
Is this wildly inconvenient?? YES. Is it better than using pot? For me, YES. Is it worth it to sleep thru night?? YES. Think you could take a handful of these suggestions and be well served. I’m an extremes who hates not sleeping.
Hi Anne, I’ve been using cannabis as well until I started tracking my sleep. On it I wake up 10 times a night, without it just 2 or 3! I was so surprised!
First of all, the idea that HRT is out of alignment with sobriety is very strange to me. Although I am no stranger to purity culture and the deeply oppressive experience I have about it. It’s been part of my journey around sobriety to face my ego and self righteous ideas of being able to do anything without help. Ugh. I’m curious about the ways estrogen supports a more balanced approach to (anything) but particularly to habits/goals/intentions. I tend to fall into the impulsive camp of folks who feel very determined and focused for a time and then collapse off a cliff. This has been such a familiar pattern I have just assumed it’s “just me” but am now wondering if it has to do with hormone spikes and drops over the past decade-ish.
I love this so much! So so good thank you!!! and yes, tragically some folks consider hrt, psych meds, and medically assisted treatment like suboxone as violations 🙃
This is a sideways question: Has Dr. Schmidt struggled with addiction as part of her life experience? I'm asking because I've realized, through therapy with various professionals, that someone who truly grasps the dynamics of addiction can only be someone who has been there and back. Not that professionals can't offer valued advice and wisdom, based on clinical trials, anecdotal evidence and a wide raft of reference materials -- either way, I welcome her input. As a medical researcher, I did look into HRT and decided against it, so I am curious to hear what other options there are for general problems like hot flashes and sleeplessness. Thanks for asking for input from the community, that's brilliantly collaborative.
Thanks for this! She talks about her experience in the first episode. That said…I used to think this and in some ways do, but there are so many wonderful professionals I know that have not had a substance addiction who are critical to the field. And I know plenty of people in the field wirh “real experience” that are toxic and dogmatic. I’ve become open to the grey of it but I understand very very much what you’re saying.
Hi Holly, thanks for requesting questions. I am well into perimenopause but my symptoms have been manageable and I don't take HRT. Will this be detrimental to my future health? Should I be taking it like an insurance policy to protect my heart, brain etc. in later life? Thanks Holly, I'll look forward to the episode :)
Who in the actual F**K would assert that HRT is in conflict with "real" sobriety?!?!?!?! Probably the same people that say antidepressants are in conflict with sobriety?? Oh man, I am offended by that idea.
Anyway, my only questions around menopause that would really help me, is how being PAST menopause might impact sobriety. I had a surgical menopause years ago, no HRT, and am now past the age anyway where I would be going through it, but I just wonder if there is any helpful info on that stage of things as it relates to sobriety.
Thank you for all the research and distilling you do, that benefits so so so many other people. You are a gift to the world.
I’m well past perimenopause and I’ve never used HRT because I used to smoke. I know they’ve removed the black box warning but even so I don’t want it. Does everyone really need HRT. I’m 64
I’m gonna ask this! I do know they are now prescribing through end of life, especially creams, but we each get to follow whatever works babe and I know you’ve found your sweet spot ♥️
GAWD, I’m so grateful for this space and conversation. Thank you Holly.
I’m 47 years old and in the thick of perimenopause (7 months without a period) and in my 5th year of sobriety. My emotions are a f’n roller coaster, I am eating my way through all my feelings, the brain fog is persistent and scary some days. I’m so glad there are spaces that will discuss the intersection of this with sobriety. We are a tender bunch!
Also curious about any concerns with HRT if thyroid issues are present. I have Hashimoto’s and been on levothyroxine for a decade.
I am 5 years into menopause (I’m 55 years old) and have been alcohol-free for 5 years. I was a smoker (20-year pack history) so the risks outweighed the benefits in my personal calculations and I’ve avoided oral birth control and HRT. Alcohol was my coping mechanism for decades - I started self-medicating as a teen - so the emotional transition into menopause and sobriety was dicey on a good day and full of suffering otherwise. I am not an angry person and the rage I felt at times scared the *#!? out of me! Several times I legit thought I was losing my mind. I was stuck in an existential crisis for a solid 4 years. My question is - would being on HRT have lessoned my emotional suffering from the double whammy of transitioning into meno and getting sober simultaneously in a meaningful way?
Jill; this was my experience. I terrified myself, the rage and swings and breaks were overwhelming. I’ve had this same question and looking forward to asking it. Big hug.
There is comfort in numbers. Thanks for sharing you felt this range of destabilization too. I hope you have found some solid ground to stand on! I, most days, feel like a semi-sane middle aged woman now. 😂
Hi Holly! I’d like to know if perimenopause truly reveals previously masked ADHD in women or if perimenopause symptoms are just very similar to ADHD symptoms? Thank you for your work
OOHHH. This is good.
Thanks for asking Fiona — it’s something I’ve been really curious about too. My own perimenopause symptoms often feel so much like ADHD, and it’s made me wonder whether this phase of life actually reveals traits that were previously masked, or if the two simply share such similar patterns that they become almost indistinguishable. Either way, it’s fascinating how much this transition seems to strip away old coping mechanisms and show us what’s been underneath all along.
What do you do about the issues of perimenopause/menopause if HRT is contraindicated? I had hormone sensitive breast cancer in my 20s so will never be able to take hormone replacement and have in fact been in chemical induced menopause for most of the last decade.
This is really great thank you so much!! Adding. I have the same q.
I recently started HRT and felt happy with my choice but then I went to a women’s health talk and the nurse practitioner said women who are still having monthly periods should not be on HRT yet. I feel like I got very conflicting views and now I’m
More confused .
Interesting okay will ask.
This conversation feels so needed, especially for women navigating both perimenopause and recovery. I’ve noticed how hormonal shifts can quietly stir up old coping mechanisms or emotional patterns — not in the same way as before, but with a kind of tenderness that demands new understanding.
For me, sobriety + sober curious living x hormonal change have both been teachers in presence and learning to be more fully embodied. I’m also curious about the link between hormones, creativity, and regulation. As an artist, I can feel cycles of energy and clarity move through my body like seasons — and I wonder how much of that is hormonal rhythm, and how much is simply being a woman in flux.
I’d love to hear more about supporting hormonal health naturally or holistically (for those of us who may not choose HRT), and how we can reframe aging not as decline, but as deepening embodiment.
These are such rich questions Jocelyn thanks for adding them. I love the artist angle too, especially because I get so personally dysmorphic about my talent/ability career choice like, cyclically :)
Thank you so much for responding, Holly!! One of the most power tools believe it or not in my creative journey the last several years as I navigate healing and the hormonal shifts has been anger! I’ve almost come to anticipate it each month and look forward to seeing what comes up…and I definitely understand the dysmorphia around talent/choices/ability because like you, I am living it! And here we are—another day!
Thank you so much for this thread! I discovered I had terrible PMDD when I quit drinking at 35yo my doctor put me on SSRIs but it barely helped. She then thought about Ritalin due to my absolute lack of motivation during my luteal phases, which was debilitating to the point I could barely motivate myself to get up and go to the toilets. Ritalin helped immediately and I then started to realize that Ive had ADHD all my life but never noticed before. I read that approx. 60% of menstruating people with adhd have pmdd. I would like to know more about that. What are the correlations between adhd, hormones, mental health and substance abuse ?
WOW. Okay I had not heard that, I can’t wait to ask this one. Thank you thank you.
Similar to some of the Qs above, how do we know when it’s the right time to go on HRT?
Great question and adding. In this episode Rachel Rubin says it’s when you have symptoms…based on symptom vs hormone levels…if I recall but still going to ask!! https://podcasts.apple.com/us/podcast/the-peter-attia-drive/id1400828889?i=1000708059382
fantastic to see this and I'd love to add to your great footnote: for some women, HRT is literally life-saving. I wondered if you will be speaking about early menopause and premature ovarian insufficiency/failure (POI/POF)? These are conditions with similar symptoms to perimenopause and menopause but happen to women before the age of 40-45 (I'm one of them, I was diagnosed with POI leading to an early menopause when I was 37 but had symptoms that went undiagnosed for years, its a rare condition and affects about 1 in 100 women). Without HRT, studies show that women with POI/early menopause can be at a higher risk for cognitive decline, heart issues, bone loss, and increased morbidity overall. HRT is akin to a vitamin supplementation for women with POI, replacing the massively imbalanced and declining estrogen and progesterone levels that are not being produced at normal levels for their age (which tends to make the perimenopausal and menopause symptoms much more severe when they occur earlier in POI rather than later/more normal age range - in short, our hormones are responsible for so many of our body systems to function in a basic homeostasis). Of course, everyones choice for HRT is different; it took me years to consider starting HRT while I came out of my denial about my diagnosis (in part confusion caused by medical doctors who 'didnt know what to do with me' and referred me to a specialist who properly diagnosed me). Now looking back, I was wish I had started HRT supplementation way sooner. I wouldn't be able to function without it. From my experience, I am baffled why some people would think HRT is in conflict with sobriety and hope my post conveys this compassionately from a biological perspective. Love the comments here and Julianna's - I can see how I've shifted myself from a 'purity' mindset from this experience too, realizing I couldn't 'fix' or 'fight' POI on my own without actual help and medical support and listening to what the doctors were eventually telling me to do re: HRT. Anyhow, sorry for the rant, its become a bit of a passion of mine to bring POI to the peri/meno/HRT conversation (I work with this as a massage therapist and yoga teacher too). This post popped up on my Substack and I was so happy to see this conversation was happening! Thank you x
Oof, thank you for sharing this. I’m adding your question, but just holding that while I didn’t have your experience, I did put off hrt for far too long until a friend who’d been riding my major ups and downs finally said, you’ve got to look into this. Thanks for all of this.
thank you for this conversation and passing our questions on! x
62 yrs old and 3 months sober. I used to rely on cannibas for a good night's sleep, but now I'm taking magnesium and all the things and have yet had a restful night's sleep.
Hey Anne I had to stop using cannabis for sleep. I’ve had to do a million things and now go to bed fine without (canna does not work for me in my life any longer).
- no caffeine after 10 am and no more than one cup
- keep blood sugar consistent throughout day, including before bedtime (for me I get a spike if I don’t eat before bed)
- before bed: hot bath sometimes with a huge bag of magnesium salt (huge—4 cups), I add different oils (currently: osea vagus nerve oil) OR hot shower OR in a pinch I do cold water on my feet only
- no screens thirty before bed but often much more; I also use a wares color filter on my screens (Apple settings: color filters)
- I take magnesium glycine in morning and at night; I dump 750’GABA under tongue (NOW brand); sometimes melatonin
- right now I am taking 200mg of cbd oil (I use a stupidly expensive kind, nuerogan) in morning and night (this is short term—it’s too expensive)
- before bed, hot tea, usually Bedtime Tea (yogi tea)
- same bed time same wake time
- room is kept cool (55 degrees); I use earplugs and there’s no light pollution
- I don’t sleep with my partner if he’s gonna wake me up — separate beds
- I do a short breath meditation before bed, four strokes in thru nose four strokes out OR long deep breath OR 4-7-8 breath
- if that doesn’t work, I do a body scan until I fall asleep
- lastly: if I can’t fall asleep I stop trying, get up, read book, try again.
Is this wildly inconvenient?? YES. Is it better than using pot? For me, YES. Is it worth it to sleep thru night?? YES. Think you could take a handful of these suggestions and be well served. I’m an extremes who hates not sleeping.
Hi Anne, I’ve been using cannabis as well until I started tracking my sleep. On it I wake up 10 times a night, without it just 2 or 3! I was so surprised!
Interesting! Thanks for your reply.
😘😘😘
First of all, the idea that HRT is out of alignment with sobriety is very strange to me. Although I am no stranger to purity culture and the deeply oppressive experience I have about it. It’s been part of my journey around sobriety to face my ego and self righteous ideas of being able to do anything without help. Ugh. I’m curious about the ways estrogen supports a more balanced approach to (anything) but particularly to habits/goals/intentions. I tend to fall into the impulsive camp of folks who feel very determined and focused for a time and then collapse off a cliff. This has been such a familiar pattern I have just assumed it’s “just me” but am now wondering if it has to do with hormone spikes and drops over the past decade-ish.
I love this so much! So so good thank you!!! and yes, tragically some folks consider hrt, psych meds, and medically assisted treatment like suboxone as violations 🙃
This is a sideways question: Has Dr. Schmidt struggled with addiction as part of her life experience? I'm asking because I've realized, through therapy with various professionals, that someone who truly grasps the dynamics of addiction can only be someone who has been there and back. Not that professionals can't offer valued advice and wisdom, based on clinical trials, anecdotal evidence and a wide raft of reference materials -- either way, I welcome her input. As a medical researcher, I did look into HRT and decided against it, so I am curious to hear what other options there are for general problems like hot flashes and sleeplessness. Thanks for asking for input from the community, that's brilliantly collaborative.
Thanks for this! She talks about her experience in the first episode. That said…I used to think this and in some ways do, but there are so many wonderful professionals I know that have not had a substance addiction who are critical to the field. And I know plenty of people in the field wirh “real experience” that are toxic and dogmatic. I’ve become open to the grey of it but I understand very very much what you’re saying.
I’m curious about the links, if any, between and premature menopause (eg entering menopause before 40) and alcohol abuse.
I’m curious about premature menopause and links to trauma, egg freezing. Is premature menopause something that can be prevented?
Great ?—adding
Hi Holly, thanks for requesting questions. I am well into perimenopause but my symptoms have been manageable and I don't take HRT. Will this be detrimental to my future health? Should I be taking it like an insurance policy to protect my heart, brain etc. in later life? Thanks Holly, I'll look forward to the episode :)
This is a great question!! THANK YOU
Who in the actual F**K would assert that HRT is in conflict with "real" sobriety?!?!?!?! Probably the same people that say antidepressants are in conflict with sobriety?? Oh man, I am offended by that idea.
Anyway, my only questions around menopause that would really help me, is how being PAST menopause might impact sobriety. I had a surgical menopause years ago, no HRT, and am now past the age anyway where I would be going through it, but I just wonder if there is any helpful info on that stage of things as it relates to sobriety.
Thank you for all the research and distilling you do, that benefits so so so many other people. You are a gift to the world.
Yes it’s those ppl lol. This is an incredible question THANK YOU. And right back at you, you little gift. 🫂🫂
I’m well past perimenopause and I’ve never used HRT because I used to smoke. I know they’ve removed the black box warning but even so I don’t want it. Does everyone really need HRT. I’m 64
I’m gonna ask this! I do know they are now prescribing through end of life, especially creams, but we each get to follow whatever works babe and I know you’ve found your sweet spot ♥️
I think it is only recommended during the 10 years since your last period. I know plenty of women who have not used it and are fine.
GAWD, I’m so grateful for this space and conversation. Thank you Holly.
I’m 47 years old and in the thick of perimenopause (7 months without a period) and in my 5th year of sobriety. My emotions are a f’n roller coaster, I am eating my way through all my feelings, the brain fog is persistent and scary some days. I’m so glad there are spaces that will discuss the intersection of this with sobriety. We are a tender bunch!
Also curious about any concerns with HRT if thyroid issues are present. I have Hashimoto’s and been on levothyroxine for a decade.
Thanks for sharing all this Allison and I really love the hashimotos thyroid question—I think this is going to be a five hour convo lol.
LOL. It's a must needed convo tho! So much to unpack xoxo
I am 5 years into menopause (I’m 55 years old) and have been alcohol-free for 5 years. I was a smoker (20-year pack history) so the risks outweighed the benefits in my personal calculations and I’ve avoided oral birth control and HRT. Alcohol was my coping mechanism for decades - I started self-medicating as a teen - so the emotional transition into menopause and sobriety was dicey on a good day and full of suffering otherwise. I am not an angry person and the rage I felt at times scared the *#!? out of me! Several times I legit thought I was losing my mind. I was stuck in an existential crisis for a solid 4 years. My question is - would being on HRT have lessoned my emotional suffering from the double whammy of transitioning into meno and getting sober simultaneously in a meaningful way?
Jill; this was my experience. I terrified myself, the rage and swings and breaks were overwhelming. I’ve had this same question and looking forward to asking it. Big hug.
There is comfort in numbers. Thanks for sharing you felt this range of destabilization too. I hope you have found some solid ground to stand on! I, most days, feel like a semi-sane middle aged woman now. 😂