HRT, Perimenopause and ADHD: Using Cycle Mapping for Self-Advocacy
The time has come, my friends.
HRT and I are about to get up close and personal.
Peri perimenopause. Which is perimenopause, when you have a spicy brain, is really getting her claws in.
My intention was always to manage my perimenopause in the most natural way I could. Informed living, knowing my hormones and my cycle, diet and lifestyle habits.
That sounded great. Until I'd had more human puddle moments in the last six months than I might have done in the last six years.
If you're a regular reader, you'll know I cry a lot.
I'm an advocate for crying.
I don't believe in binary emotion. You can be having a genuinely lovely day and still need a little cry because things got too much.
Two things can be true at the same time.
And for neurodivergent people, especially, tears are often just a release from an already overloaded nervous system.
It's frequently mechanical. We just attach emotion to it.
But anyway. I've side-quested early.
What hasn't been OK is the wild levels of emotional dysregulation I've been managing over the last six months.
A few weeks ago, I made the decision, in no uncertain terms, that I am absolutely not prepared to white-knuckle my way through perimenopause feeling like this.
When neurodivergence meets perimenopause
Two years ago, I got my autism and ADHD diagnoses, though the realisation had been building long before that.
Since then, I've been mapping my neurodivergent traits alongside my hormonal shifts, which has delivered some very interesting insights into how my various traits show up across my cycle, where they feel loudest, and where they're hardest to manage.
I've always preferred to anticipate those shifts rather than be blindsided by them at the most inconvenient possible moment. And for a long time, the pattern stayed predictable.
But the last six months had been completely wild.
There are some neurodivergent traits and perimenopausal symptoms that overlap, so it's hard to know where one ends and the other begins, and honestly, to a certain point, it doesn't really matter.
What matters more is what tools you have to manage it.
Because ultimately, when you can't remember your own name and you're halfway through yet another box of tissues, it doesn't really matter how you got there. Just what's going to pull you out of it.
Yes, there have been some physical symptoms like night sweats and hot flushes.
But I never really expected the level of cognitive and emotional regulation challenges that have floored me.
I'd been having a chat with a friend who's very well-versed in all things menopause, and I asked about managing things naturally, because that was always my intention.
She said, "But I think you're already there, you already manage your diet and lifestyle well, and you have all of the information".
She asked me what other tweaks I could realistically make.
And it kind of hit me.
I was doing everything I could possibly do to manage this naturally, and it was still resulting in the feeling that I was slowly losing myself.
So I decided to investigate more.
The dopamine problem nobody told you about
I've noticed that the further into perimenopause I've got, the louder my ADHD traits have become.
Emotional regulation, executive functioning, decision making, and organisation are all off the chart.
ADHD creates a lack of dopamine in the brain.
Oestrogen is what helps support serotonin and dopamine accessibility across our cycle.
So with wonky oestrogen in the first half of my cycle, there is even less access to the dopamine I had too little of in the first place.
Cue many days feeling quite low. Which is so very far removed from my usual state of being.
And what I was very acutely aware of was that I felt low with no instigator, no reason, just a low feeling.
And that told me clearly it was my hormones and my neurodivergent traits not playing nicely together.
When we can separate the physiological response our body is having from our feelings, we have more perspective.
It doesn't mean it feels less intense. It just doesn't take over in the same way.
But when we don't understand what's happening to us, that feeling attaches itself to thoughts that don't belong.
e.g., I feel depressed, so I am depressed, or any number of things that aren't the full picture.
And it worries me to think about the people out there who don't have this understanding, who will arrive in their forties feeling like this and not be able to pinpoint why.
Which is why I'm so very grateful that I've been charting my cycle for many years and have this information at my fingertips.
I use a shading system across categories, which means I can see patterns visually across a page.
What I could see, looking back over the last six months, was that the darker shading had spread. The difficult times, which used to cluster mostly in the second half of my cycle, had moved forward into the first half too.
My cycle length has also shortened, from 33 days to 30. This is a recognised marker of perimenopause.
So I knew this data was the thing I needed to take with me to the GP appointment.
The appointment
I made the appointment, and I waited all day. They finally called at 7pm.
I got on the call knowing what I wanted to say, what evidence I had, and what I was asking for.
I told her how my traits had shifted and exacerbated over time.
I explained that my first option had been ADHD medication, but I've been on the waiting list for titration for a year, and I'm still roughly six months away from having anything in place.
So, HRT wasn't my plan B now. It had become the only available intervention.
I said I didn't want to feel the way I'd been feeling any more, and that's why I was there.
I said I wanted to trial body-identical progesterone and an oestrogen gel, if she agreed that was appropriate.
I also said I'm 44 and will be 45Â in six weeks because the NICE gui delines mean perimenopause can be a clinical diagnosis without blood tests for women over 45.
She tried to book me for a blood pressure check in two weeks, but I pushed back.
I said quite honestly that I didn't want to feel like this much longer, that I had a monitor at home, and I'd send her a photo.
She agreed. I sent the photo, and now I'm waiting for the prescription as I type this.
Honestly, I expected a bit more of a battle. But with two years of data, a clear rationale, and a specific ask, there isn't much room for argument.
She agreed with me, and I got what I asked for in the timeframe I needed.
And I kept thinking, what if I hadn't had that information?
What if I'd just gone in and said I don't feel very well and I'm not sure why?
What a different appointment that could have been.
Lengthy processes, endless follow-ups that didn't land anywhere, being fobbed off, and having it put down to something else entirely.
Why cycle mapping matters
Which is why I'm going to make the case for cycle mapping again.
Cycle mapping is not a tool to predict your period. I'm not interested in predicting periods.
I'm interested in everything else that happens across the cycle.
The other three or so weeks that don't come with the same obvious biomarker of a bleed, and which in many cases are harder to manage because of that.
You might be reading this, thinking it doesn't really apply to you right now.
But at the moment when you need data to advocate for yourself, you might feel differently.
Whether it's perimenopause, PCOS, endometriosis, PMDD, or anything with a cyclical pattern, having some kind of historical record means you can be specific.
Then, you can show what's happening and make an evidence-based case.
Becuase the gender pain gap is real.
I hear regularly from people that even female GPs aren't always sympathetic, and the stories of being dismissed entirely are not rare.
We need data.
Not because the burden of proof should fall on us. It absolutely shouldn't. But because when we go in and say I don't feel very well, that's often not enough.
Being specific, having something to point to, something that shows a pattern over time, changes the conversation.
Whatever form that takes for you, an app, a notebook, my mapping tools, or whichever, it doesn't matter.
Just start somewhere.
And please never be afraid to push back.
You know your body and its patterns better than anyone.
You have every right to be taken seriously by the people responsible for your health.
Don't let anyone convince you otherwise.
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