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Oh well, Hi there, but are you happy?
Fam?
I am Claire Murphy. I'm from Mumma MEA's new health podcast called Well. It's hosted by me and doctor Merriam who is this absolutely brilliant gp and advocate for women's health. Well, if you haven't come across it yet, is a podcast about the taboo, the annoying, the embarrassing, and the scary. We cover concerns that you might be considering seeing a doctor about, from I don't know insomnia, to weird periods to how to prevent dementia. And this month we're focusing
in on the mind. So in this episode we're talking about ADHD in particular, including how women often experience more inattentive features and why they may try to mask those symptoms. We're also going to talk about things like time blindness and memory issues and emotional dysregulation and if you have been diagnosed with ADHD or feel that you might have it, or someone you know and they're always told they're just too sensitive, maybe they're dealing with a condition called rejection
sensitive dysphoria. This is well Australian women. Welcome to your full body health check. I'm Claire Murphy, the journalist who wants to know everything about your health, and let's be honest my own while we're at it.
And I'm doctor Mariam, the GP girlfriend that you wish you had so you could ask all those annoying health questions over a glass of wine midweek.
Today, we're trying to focus so we can talk about ADHD. I'm so sorry if that is a terrible, terrible joke, I forgot what you said.
Stop it.
We are legitimately going to find out if those ADHD tests on TikTok are real or bullshit. We're going to look at the pros and cons of medicating and how we manage some of the tougher parts of an ADHD diagnosis, like you know, your partner feeling like you just don't care when really you're struggling to remember things. Will also beating into a quick consults where you can ask our very own doctor Marriam anything about your weird and wonderful body doing weird and wonderful things.
Today.
Amali says she's got no idea how to tell the difference between a good lump and a bad lump. But first up, it's time to head to med school for today's lesson on why your vagina's problem might also be your partner's fault.
Welcome to med school.
Look, we found something out recently which is very interesting because we as women have been dealing with it pretty much solo. But we've heard it actually can get better if we treat the men in our lives too. So an Australian clinical trial found that bacterial vaginosis can actually be transmitted sexually and that treating a suffer's male partner for it could reduce reinfection and reoccurrence. So technically it
is also an STI. According to Professor Katrina Bradshaw, who co authored the study, it appears the penis and its microbiome. I don't know why I get weirdly laughy when I say the word penis.
I'm very immature.
I've seen peters and it's microbiome plays a role in some instances, not all off BV bacterial vaginosis cases and their partners, with uncircumcised men having a more how should we put this diverse microbiome than circumcised men, including the types of bacteria that can take over the vagina.
Yes, this is such a great study and I'm hoping this is going to lead to guideline changes and maybe a new name, bacterial pinios. That sounds like Harry Potter doing some kind of spell bucketerial pineosice. But yeah, recurrent BV massive issues something I see all the time in clinic. We know bb effects one in three females reproductive age. We treat it fifty percent of the time. It will come back within three months. It's very frustrating, very difficult
to treat. So yeah, now with this study we're seeing this potentially maybe some going back and forth from partners getting treated and she's having sexual contact again with her partner, they're getting reinfected.
Well, you know, like men, you're not responsible for all the things, but in this instance.
Most of the things you are, let's be honest responsible.
Maybe in this instance that's terial pineos be gone. Okay, grab your fidget spinners, folks, it's check up time today.
We are talking about ADHD. Yes, let's do it. It's time for the checkup.
ADHD is really having a moment on social media right now. I particularly love this song by Guy with the Hair on TikTok, so funny.
I have ADHD, and just maybe it's a thing that sometimes I get distracted with, Oh look a shiny ring. I start a project than my god, like nine hours go by and all I've done is started twenty other things in crime. When I'm super hyper focused, yeah I notice everything, But when I'm not, my frazzle dots go bivity bobbity thing. I don't think it's a secret that some people think I'm different just because I have the
attention span of a goldfish or a pigeon. So if you are like me and talk it ninety miles per hour, then help me normalize us born with eighty HD powers.
And I also saw this really great video of lots of hidden symptoms of ADHD, so people who actually have been diagnosed with it talk about the ways in which they knew maybe they were. Things like being able to predict the movie plot from the get go, so your worst cinema going friend you could potentially have hating appointments if they're in the afternoon because it is way too
long to be in waiting mode. And being able to smash out an essay at the last minute, even though you've had like actual weeks to get it done, but then also constantly losing your things, not being able to remember someone's name, and fighting with your significant other because you forgot that thing again. And it's actually believed to be the most common mental health condition around the globe.
There's about a million Aussies who have been diagnosed. Mariam, If someone does come into your rooms and you have a suspicion that they might have ADHD, what are you actually looking out for and are you seeing more people come forward looking for.
A diagnosis now?
Yeah, So if someone comes into my claim and I suspect or they suspect they might have ADHD, I'm looking out for a few key signs and symptoms and I usually kind of direct the consult by using like an ADHD Adult questionnaire, which kind of helps we through and kind of direct those questions so I can get those answers that I need. So we know that there's three
types of ADHD. So there's the hyperactive and impulsive type, and generally the signs we see with that are you're restless, you're agitated, your fidgety, you know, you're interrupting conversations, you can't wait in the line, you're talking over people, you're acting impulsively, and you're not thinking of consequences.
Then this is what we see commonly in like young boys and where they're like a thinking habit.
Yeah, and so I think that's kind of the picture of people always assume ADHD looks like but it doesn't always look like that, you know. It can also be the inattentive type, and this is where most females generally
tend to fit as well. Here we're looking for difficulties with attention, so difficulty starting tasks, initiating tasks, finishing tasks, poor time management for getting appointments, easily distractable, you're going off with the fairies, you're daydreaming, you're losing things, you're procrastinating. And the third type is a combination of the two
as well. I also consider the context of these symptoms, whether they were being present in childhood and their effect on your quality of life in different settings, whether that's work at home and in relationships, and then family history is also a big part of the consult as well as for whether I'm seeing more people come in definitely, and I think that's just because ADHD is finally getting
the platform it deserves, is a lot more awareness. Interestingly, being a female GP, I see a lot of patients going through the perimenopause or space, and I'm picking up ADHD so much in these patients a lot from my own conversations with the patients, but a lot of the time they're like, hey, I think I have ADHD. We know those hormonal changes can exacerbate a lot of the symptoms of ADHD.
What do people need to do to prepare for a diet diagnosis? I've heard it does involve a lot of appointments and a fair bit of paperwork, and it can also be pretty costly too.
Unfortunately that is the case. You know, gps are really pushing for a massive reform with ADHD, and we're hoping that will come in the near future, but for the time being, it is a bit of a process. You start by seeing your GP. Your GP will assess your symptoms and your history. They will use those screening tools and questionnaires in the consultation or send you home with them, and if they do suspect you have ADHD, you'll be given a referral to a psychiatrist. Or a psychologist who
has that specialty in diagnosing ADHD. It's your preference where you want to go. But a lot of people prefer just going straight to the psychiatrist because they can prescribe the medication if you do have ADHD and the medication is needed, so you just kind.
Of save that extra step.
Unfortunately, diagnosis does come with a hefty price tag, and that could range from one thousand to three thousand dollars with limited rebates. But to make your appointments more effectively, I will offer some advice which people might find helpful,
and so I always say document your symptoms. So anything you suspect might be ADHD related, put it all down in a journal and write its impact on your quality of life and how long you've had these symptoms, what school life was like for you, what your partner thinks, what your family thinks, those sorts of things.
Gather your history.
So if you've seen mental health professionals in the past, try to get your notes from them as well. That will be really helpful for the psychiatrist or psychologists to collaborate and help with with the diagnosis. So complete the questionnaires and take those to the appointment and prepare questions. So if you are diagnosed with ADHD, you're going to leave with a million questions. Try to think, Okay, if I do have ADHD, what are things that I want
to know? Write them down and make sure that you get those answers before you leave that appointment and ask for support. So bring a friend or a trusted family member for emotional support or to help remember important details and get that organizational help. So a big part of why people find the diagnosis process difficult is because of that organizational part.
I need to ask you about another person who can potentially be in your ADHD diagnosis journey, and that is the ADHD coach in this instance. Who is an ADHD coach And do you ever refer people to them?
Yeah, definitely. So the Australasian ADHD guidelines actually recommend ADHD coaching as a valuable non pharmacological tool for managing ADHD, and the approach focuses on educating people about ADHD, leveraging their strengths, and developing practical strategies to modified behavior, so like you know, emotional regulation, time management skills, those sorts of things. The coaches might be allied health professionals or
they might be specialized ADHD coaches. It's just important to ensure that they're affiliated and credited by the International Coaching Federation. So if you are booked in, make sure that they have that tick of approval. That's really important. The only issue with accessing ADHD co coaches is that might require a private payment, so there might not be any Medicare rebate. Some psychologists do offer that service and if they do that you might get some rebate through the Better Access Plan.
Okay, So because we are talking about ADHD, we absolutely wanted to speak to somebody who specializes in this space. So the other day I caught up with doctor Kieran Kennedy. He's a psychiatrist and ADHD specialist and health and mental health advocate.
He's also the author of the book.
The Manual, A Practical Guide to Life, Health and Happiness. Kieran, thank you so much for joining us today to dispel some ADHD myths and beliefs.
But we wanted to.
Start with something that has become more apparent in recent years, and that is that ADHD presents differently in girls and women.
As opposed to what it does in boys and men.
As you say, there's so much out there at the moment around ADHD, and I think in a lot of ways, girls and women are being hit with the brunt of a lot of that information. And I obviously see a lot of women questioning ADHD as a diagnosis at whatever age and stage they might be at. And I think it is this really growing awareness, thankfully around ADHD presenting differently not just for girls and boys, but also for men and women as well. We know that that's different
for a number of reasons. I mean, as with all medicine and mental health, you know, there's an element of biology potentially there in terms of how ADHD presents differently in the brain for girls and boys versus men and
women as well. But a really interesting part to it is that women often present more with inattentive features of ADHD, which is where the struggles are actually less overt or externally observable, and so that might be focus and distraction related issues, It might be really struggling with rejection, sensitivity, organization, procrastination, all of these elements that I think for a long time we didn't traditionally see on the surface as being ADHD.
Compared to say, the more hyperactive or behavioral features, which are a lot more common in boys and men comparatively I think for women and for a lot of adults. In terms of adult ADHD for women, we're also seeing
that culture, gender pressures, socialization. This has a huge part to play for ADHD for women and girls as well, because even if there are hyperactive elements or other features, I think from an early age, girls are pressured to be behaving in a certain way, presenting in a certain way.
And so I speak to a lot of women who have their entire lives really known and felt something's there on the inside, but they've sort of been pressured in a way to containing that and to actually never really allowing themselves in a lot of ways to align with or really recognize those fearstures of ADHD that might be there all along.
Well. Some of the things that we're seeing these women experience include things like time blindness, which is I've only just come to realize is something that our boss Mia Friedman has to deal with because she believes in her brain that everything is just twenty minutes either twenty minutes to do twenty minutes away, and so she doesn't have a comprehension of just how long things might take to do or to travel to and so that then will often lead to.
Things like chronic lateness.
How do we find strategies to deal with those kinds of things?
Yeah, really tricky, and I mean time blindness is a really really interesting one that so many women and just people of all gender struggle with when it comes to ADHD. But it's not on we typically sort of really put up the front of our mind. But it is one, as you say, that can really impact our work, It can impact our relationships, our personal goals, and so I think when it comes to time blindness, it's that level
of insight that's the first step, and that's key. I think often with time blindness, we're often just that we're blind to the fact that we can actually really struggle to sort of conceptualize time in our mind and how long things might take, or that we need some scaffold. So I think being aware that time blindness might be part of ADHD for you is a really really kind of key one to just acknowledge it, and then strategies for that do come around just giving ourselves more structure
and planning when it comes to timing. It's also practice we know that for ADHD, a lot of these things do gradually kind of change and can improve with time and practice. So it's almost like a little bit of a muscle.
Does ADHD affect your memory?
Memory and retention are really prominent features of ADHD for a lot of people. And it's amazing how many people I see who actually get a little bit emotional or obviously anxious when we come to this point of the assessment, because they've often said to themselves, God, I wonder whether I'm sort of getting early onset dementia here, or I just always felt like some was actually wrong with my
brain when it comes to memory. But if we really nail it down, it's not so much an issue with the actual memory or recalling things or laying down memories. It's more an issue with that intentional dynamic, meaning our brain didn't quite get the chance to sort of take and focus on and retain that information from the get go, And so that's where things like names being given instructions
by a colleague or our partner conversations. Even it's often the sense that it's it's not the hardware of our brain that's struggling to actually lay down memories and recall them. It's the fact that that intentional dynamic of ADHD impacts being able to take in that information and then recall it later.
A lot of people who have ad actually say they struggle with personal relationships.
And it can be for various reasons.
I mean, the time blindness and the chronic lateness and you know, the memory issues like all of that can add up if you are in a relationship with someone who has eighty eight and they can get frustrating. But other strategies to help improve communication for someone who is struggling to maintain a relationship.
Yeah, definitely. And I think you know, for so long as well, we focused on for kids obviously with school and learning, but also for adults when it comes to study, but also work. We focused on that very work learning study related side to ADHD and how these symptoms impact
kids and adults, and especially for adults. We know that the impacts on relationships and our personal lives are just as wide reaching and significant, and relationships as an area where those with ADHD can really struggle, And as you say, it's often to do with a number of different things, but I think it's often the level of again calling that out an insight around what's happening and why that
I see making the biggest difference. And I think part of my work and working with people with ADHD that I love so much is just these beautiful little ripple effects to a diagnosis that we see. And I have so many patients say, God, things have been so much better with my partner and with my nearest and dearest since the diagnosis, because not only now do I understand where some of these things were coming from, but they have a much gentler, more open understanding of that as well.
And with ADHD, we know obviously that things like forgetting a conversation with our partner, or struggling with time management or getting to the restaurant to meet them on time, these things are not anything to do with an active sense of trying to do those things, or not finding that relationship important, or not valuing that information or that time. It's just that these things on a more neurochemical level are very, very difficult.
Can we talk about diagnosis, because if you're to believe social media, you can ask one question, like I was just watching a video of someone who said pretending to be the therapist, saying, do you interrupt people a lot, and the person who's the patient says, no, I don't no, because I'm constantly stopping myself in my head saying don't interrupt, don't interrupt, don't interrupt, don't interrupt it, and thinking about what it is that I'm going to say to contribute to,
and then forgetting what I was going to say, and then the therapist goes, oh, you definitely have ADHD, Like, is it that simple?
Unfortunately not. I mean, my job will be a lot easier if it was. But no, I'm so glad that you wanted to chat on this point because I see so much of it too, and it does drive me slightly insane, even as a psychiatrist to see some of this. I mean, I think even earlier today, I saw something on my Instagram scroll of if you see green in
this image, it means you have ADHD. There's so much floating around on social media now that obviously is really grounded and misinformation, but also for me as an ADHD psychiatrist, really concerns me because I think it oversimplifies and actually
disregards a lot of what ADHD is. And I've had a lot of patience and even friends and people I know with ADHD say when they see that type of thing on social media, it's actually really quite invalidating to feel that their experience and their diagnosis and condition can be boiled down to a oh yeah, you look at this color chart and if you can see green rather than blue, then it means you must.
Have as can We talk about another aspect of ADHD, and that is dysregulation and rejection sensitive dysphoria.
Now a lot of women I know have.
Experienced this, not because they have ADHD, but because they get PMT. You go through this week every twenty eight days where you think everybody hates you, and there's no reason for it, but you just have convinced yourself that everyone hates you, no one likes you, You're the worst person in the world. And that is apparently something there's quite common for people who have ADHD, but not just for one week every twenty eight days.
Yeah, exactly. I mean it might be slightly worse for that one week every twenty eight days.
Okay, that's rip that week.
Here exactly, very very are But no, you're exactly right. For those with ADHD and for neurodivigence in general. We know that regulating emotions can be really quite difficult. I often talk to patients about pinball emotions, where there's a sense that our emotions can really shift and pinball and
change quite quickly but also quite intensely. And I think hand in hand with that can come RSD, where As you say, we're sort of really really hyper vigilant to any perceived sense of rejection abandonment, that the other person or people might be displeased or unhappy. And the interesting thing is that we're starting to see there might be a neurological correlate to that in terms of that vigilance
to rejection and emotional responses in ADHD. But the fascinating thing is that for those who struggle with rejection sensitivity and ADHD, it's often because there's been a collection of messages and signs across their life from early in childhood that they're not quite behaving as they should, or they're
not quite achieving as much as they could. She would have amazing potential if she just learned to not talk so much in class, And so when it comes to rejection sensitivity, it's often this background history of being made to feel and soak in explicit and implicit messages across a lifetime. That lead us to be really really sensitive
to gauging how we're doing with other people. And if we sense that there's a sense from them that we are not doing as we should, performing as we should, or that they might be considering rejecting or leaving, that can strike this hugely powerful emotional and even physical type reaction where we feel that intensely. And so we now know that that is really really common for a lot of people with neurodivergence and ADHD.
Do we know what causes ADHD? I've been reading quite a bit that it's got a genetic hereditory aspect to it. Is that what we sort of understand is its root cause.
Yeah, absolutely, we know that compared to especially a lot of our psychiatric or neurodevelopmental conditions, ADHD has a significant genetic component. So we are much more likely to have a diagnosis of ADHD or maybe struggle with subdiagnostic traits or elements of ADHD if we have a direct family member who also struggles with ADHD or has the diagnosis. We're not exactly sure how and why that gets expressed
in some people rather than others. There's no clear environmental cause for ADHD or one clear trigger or switch, and so it's probably, as with much of medicine, this really complicated melting pot mix of genetic, biological, environmental, and other factors that leads to ADHD being there.
Well, finally, let's talk about medication.
I did see this great video of a doctor who said the side effects of taking ADHD medication might be that you graduate high school or graduate university, or reduce your likelihood of getting arrested, or becoming an addict or getting divorced. Like, could we talk about the impacts of ADHD medication?
Absolutely, you know, And I love that spin on it as well. You know. I think there's a lot out there about ADHD medication. But as you say, if the diagnosis is there, if the medication is right for someone and it works, the positive side effects and spin offs can be some massive improvements and supports. It's really really important to not feel like medication is the only option, because it's absolutely not. We know that psychology and coaching
for ADHD can make a huge difference. Things like a balanced diet, regular meals, exercise, sleep, managing other elements of our mental health like mood and anxiety. These things can all help support and prop up our brain to make sure ADHD symptoms are significantly improved.
What's the side effects that we need to be concerned about.
When it comes to stimulant medications for ADHD, There are some potential significant risks, even though those are very very low. I don't want to worry people or parents at all. With adults, we can notice some initial things because it is a stimulant around our heart rate picking up slightly, maybe some headaches, shapes, even feeling slightly anxious as the medication settles in. But significant symptoms to watch out for can be reduced appetites, reduce food and taken loss of weight.
That's one that mean kids need to be regularly monitored by their pediatrician or psychiatrist and GP sleep can be something that's impacted sometimes. And the very very rare but potentially serious side effects would be around the heart and brain and so depending on the psychiatrist and doctor. Getting checks for heart fire, option with an ECG, getting routine
blood tests, getting a medical exam. All of these are paths to the medication side of things that mean we try and make sure there are no significant risk factors or contraindications for people. Generally they're very safe medications, but as we mentioned, it's always a weighing of risks verst benefits and can be a complicated question. So definitely one
of people, whether they're on medication or not. For a DHD, if you have concerns, if you have questions, going straight to the horse's mouth and talking to your GP or your psychiatrist about that is really really key.
A really big thank you to doctor Kennedy for taking the time to explain a bit more about ADHD to us.
Mariam, how did you feel about what he said?
What he was speaking about with females obviously getting diagnosed later in life, and that's generally what we see in general practice is you know, females in that forty five age range group coming in and getting that diagnosis. And a big part of it is those cultural and gentle pressures to behave a certain way. So it's really sad to I think they've been masking and acting for all this way because of all these pressures on how they should behave.
It sounds thoroughly exhausting that they've had to essentially put on a show every day just to get through. Yeah, from waking to sleep that's incredible. Next, we are heading into the consultation room to find out exactly what is totally fine and normal when you touch your boobs and might find something a little lumpy and what is it totally not fine and needs a biopsy kind of lump. As we remind you all to do your monthly boob checks.
The doctor will see you now. Just through here to consort Room one.
Thank you for waiting.
How can I help you?
So?
This is where you can have your health concerns heard. If you have something you want to ask doctor Marriam or any expert in the health space, make sure you reach out our email as well at mmamea dot com dot are you all leave a voice note. You can find a link to that in the show notes. Amali said in this question and it is one for all the lumpy boobed gals.
Okay, here we go.
She wrote this, I just don't know if I'm doing my breast check exams right. I've been doing them for a while now, and I feel things in there. They're not lumps as such, but they're not not lumps, if you know what I mean.
Now, I hear you, Amali, as a fellow lumpy boobed gal, and I've been trying to tell my colleagues that I wish it wasn't an HR violation and I could allow them to touch my boobs so they could feel what I can feel. Because everyone's boobs feel different, right, they have decided not to break that HR violation.
You're lost, ah, exactly, So how.
Do we tell the difference? And what are we actually feeling when we're feeling our boobs?
Yeah, Amali, First of all, great work that you are breast aware, so we know breast self awareness is about becoming familiar, having your relationship with your breasts, getting on top of how they look and feel. So generally advise all my patients to be breast self aware, and that's doing a breast examination every month, and I generally recommend that two to three days after your period if you don't have a period anymore, setting a start date every
month and sticking to that date. Everyone's breast look and feel different. They may be lumpy, you might have inverted nipples, whatever it might be. Everyone's breasts are normal, so you need to get used to your normal by doing these self examination tests. So, Amali, the things that you might be feeling when you're examining your breast. They might be the fatty tissue which you've described. They could be the glandular tissue, and that includes the lobes and the lobules,
and that's what produces milk. You've got the milk ducks, which are thin tubes that go from the lobules to the nipples. You've got the nipples and.
That because lobules is the most glorious word. I have. Lobules. Is that what I'm feeling under my nipple.
You've got some lobules.
I love that.
And then yeah, so you've got these milk ducts, which are thin tubes that carry the milk from the lobules to the nipple, the nipple and the surrounding areola. And then you've got the supportive connective tissue. You've also got lymph vessels and lymph nodes. And when you're doing an examination, you want to make sure that you're going under the arm, around the breast, all the way below the collar bone, all those lumpy breasts. You need to know what your
normal is. So if you're feeling something and you're not quite sure, just go in and see your GP. They'll do a breast examination, and there's aside whether or not you need some imaging. If the imaging is all fine, then we know that's your normal, and then you just continue examinations and then if anything changes, you see your doctor. So it's just knowing what is right for you and
what is your normal. It's very important to note that self awareness does not replace the two yearly mammograms, so you still need to do those mammograms from the age of fifty, or if you want to do them earlier, you can do them from the age of forty as well.
There's also been a lot of chat around about DNSE breasts because imaging it's harder to pick up breast cancer. If you have dance breast. Can you feel if your breast tissue is dense, like, would it feel different to someone who's isn't.
It may or may not feel that way during examination. We only generally pick that up in imaging. But yeah, if you've got any concerns during an examination and you're feeling like, oh, I don't know if this is normal, just see your doctor get some clarity, don't leave it.
Thank you Omali, and remember if you do want to send through a question to doctor Mariam go in our show notes, leave us a voice note, or if you want to remain anonymous, there's a way to do that too. Thank you so much for joining us on our well adventure today. If you have any questions about what we discussed or any health concerns you want us to look into, shoot us an email well at mamamea dot com.
Dot au or leave us a voice note.
Next week, we're talking about two things that can either be a constant companion or an infrequent visitor, but always messes with our heads. It is something that both Mariam and I have experienced at some stage. We're talking about anxiety and depression. They also sometimes hang out together along with Adhd, as we.
Found out today.
And if you are interested in anything that you have heard or learnt here today, make sure you sign up to the Well newsletter. You can find a link to that in our show notes. Of course, the advice you've heard here today.
It's general.
It may not suit your exact needs, so make sure you reach out to your own doctor or a health specialist to get the info that is one hundred percent right for you and Mariam.
We will see you for your appointment next week. Back to your opinions.
Well is produced by me Claire Murphy, Our Group Executive producer Georgie Page and SEENI producer Sasha Tanic, with audio production by Scott Stronik. We hope you enjoyed this episode of Well. If you're after more women's health news, just like this, Well is your full body health Check. We drop episodes every week on a Thursday. Coming up in our next topic, we're going to be focusing in on the body, so we're delving into weight, weight loss, drugs,
and body longevity. There's a link to follow us right there in the show notes.