In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Sasha Hamdani, a board certified psychiatrist, ADHD clinical expert, and author of the forthcoming book Too Sensitive, for the first half of a two part conversation on why so many women are discovering ADHD for the first time in their forties and fifties.

Dr. Hamdani reframes ADHD as a regulation issue rather than a simple attention deficit, and explains why perimenopause does not create the condition but instead unmasks it, as the estrogen scaffolding that let women mask and compensate for a lifetime starts to fall away. She and Dr. Haver walk through how ADHD tends to present differently in women, often as the inattentive, easily overlooked type rather than the hyperactive presentation the diagnostic criteria were built around, and why that gap has left generations of high achieving women undiagnosed.

The conversation moves into the biology behind the brain fog so many women describe in perimenopause, tracing the connection between declining estrogen and dopamine and what that does to memory, focus, and executive function. Dr. Hamdani and Dr. Haver also discuss where hormone therapy fits, including estradiol, progesterone, and testosterone, and how each one can help or complicate cognitive symptoms depending on the person. They also cover how a proper ADHD assessment works during perimenopause and how stimulant and nonstimulant medication options differ.

Guest links:

• Sasha Hamdani, MD
  
• Sasha Hamdani, MD (Facebook)
  
• Sasha Hamdani, MD (YouTube)
  
• Sasha Hamdani, MD (Instagram)
  
• Sasha Hamdani, MD (TikTok)
  
• Sasha Hamdani (LinkedIn)

Books:

• “Too Sensitive: Rejection, Resilience, and the Science of Feeling Deeply,” by Dr. Sasha Hamdani
  
• “Self Care For People With ADHD,” by Dr. Sasha Hamdani
  
• “The New Perimenopause,” by Dr. Mary Claire Haver
  
• “The New Menopause,"⁠ by Dr. Mary Claire Haver

Articles

• Genetics of attention deficit hyperactivity disorder (Molecular Psychology)
  
• The heritability of clinically diagnosed Attention-Deficit/Hyperactivity Disorder across the life span (Psychological Medicine)
  
• Attention-Deficit Hyperactivity Disorder: A Category or a Continuum? Genetic Analysis of a Large-Scale Twin Study (Journal of the American Academy of Child & Adolescent Psychiatry)
  
• Menopause depression: Under recognised and poorly treated (Australian & New Zealand Journal of Psychiatry)
  
• Stimulant medications affect arousal and reward, not attention networks (Cell)
  
• New Insights into the Mechanism of Action of Viloxazine: Serotonin and Norepinephrine Modulating Properties (Journal of Experimental Pharmacology)
  
• The role of the Mediterranean diet in reducing the risk of cognitive impairement, dementia, and Alzheimer's disease: a meta-analysis (Geroscience)
  
• Omega-3 Polyunsaturated Fatty Acids for Core Symptoms of Attention-Deficit/Hyperactivity Disorder: A Meta-Analysis of Randomized Controlled Trials (The Journal of Clinical Psychiatry)
  
• Dietary Interventions and Supplements for Managing Attention-Deficit/Hyperactivity Disorder (ADHD): A Systematic Review of Efficacy and Recommendations (Cureus)
  
• The effect of vitamin D and magnesium supplementation on the mental health status of attention-deficit hyperactive children: a randomized controlled trial (BMC Pediatrics)
  

Other Resources:

• Stimulant ADHD medications work differently than thought (Washington University)
  
• QELBREE Drug Data Fact Sheet (FDA)