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Welcome to The Modern Midlife Collective—where midlife isn’t a crisis, it’s a rebirth. Hosted by Dr. Ade Akindipe, DNP, and Dr. Jillian Woodruff, MD, this is the podcast for women ready to unapologetically own their power, thrive through the ups and downs of hormones, weight, and self-care, and show the world that thriving at 40 and beyond isn’t just possible—it’s your birthright.
Biweekly, we bring you science-backed insights on hormones, menopause, longevity, and sexual health—real tools to empower women in midlife and beyond. With a fearless blend of functional medicine, real-life wisdom, and no-nonsense empowerment, we’re here to challenge the norms, break through the barriers, and help you step into a life of vitality, confidence, and unstoppable strength.
Ready to rise? Let’s do this.
Jillian Woodruff, MD (00:00)
If the brain you've relied on for 40 years suddenly feels unreliable, you are not becoming lazy, careless, or incapable. During perimenopause, changing estrogen levels can affect attention, memory, sleep, and emotional regulation, the same areas that can affect women or people that have been diagnosed with ADHD.
Dr. Ade Akindipe, DNP (00:21)
Which also means three different things may be happening all at the same time. perimenopause can look like ADHD. It can expose ADHD that has been masked for decades, or it can make existing ADHD feel much harder to manage.
Jillian Woodruff, MD (00:38)
Yeah, and that distinction matters because brain fog by itself does not automatically mean ADHD. And most women who notice cognitive changes during perimenopause do not suddenly develop a neurodevelopmental condition in their forties.
Dr. Ade Akindipe, DNP (00:51)
That's right. And some women do reach midlife and realize there has been a pattern for a while. maybe
Jillian Woodruff, MD (00:58)
Mm.
Dr. Ade Akindipe, DNP (00:58)
they were always the over preparer. Maybe every success came with an invisible amount of effort. maybe they could manage everything only because the routines were very rigid or the deadlines were urgent and the consequences of dropping a ball felt unbearable to them.
Jillian Woodruff, MD (01:14)
Then perimenopause arrives and sleep is unpredictable. Your hormones are unpredictable. They're fluctuating. Your responsibilities multiply. I'm getting exhausted just talking about this right now. And the system that
Jillian Woodruff, MD (01:29)
before maybe looked effortless from the outside suddenly cannot hold everything together.
Dr. Ade Akindipe, DNP (01:35)
Yeah, and today we are going to help you recognize the clues that point toward perimenopause brain fog, the clues that suggest ADHD may deserve a formal evaluation, and what it can look like when both of them are present.
Jillian Woodruff, MD (01:49)
Yeah, because your coping didn't necessarily fail. Sometimes the floor it was standing on moved or dropped.
Dr. Ade Akindipe, DNP (01:57)
That's right. So we're going to start with the question so many women are quietly asking, Was I always like this or did something certain suddenly change?
Jillian Woodruff, MD (02:06)
And that question's more useful than it sounds because timing and history are two of the strongest clues that we have in identifying ADHD.
Dr. Ade Akindipe, DNP (02:12)
Absolutely.
Dr. Ade Akindipe, DNP (03:07)
And before we sort anything into categories, let's name that experience. brain fog. We know it's not a formal diagnosis. It's the phrase people use when they you know their thinking is slower, less reliable, or they it takes more effort than it used to.
Jillian Woodruff, MD (03:24)
It may look like rereading the same paragraph three times for because the information didn't stick or you're like, what was I reading? maybe you're losing a familiar word in the middle of a sentence. I know you hear that all of the time from people, like the word is there. Why can't I remember what I was going to say? Why can't I bring it out? It's maybe sitting down to do one specific thing and then 20 minutes later having done four unrelated.
Jillian Woodruff, MD (03:49)
Tasks and not even the one you intended to do.
Dr. Ade Akindipe, DNP (03:53)
Yes, and it can also feel like having forty browser tabs, like having your computer open with tabs open in your brain, with music playing from one of them and no idea which one of it's coming from. Does that sound familiar?
Jillian Woodruff, MD (04:07)
absolutely. And I
Jillian Woodruff, MD (04:09)
guess I would even add, so that is the tabs in your brain, but what if you physically do have forty tabs open on your computer? I think that's a clue too. Right? Yeah.
Dr. Ade Akindipe, DNP (04:16)
yes, that is a big one. I I don't know how
Dr. Ade Akindipe, DNP (04:20)
to cope with that, but yes, that is a clue.
Jillian Woodruff, MD (04:22)
No. So for
Jillian Woodruff, MD (04:24)
some women, the main issue is memory and processing speed. And for others, it is planning, prioritizing, starting a task, switching tasks, finishing tasks. Those differences do matter.
Dr. Ade Akindipe, DNP (04:38)
And we need to say this very clearly. New cognitive symptoms are not automatically caused by perimenopause or ADHD. You could also have things like poor sleep, anxiety, depression, thyroid problems, even anemia, side effects from medications or substance use and other medical or neurological conditions, which can also affect concentration in memory.
Jillian Woodruff, MD (05:05)
Exactly. maybe think of it like this. If there's a sudden, severe, progressive, or even a safety threatening change, this deserves prompt medical attention.
Dr. Ade Akindipe, DNP (05:15)
Absolutely.
Jillian Woodruff, MD (05:16)
right. This episode that we're talking about today is a framework for a conversation. It's certainly not a self-diagnosis tool.
Dr. Ade Akindipe, DNP (05:23)
Yes. Think about your own experience for a moment. is the biggest change that words and memories feel harder to retrieve, or does it feel more broader, like you know, having difficulty taking managing your time, regulating your emotions, finishing projects, impulsive decision making or difficulty organizing almost every part of your life?
Jillian Woodruff, MD (05:45)
That's a great start, Dr. Aday. So why don't we have you get us started on the framework we discussed for how we begin to sort this out?
Dr. Ade Akindipe, DNP (05:54)
Sure. So we're gonna start with the bucket one. Bucket one is perimenopause cognitive change. The symptoms are genuinely new. So they appear during the menopause transition and often travel with other changes like irregular cycles, hot flashes, night sweats, sleep disruption, mood changes, or maybe some increased anxiety. So those changes, those cognitive complaints may include.
Dr. Ade Akindipe, DNP (06:21)
word finding difficulty, forgetfulness, feeling mentally slower or needing more effort to learn and retrieve information. You know, that feeling like there's something at the tip of my tongue, but I just I can't I have a difficult time getting it, but it's there. These are experiences are very common.
Jillian Woodruff, MD (06:38)
Yes, very common. Very common. bucket two is ADHD that was present earlier in life, but was never recognized. ADHD is a neurodevelopmental condition, so the pattern does not begin for the first time in perimenopause. Even when perimenopause is the moment that it maybe becomes impossible to ignore, the earlier life clues may not look like the stereotype of.
Jillian Woodruff, MD (07:04)
Disruptive child, which is kind of what in our generation we think about when we're thinking about ADHD and the diagnosis. So it may have looked like chronic procrastination followed by a heroic last minute effort, constantly misplacing things or organizing them away. I'm using my ear quotes. Daydreaming, missing verbal instructions, difficulty estimating time. How much time do I have to?
Jillian Woodruff, MD (07:30)
That task that may be very difficult to manage. Emotional reactivity, that's a big one. So you could have been, you know, they may have used words like drama queen for a young girl, you know, she's so dramatic, right? where they're just emotionally reactive. Or maybe needing elaborate systems to do what seemed easy for everyone else to do.
Dr. Ade Akindipe, DNP (07:52)
Yeah, and bucket three is both. So there was an ADHD pattern all along. And then you go into perimenopause, then you add sleep disruption, hormone fluctuations, and then you have that strain on the brain on top of it. So the results can feel like a sudden collapse, even though it is really an old vulnerable pattern where you know you had these symptoms growing up and maybe it was unmasked.
Dr. Ade Akindipe, DNP (08:18)
You didn't really know what was going on, but now you have this tr biologic transition and then everything kinda comes together and starts to wreak havoc and maybe you you start to get newly diagnosed.
Jillian Woodruff, MD (08:27)
Right. You know, the purpose of this framework is not to force yourself into one label, it's to help you notice a pattern when the symptoms began, where they show up in your life, whether they were present before midlife, or you're just noticing them now. So then you can bring all of this useful information into an appointment. So let's walk through.
Jillian Woodruff, MD (08:48)
Some clues that can help you to tell whether your symptoms are more consistent with perimenopause, menopausal brain fog, or ADHD, or that combination of both, where maybe you even had ADHD all along, but now your medications just aren't working for you anymore. There's been a change at midlife. So the first clue is when did your symptoms begin? Like we said, this is a neurodevelopmental condition, means some version of
Jillian Woodruff, MD (09:15)
The pattern usually appeared earlier in life, even if no one recognized it at the time. Perimenopausal brain fog is more likely to feel genuinely new, like it occurred in the last one to two years. when you may have started to have symptoms of irregular menstrual cycles, or you may have started to have some night sweats and maybe other perimenopausal symptoms at the same time.
Dr. Ade Akindipe, DNP (09:36)
Yeah, I totally agree. Those clues can help really separate things because, you know, my own experience when I was when I turned 40, I didn't really connect the dots. But look, having those clues and and tracking when they happen is super important. So we shouldn't only just ask what changed when I turned 45, also ask, you know, was there an earlier version of this when I was twelve, eighteen, twenty-five, or thirty? Because that'll let you know if this is not just perimenopause, maybe there was something there all along.
Jillian Woodruff, MD (10:04)
So to help you kind of think about identifying yourself, did teachers in your past, when you were growing up, describe you as bright, but maybe inconsistent? maybe scatterbrained? Did you regularly forget homework even when you understood the material? maybe you you know you did the homework but didn't turn it in. did you stay up late rebuilding work you just couldn't organize yourself to do earlier? Like you procrastinated to the last minute.
Jillian Woodruff, MD (10:30)
But you may have gotten all that work done and turned it in, you're very successful. maybe you misplaced things, your wallet, you know, a paper that you needed to take in, or you forgot appointment times. you really relied on a sense of urgency to activate your brain.
Dr. Ade Akindipe, DNP (10:47)
So I'm wondering now if this was me as an ADHD teenager or this was me being a teenager. Forgetting
Jillian Woodruff, MD (10:52)
Right. I think that's difficult to distinguish,
Jillian Woodruff, MD (10:57)
right? Yeah.
Dr. Ade Akindipe, DNP (10:57)
Some of those things, I'm like, hmm, I lost a lot of those things and that last minute thing. But you know, you you th those patterns are they don't just it's not just a one-time thing, right? This is something that trends over and over again. You know, or were you consistently organized and attentive until the last year or two, when sleep changed, when your cycles became unpredictable and hot flashes began, you know, that history really leans more towards perimenopause.
Dr. Ade Akindipe, DNP (11:24)
as the primary driver versus something that was diagnosed that was there previously.
Jillian Woodruff, MD (11:28)
Yeah, I agree with that. The next clue is how broad the symptoms are. Perimenopausal brain fog often centers on memory retrieval, verbal fluency, processing speed, mental fatigue. ADHD usually affects a wider set of executive functions. And like we mentioned, planning, time, awareness, task initiation, your
Jillian Woodruff, MD (11:52)
follow through, your impulse control, your emotional regulation.
Dr. Ade Akindipe, DNP (11:55)
Right. And the third clue is context, that is where the symptoms show up. So ADHD tends to create a persistent pattern across different parts of your life, you know, work, home, school, finances, relationships, and your what you do on a daily basis. So if the problem appears only during severe sleep deprivation or in one very sp stressful time or environment,
Dr. Ade Akindipe, DNP (12:20)
then there may be another explanation. The study of women's across women's health across the nation, a SWAN study, followed women for over 20 years during the menopause transition and found that nearly 60% of perimenopausal women report real memory complaints with measurable temporary decline in verbal memory and processing speed that often partially improve again.
Dr. Ade Akindipe, DNP (12:45)
after menopause. That's pretty dramatic, sixty percent.
Jillian Woodruff, MD (12:48)
You know, yeah, one of our favorite studies to mention, and also sadly, you know, we there aren't so many studies for women. So many of these things that were diagnosed in childhood were studied with men or with boys. And so much of the ADHD research comes from the study of boys, usually hyperactive boys, right? So
Jillian Woodruff, MD (13:11)
Like I said, we can't just extrapolate data from one group and make it fit another one, which is what we've done for many of our years practicing
Dr. Ade Akindipe, DNP (13:19)
Right.
Jillian Woodruff, MD (13:20)
medicine. And so that's why probably I think so many people have been missed in looking at the data of how many people are now diagnosed with ADHD and that
Dr. Ade Akindipe, DNP (13:29)
H D
Jillian Woodruff, MD (13:30)
period, like 29 to 45, it's the fasting growing period age for.
Jillian Woodruff, MD (13:35)
people, adults to get diagnosed with ADHD. The fastest growing group is like midlife women and men. Pretty significant. Hmm.
Dr. Ade Akindipe, DNP (13:43)
That is.
Jillian Woodruff, MD (13:44)
Anyway, that's the what you spoke of. That's the majority experience for brain fog and perimenopausal changes. So if what you're dealing with is memory and word finding trouble that showed up in the last year or two,
Jillian Woodruff, MD (13:56)
It could be perimenopause. You're at midlife, you may have some of these other perimenopausal symptoms. So our final clue, compensation. How much effort it has taken to keep everything together. So many high achieving women build very effective scaffolding without realizing it. Multiple calendars, or some realize it. I realize the effort it takes.
Jillian Woodruff, MD (14:18)
You know, multiple calendars, you have your alarms, you may be a perfectionist, you're over-preparing, you're making list after list after list, you may be working late, never saying no, using that anxiety as a fuel to get things done.
Dr. Ade Akindipe, DNP (14:32)
Hmm. I'm just pausing because it just really resonates with me. I mean, I'm
Jillian Woodruff, MD (14:37)
Mm-hmm.
Dr. Ade Akindipe, DNP (14:37)
in my mid forties and when you have multiple priorities and things that need to be done with, you know, the home life and the work life, you know, I find myself reaching for another calendar. I need a calendar to figure this out, and I need a Google calendar, and I just so you don't miss anything. And sometimes that may actually add another layer of anxiety and make you feel like
Dr. Ade Akindipe, DNP (14:59)
my gosh, you're just a hot mess.
Jillian Woodruff, MD (15:00)
Yeah, it's something else to manage too, right? I I'm not gonna show
Dr. Ade Akindipe, DNP (15:03)
It's something else to manage.
Jillian Woodruff, MD (15:05)
you my desk and my multiple calendars because yes, you know, I'm the queen of the Google Calendar and the multiple tabs. Although, you know,
Dr. Ade Akindipe, DNP (15:10)
And the multiple tabs. And the multiple tabs that I'm scared to close 'cause you might miss something.
Jillian Woodruff, MD (15:16)
I close those tabs. I do do that because it makes me feel more scattered to have so many. So
Dr. Ade Akindipe, DNP (15:22)
Same. Same.
Jillian Woodruff, MD (15:25)
otherwise I would. My brain certainly has multiple tabs and open in it.
Dr. Ade Akindipe, DNP (15:28)
Yeah, it's insane.
Dr. Ade Akindipe, DNP (15:30)
But yeah, you're absolutely right.
Jillian Woodruff, MD (15:30)
But how much are we bringing
Jillian Woodruff, MD (15:32)
on ourselves? You know, how much of this
Dr. Ade Akindipe, DNP (15:33)
Yeah, yeah.
Jillian Woodruff, MD (15:34)
do we bring on by not saying no to things? You know? How
Dr. Ade Akindipe, DNP (15:37)
Mm-hmm. Overpreparing,
Dr. Ade Akindipe, DNP (15:39)
working late just in that compounds on it, right? Because you're trying to make sure that you get everything done. So that scaffolding can really hide it because you we are, you know, especially high achieving women who want to have their hands in everything. They want to be home with their kids. They want to help their friends. They want to we want to do all the things, but success does not rule out ADHD, right? The more useful question is, what did that success cost?
Dr. Ade Akindipe, DNP (16:04)
if maintaining fine, you know, everything's fine required relentless effort, chronic exhaustion and fear of disappointing people, that belongs in the evaluation as well, for sure.
Jillian Woodruff, MD (16:13)
Yeah, the question worth writing down is were the symptoms absent before midlife or were they present but quite expensive to hide?
Dr. Ade Akindipe, DNP (16:22)
Absolutely. Okay, so let's talk about the estrogen connection here. I think this is a really important part for our audience to understand without turning it into, you know, oversimplifying it for social media.
Jillian Woodruff, MD (16:35)
Well, we talk about estrogen so much, right? We love talking about
Dr. Ade Akindipe, DNP (16:38)
Mm-hmm.
Jillian Woodruff, MD (16:39)
estrogen and how it affects every system of our body. And it has significant effects throughout the brain, interacting with neurotransmitter systems involved in attention, involved in mood and memory and motivation and executive function, getting things done. this is including the dopamine pathways.
Dr. Ade Akindipe, DNP (16:58)
Yeah, during paramenopause, estrogen does not simply just decline in a smooth downward line. You know, it's it's not predictable. It can fluctuate. And because we have, you know, so many different so many receptors in our brain, it can really impact our our brain. So sleep may also become fragmented by all the vasomotor symptoms like hot flashes, night sweats, increased anxiety.
Dr. Ade Akindipe, DNP (17:23)
Or even the change in circadian patterns if if you tend to stay up late or maybe your work schedule kind of changes things where you're working at night, you know, that can also wreak havoc on on your estrogen loss as you continue the trajectory to perimet to menopause.
Jillian Woodruff, MD (17:39)
Yeah, and that combination can make concentration or memory retrieval and your emotional regulation feel less stable. So even in a woman who's never had ADHD, for a woman who already has ADHD, those changes may reduce the margin that allowed her systems her systems to work. So a medication regimen or routine that was reliable for so many years to treat their ADHD may no longer feel consistent.
Dr. Ade Akindipe, DNP (18:06)
Yeah, and it doesn't necessarily mean you know, estrogen or the lack of causes or the lack of estrogen causes ADHD. it does not mean every woman with brain fog needs a stimulant medication. oftentimes too, there's sometimes an overlapping I find some women also get diagnosed with depression and anxiety because of the overwhelm, you know.
Dr. Ade Akindipe, DNP (18:31)
Sometimes that comes together like that. And it does not mean hormone therapy is an ADHD treatment either. So it means hormonal transition may change the environment in which attention and executive functions are operating.
Jillian Woodruff, MD (18:44)
Well, in longitudinal research on menopause, much like the Swan study, that's a longitudinal research where they've followed women over time, they've documented temporary changes in these areas, like verbal learning, processing, speed, memory. So very temporary changes during the menopause transition. There's a decline. And for many women, these changes stabilize or partially improve after the transition.
Dr. Ade Akindipe, DNP (19:08)
Well that's kind of encouraging. there's also emerging research also suggesting that women who report ADHD may experience a greater burden of perimenopause symptoms, but
Jillian Woodruff, MD (19:19)
Mm.
Dr. Ade Akindipe, DNP (19:19)
this is still a developing field. much of the available evidence is observational and it does not yield, it doesn't give us a single test or a universal medication strategy or a definitive explanation for every woman.
Jillian Woodruff, MD (19:34)
So that part is discouraging, right? So if you have,
Dr. Ade Akindipe, DNP (19:36)
I know.
Jillian Woodruff, MD (19:37)
you know, ADHD, you're saying that other symptoms may be worse or exacerbated. So not just your
Dr. Ade Akindipe, DNP (19:42)
Me right, right.
Jillian Woodruff, MD (19:44)
ADHD being exacerbated. gotta love midlife. Well, let's just briefly talk about, because I've I'm always curious and thinking about this.
Jillian Woodruff, MD (19:54)
Why so many women are only recognizing ADHD in midlife. And I think we kind of touched on this with the research, but for decades ADHD research was focused heavily and on visibly hyperactive boys. So so the child who was disruptive in class, who couldn't stay in their seats, who constantly interrupted.
Dr. Ade Akindipe, DNP (20:13)
Yeah. And you know, many girls looked different. You know, they were more they were more likely to daydream, quietly
Jillian Woodruff, MD (20:20)
Mm-hmm.
Dr. Ade Akindipe, DNP (20:21)
miss instructions, lose track of assignments, or they compensate after procrastination by over preparing and working twice as hard. So of course of course it's easier to miss because they're not disrupting a class or creating problems. So they were often just kind of described as scattered or dreamy, not reaching their potential.
Dr. Ade Akindipe, DNP (20:41)
Unlike, you know, when you compare it to their boy boy male counterparts.
Jillian Woodruff, MD (20:45)
Many also learned to mask, so they appeared organized, they appeared calm, capable, while they may managed a tremendous amount of effort underneath. And that is why a woman can reach her 40s with a successful career, a family, and not yet having a di ADHD diagnosis, even though the pattern may have been there all along. Then the hormonal changes come in, the disrupted sleep appears, and there's an increasing cognitive load.
Jillian Woodruff, MD (21:11)
That can make this lifelong compensation much harder to maintain. And for some women, midlife is not when ADHD begins. Well, for really all women, it's not when ADHD begins, right? This is when it finally just becomes visible.
Dr. Ade Akindipe, DNP (21:25)
Yeah. All right. So let's get bring this into real life. You know, the clinical explanation matters, but one of the most painful parts of this experience is that it does not stay inside your own head. Right. It it often starts showing up in relationships that used to feel easy, your partner, your closest friends, even the group chats and social circles where you've once felt completely at home. Maybe, you know, all of that can get really disorganized and
Dr. Ade Akindipe, DNP (21:52)
distracting, you it might show up different for each woman.
Jillian Woodruff, MD (21:55)
Right. And it may be hard to recognize that in yourself because you may have always been known as the, you know, good friend or the one that was always the thoughtful one, the one that remembered everything, because you had all of these systems, you compensated, you had got it all done. And then there is a change. And you may notice this in your relationship with your intimate partner in the strain beginning in small moments. maybe you interrupt.
Jillian Woodruff, MD (22:19)
your partner a lot because you're afraid you'll lose the thought you had. You want to tell them something and you're like, I gotta just say it right then. You're interrupting mid-conversation, or you forget something your partner told you, even though you do genuinely care. They may have said it more than once. You miss part of a conversation because your attention may have drifted and your partner
Dr. Ade Akindipe, DNP (22:39)
Mm-hmm.
Jillian Woodruff, MD (22:39)
is experiencing all of this as you being disinterested or they're feeling dismissed.
Dr. Ade Akindipe, DNP (22:45)
Or text messages that don't get sent because you start doing something else.
Jillian Woodruff, MD (22:49)
Mm-hmm. Yes.
Dr. Ade Akindipe, DNP (22:51)
You may also become more reactive. A neutral
Jillian Woodruff, MD (22:54)
Mm.
Dr. Ade Akindipe, DNP (22:55)
comment about the dishes, for example, a late bill or a forgotten plan can suddenly feel much bigger than it is. Instead of hearing, can we talk about this? You may hear you are failing, you know, you did something wrong, you're not a good mom, you don't act like you love me.
Dr. Ade Akindipe, DNP (23:11)
And that can lead to defensiveness and tears, anger and just shutting down or pulling away, you know, when things like that start to happen.
Jillian Woodruff, MD (23:20)
Yeah, and over time both people can feel misunderstood. the woman experiencing the symptoms may think, Why is everyone criticizing me? Why are you always mad at me? And her partner may think, why can't I say anything without it becoming a conflict? And of course, that tension affects intimacy. When you feel overstimulated or ashamed or exhausted or constantly behind, it's difficult to feel emotionally available.
Jillian Woodruff, MD (23:45)
And so physical closeness may start to feel like one more demand, one more thing you have to do, especially if there's unresolved frustration underneath it.
Dr. Ade Akindipe, DNP (23:53)
Yeah, and the same changes can affect parenting, especially when you're raising teenagers or young adults while also managing work and a household and aging parents and your own changing body.
Jillian Woodruff, MD (24:06)
Right. You may forget something your child told you. You may lose track of a school deadline or not sign something you were supposed to or send something into school that you were supposed to. You may become overwhelmed with some forms. And you know, as so many things. And your child may experience that as mom is not listening. When the reality is that your cognitive load is already beyond capacity. That's like my favorite thing to say.
Jillian Woodruff, MD (24:33)
goodness. I'm like, I'm at capacity. I I'm at capacity. Sorry. I don't have capacity. Yeah. Yep.
Dr. Ade Akindipe, DNP (24:33)
Beyond capacity. I'm unavailable. Yeah, I t
Dr. Ade Akindipe, DNP (24:42)
definitely it's it can be hard. You know, emotional regulation can can become very difficult during this time to, you know, a teenager's tone, for example. I've got two teenagers and sometimes it's like, you know, err, you know, a messy room or one more request at the end of the day may just trigger you to react in a way that you wouldn't normally react.
Dr. Ade Akindipe, DNP (25:01)
then you start to feel guilt almost immediately. And I know this for a fact. It's like, why did I say that? Why did I react that way? Because you know this is not like you, right? This is not the normal way you would react in that situation.
Jillian Woodruff, MD (25:14)
Yeah, many women tell us they feel like the worst parents, the worst partner in their forties, more so than they did at any other time. And it's not because they care less. It's because the attention, the the patience, you know, the emotional reserves they once relied on are being taxed by poor sleep, by hormonal changes, by cognitive overload, could be by ADHD or a combination of all of those things.
Dr. Ade Akindipe, DNP (25:40)
Mm-hmm. I like that word cognitive overload. That's my new one. Our goal. I'm
Jillian Woodruff, MD (25:43)
Mm You can use it.
Dr. Ade Akindipe, DNP (25:47)
cognitively overloaded. No more for the day. So, you know, of course. All right.
Jillian Woodruff, MD (25:49)
Yes. Yeah. You heard it here. If everyone starts saying that now.
Dr. Ade Akindipe, DNP (25:56)
so you know, this discussion is the goal is really not to excuse hurtful behavior in any way. Okay. It it it is
Jillian Woodruff, MD (26:01)
Mm. Mm-hmm.
Dr. Ade Akindipe, DNP (26:03)
to understand the pattern early enough.
Dr. Ade Akindipe, DNP (26:05)
That you can interrupt it and do something about it. So a parent might say, I know I have been more reactive lately, I'm working on it. And I want us to slow this conversation down so I can rest respond instead of snapping, right? So let me ask the listeners what is the sentence your family has been using about lately? you never listen or you're always overwhelmed or you're not yourself or you're not listening, right?
Dr. Ade Akindipe, DNP (26:31)
so that's not a diagnosis, right? But it might be useful information. If you're hearing this from your family or from your friends, then maybe it's time to really take a look at what's really happening. What's the pattern telling you?
Jillian Woodruff, MD (26:42)
Mm. Okay, let's make this even more practical. Then what should we do? What do we do with this info?
Dr. Ade Akindipe, DNP (26:48)
Well, I mean with this, you know, n the c the cognitive overlow we just talked about, those symptoms, you know, your sleep, your cycle changing, your hot flashes, night sweats, the next step is you know, a menopause informed medical evaluation.
Jillian Woodruff, MD (27:04)
Yeah, that conversation should include all of those things. the full picture, symptoms, cycle history, sleep mood, medications, medical conditions, and whether anything else needs to be tested or ruled out. Like that's a full menopause evaluation. So it's not just
Dr. Ade Akindipe, DNP (27:19)
Yeah.
Jillian Woodruff, MD (27:19)
are you having periods yes or no, you know, or are your periods irregular and then making a decision. No, that's not ha that's not the menopause evaluation.
Jillian Woodruff, MD (27:30)
All of these things are important
Dr. Ade Akindipe, DNP (27:30)
Sure.
Jillian Woodruff, MD (27:31)
for this. Mm-hmm.
Dr. Ade Akindipe, DNP (27:32)
Yeah, and for the appropriate candidate, treating disruptive menopause symptoms may improve sleep, your daily functioning, which can help some women's, you know, brain function, their cognition better. So hormone therapy is not an ADHD treatment, and it should not be prescribed solely to prevent cognitive decline, but
Dr. Ade Akindipe, DNP (27:54)
The decision must be individualized based on your symptoms, your risks, your benefits, preference, and then of course your medical history.
Jillian Woodruff, MD (28:02)
So if the pattern sounds ADHD-shaped, there is an earlier life history. Symptoms affect multiple settings, and if executive function difficulties go well beyond new memory lapses or just thinking through a cloud, right? So you may need to ask for a formal adult ADHD evaluation. Now that you know many of these symptoms and changes that you may not notice until later in life.
Jillian Woodruff, MD (28:28)
This can be the stimulus to ask for that evaluation for ADHD. And an ADHD evaluation does not happen with the menopause specialist unless they're also ADHD specialists or mental health care providers or that sort of thing, right? Or neuropsychologists. So they may be two different things, but your menopause provider may help to steer you in a direction. Okay, let's evaluate the hormonal aspects and
Jillian Woodruff, MD (28:54)
your your lifestyle management and also I recommend that you see this other provider for a formal evaluation.
Dr. Ade Akindipe, DNP (29:02)
Yeah, that's a really good point. A a good evaluation has to be has to cover everything. It's not just hormones, right? You know, a good evaluation is more than a quick online checklist, too. So
Jillian Woodruff, MD (29:12)
Mm-hmm.
Dr. Ade Akindipe, DNP (29:13)
there are lots of tools out there, but it should examine your history, your childhood history, current impairment, sleep, anxiety, depression, any trauma that you've experienced in the past or currently. substance abuse, of course, can also impact our cognitive function.
Dr. Ade Akindipe, DNP (29:29)
Medications, are there any side effects that you're experiencing as a result of a medication that you're on? These are all possible explanations for what you might be going through. If both appear to be present, the care should be coordinated when you're dealing when you're with someone who is looking at the menopause-related symptoms, ADHD, the clinician managing ADHD, and the one going through the menopausal symptoms should be working together so that they can help you navigate this transition.
Jillian Woodruff, MD (29:56)
Right. And for women already taking ADHD medication, a change in effectiveness is a reason to speak with the prescriber. Do not independently increase or split or skip or re-time your doses. And medication is only one part of the picture. Midlife may require rebuilding that scaffolding that worked in earlier decades. Maybe if you're on medication, it may mean a medication change.
Dr. Ade Akindipe, DNP (30:19)
Yes, absolutely. And this is a season where you have to really protect your sleep as aggressively as possible. You know, we're juggling multiple things and sometimes we are going to bed later and still having to wake up at the same time. So you using any method, you know, getting this a a good really good sleep hygiene, external reminders, reduce reducing unnecessary decision making when it's getting close to bedtime.
Dr. Ade Akindipe, DNP (30:43)
breaking multi multiple steps into visible steps so it's easier to manage and not get so overwhelming. putting in information in one reliable location instead of five, this has helped me a lot. Having certain places where things live as much as possible has been really good. And of course, movement, movement, movement, movement is important. Eating very good nutritious meals with protein and hydration.
Dr. Ade Akindipe, DNP (31:06)
and realistic transitions between tasks, not overloading yourself. And stop treating recovery time as a reward you earn. Absolutely not. You need that downtime after you finish a task or when the day is over. So
Jillian Woodruff, MD (31:21)
Yeah, because everything is never finished. And that is something
Dr. Ade Akindipe, DNP (31:24)
Mm-mm.
Jillian Woodruff, MD (31:25)
that took me so long to realize because I would say, things will clear up after this project. You know, I'll have more time to spend with, you know, these friends when I finish this work event. No, there's always something else
Dr. Ade Akindipe, DNP (31:39)
Yeah.
Jillian Woodruff, MD (31:39)
that comes up. Always something else. Everything is never finished. There's no like certificate at the end. So maybe.
Dr. Ade Akindipe, DNP (31:46)
It's true. Maybe
Jillian Woodruff, MD (31:47)
This is a hard one for me
Dr. Ade Akindipe, DNP (31:48)
it doesn't work.
Jillian Woodruff, MD (31:49)
to say, but consider what can be removed. So sometimes the most effective executive function strategy is not a better planner. It's fewer obligations. Dr. Day, you know that was not easy. Not easy to say. We may have, right?
Dr. Ade Akindipe, DNP (32:01)
It wasn't easy for me to I know
Dr. Ade Akindipe, DNP (32:03)
I had to stop and think I just bought another planner. boy. another commitment, yes. So
Jillian Woodruff, MD (32:08)
To write down yet another commitment, right? Mm-hmm. Yep. Mm-hmm.
Dr. Ade Akindipe, DNP (32:13)
you know many women know something has changed, but they freeze when the clinician asks, what brings you in, right? So when you are in this situation, you you can say something like this, hey, over the last year, hey, I've noticed.
Dr. Ade Akindipe, DNP (32:28)
changes in my attention, my memory, I just don't remember the way I used to. I feel really, you know, and then you know, you can use real words. Like I really feel like I have multiple tabs open in my brain. It's okay to say things like that. some symptoms are new, but I also may also have had a similar pattern in my life. I would like help, you know, managing this. You know, could this be perimenopause?
Dr. Ade Akindipe, DNP (32:52)
even my sleep. I've noticed I'm not sleeping as deeply as I used to. are there medications that I'm taking that could be causing this? Or maybe you've noticed a pattern with a medication. You know, when I take this medication, I notice this is happening. When I don't take it, like like we said before, a lot of different things can cause a change in your in your cognition. And then also, of course, whether ADHD should be considered as part of what you're what you're going through.
Jillian Woodruff, MD (33:16)
Right. And for those with ADHD, you may have a change of what in your symptoms or your ability to manage or treat ADHD. And that could be due to perimenopause. So that's certainly a time to bring those symptoms in and discuss being evaluated for. Could this be perimenopause? You may not need a change of your ADHD medications, the strength, the type. It could be that we have to come in.
Jillian Woodruff, MD (33:42)
And discuss hormones. And it could be also not a hormone discussion, but more of how do I manage this lifestyle-wise as far as the sleep? Is there something else that's impacting my sleep that I need to deal with? And the lack of sleep is exacerbating ADHD. You know, it's so it's difficult. You do need someone that can pull of all of these things together. So you want to bring your examples, not just labels, not just I have ADHD or I don't have it.
Jillian Woodruff, MD (34:09)
You want to describe what happens at work, what happens at home, what happens with schedules and unfinished tasks.
Dr. Ade Akindipe, DNP (34:15)
Yeah, absolutely. And if possible, you know, note the timing of symptoms for several weeks. tracking your sleep. There's lots of different tools these days, you know, when those half lashes, cycle changes, your mood, concentration, or a medication response, like we've said before. You know, the goal is not to prove a diagnosis, it's just to kind of give the provider enough information to see a pattern.
Dr. Ade Akindipe, DNP (34:40)
and be able to figure out, you know, is this in fact ADHD? Is this perimenopause or b or both?
Jillian Woodruff, MD (34:45)
So Doctor Day, is it ADHD? Is it perimenopause? Is it both?
Dr. Ade Akindipe, DNP (34:49)
Well,
Dr. Ade Akindipe, DNP (34:50)
the answer begins with history, right? So ADHD
Jillian Woodruff, MD (34:52)
Yeah.
Dr. Ade Akindipe, DNP (34:53)
l leaves an earlier life echo. Remember that.
Jillian Woodruff, MD (34:56)
Mm.
Dr. Ade Akindipe, DNP (34:58)
perimenopause brain fog is more likely to be genuinely new and to arrive with a broader menopause transition. And for some women, both stories are definitely true.
Jillian Woodruff, MD (35:08)
What you're experiencing deserves attention, even if it does not result in a new diagnosis.
Dr. Ade Akindipe, DNP (35:14)
Yeah, you do not need to be falling apart dramatically before asking for help. Quietly working twice as hard to making the same life is enough.
Jillian Woodruff, MD (35:22)
Yes. So if you've been wondering, was this always me? The answer may be yes. And that may simply explain why so much of your life required invisible effort, more cognitive load. The coping didn't fail, the floor moved, and now the support system has to move with it.
Dr. Ade Akindipe, DNP (35:39)
Yes, and if this episode gave you the language for something you have been living with, share it with the woman who keeps saying, I don't feel like myself.
Jillian Woodruff, MD (35:48)
Yes. If you have a comment or question you'd like to share with us, you can reach us through our website at www.modernmidlife collective.com or you can email us at connect at modern midlife collective.com. Please send us your questions or things that you want us to discuss. we want to hear from you.
Dr. Ade Akindipe, DNP (36:08)
Thank you so much for listening and take care of yourselves out there.
Jillian Woodruff, MD (36:11)
Hi.