The ADHD Perimenopause Connection & Why Women Get Diagnosed Later in Life | Mandi Dixon

Sameena Rahman (: 00:01

All right. All right. Welcome back. I call my listeners, Vagilantes by the way. My husband made that up like, I don't know, like a month or two ago. And I'm just like, you know, we'll see. We'll see if it sticks. Okay. Welcome back Vagilantes. Today we're going to dive into a powerful conversation around midlife menopause and mental health.

Mandi Dixon (: 00:17

Brilliant.

Sameena Rahman (: 00:27

You may have seen both myself and my guest on a recent USA Today article about menodivorce, but I'm super excited to have my guest Mandy Dixon on today. And we're going to talk about why women aren't really sweating marriage in a sea of hot flashes. We're going to see what she says about that. But Mandy Dixon is a

Sameena Rahman (: 00:55

OK. Mandy Dixon is known as the ADH menopause specialist on Instagram. OK. And she is a licensed therapist based in Texas who focuses on women's mental health across the lifespan, works with clients navigating period menopause, relationship changes, ADHD, and trauma recovery. She's EMDR trained and

Mandi Dixon (: 01:03

a post therapist, yeah.

Sameena Rahman (: 01:23

which is all about helping women heal and reclaim their story. Mandy, I'm so thrilled to have you. Your full bio will be in the show notes. So welcome to Gyno Girl Presents Sex, Drugs, and Morals.

Mandi Dixon (: 01:37

Thank you so much for having me.

Sameena Rahman (: 01:39

Oh yeah, we just literally connected on Instagram like two weeks ago and we're like, Hey, we were both in that article.

Mandi Dixon (: 01:45

So you don't know, you probably don't know this, but we actually did meet before. So, so something I was at a menopause conference and feeling very out of place, very overstimulated. It's a good word because I get like that, like in large crowds. So sometimes I will go and hang out in the bathroom and like just wash my hands, you know, or hang out. I'm, that's what I was doing in there. Just like getting away, you know?

Sameena Rahman (: 01:51

Texas right? Yes I remember that actually.

Mandi Dixon (: 02:15

and this little ball of sunshine comes in and is like, I love your blazer. And I'm like, I love your blazer. And then you're like, I love your purse. And we talked in the bathroom and I was just like, I don't know, it helps me feel so much better, I don't know. So I go back out and then you just walk up on stage and I'm like, that was gone, girl, I didn't even know.

Sameena Rahman (: 02:38

No, I do remember now actually. I always remember good fashion sense. That's awesome. Yeah, so then I think you and I started following each other on Instagram and then that's the rest is history. So but I was excited to like see the fact that, you know, the USA Today and people are talking about, you know, all the things.

Mandi Dixon (: 02:41

Yeah, it was so funny.

Ha!

Yeah.

Mandi Dixon (: 02:55

Yeah.

Sameena Rahman (: 03:03

Before we start talking about that, always like to get an idea of what brought you into the sort perimenopause menopause space. And if you have anything in your personal journey, like in this landscape to discuss, if you wanted to talk about it, like symptom-wise or whatever, happy to hear.

Mandi Dixon (: 03:19

Yeah, my personal journey is really what brought me here. I mean, I was just a therapist, but you I was a therapist that focused on, I don't know, would say everyone. I didn't work with a lot of kids at this point because I have little kids. So it was more of like teens and up. So I was just noticing, I noticed like patterns with things a lot. I found that out about myself and it helps me as a therapist a lot, you know, to gain insight.

Sameena Rahman (: 03:34

Right.

Mandi Dixon (: 03:47

But I noticed women in midlife just coming in for regular counseling, having things, know, the thing I always heard was, I just don't feel like myself. And, you know, we would go through the depression, the anxiety, it, you know, symptoms of both, but just not enough to like really meet that criteria. you know, they had been to the doctor, the doctor had given them antidepressants and said, go to counseling. So here they are. So we're, you know, we're doing counseling. They're not sleeping. They're waking up with anxiety.

Sameena Rahman (: 03:56

Sure.

Sameena Rahman (: 04:06

it.

Mandi Dixon (: 04:17

And it just, it really, I started noticing it because it was women within like, you know, 10 years of my age and I was feeling the same thing. And I had been going to my doctor and they had told me it was PMDD and that you can treat it with birth control pills. I didn't want to do that. So it was, I was going through my own journey and maybe that's why it stood out to me too, as they were. And so I just started asking them, like, do you feel like it's related to hormones? And every time they were like, yeah.

Sameena Rahman (: 04:24

Yeah.

Sameena Rahman (: 04:34

All

Mandi Dixon (: 04:47

Absolutely. But there's nothing we can do. It was just this, you know, this huge injustice, like what, what is this? And I just sat down on a mission to like figure it out. Like what, what is happening? And I learned about Harry Menopause. I joined the Menopause Society. I read every single Menopause piece of literature I could find, which isn't a lot or wasn't, you know, then.

Sameena Rahman (: 04:51

I know.

Sameena Rahman (: 05:10

Like that, yeah.

Mandi Dixon (: 05:12

you know, just I started listening to everything, reading all the books, Estrogen Matters, every book I could find and connecting with experts, going to conferences, menopause conferences, just things like that. it then I just felt this huge, like, why is no one training us? Why is no one training the mental health professionals to know about this? So I started reaching out to other experts and just about this huge injustice in their life.

Sameena Rahman (: 05:23

Yeah.

Sameena Rahman (: 05:41

Yeah.

Mandi Dixon (: 05:41

will calm down because every other profession feels that too. Nobody's getting trained. Nobody's getting trained. And so, you know, I live here in the Dallas area. So I would just go to every event that I could host events, ask to speak at things and talk about menopause and mental health. And, know, to other clinicians, what you may be seeing could be related to hormones, not always, but it could be. And these women should know that there's treatment, there's options they have. They don't

Sameena Rahman (: 05:44

We felt like we were going to die. Nobody was going to turn in.

Mandi Dixon (: 06:10

just need to be handed either birth control pills or an SSR. Like there's other options to talk about too. Yeah, so that that led me to opening my own practice where I could have more freedom and flexibility and just really focus on that.

Sameena Rahman (: 06:17

Absolutely. Absolutely.

Sameena Rahman (: 06:25

Yeah. I mean, you have to, right? In some ways you have to like, think for those, because your journey sounds almost identical to, you know, mine in terms of like, you know, going out and finding more information, teaching yourself, working with mentors, all the things because we weren't, and then starting your own practice because you realize within a model of, within the healthcare system model that we have right now, there's no room for menopause management, perimenopause, you know, all of that. So.

Mandi Dixon (: 06:37

and

Sameena Rahman (: 06:51

I always talk about this almost on every podcast, how our health care system's broken. And it's really set up women to fail in so many ways. But I love to hear how other people sort of, and every time it's almost identical story. Because either you feel something or you realize something with a patient, and then you figure it out, and then you're just pissed off. Yeah. You sound like Vagilante. Yes.

Mandi Dixon (: 06:58

has.

Mandi Dixon (: 07:15

be happening I have to stop it yes exactly yeah

Sameena Rahman (: 07:21

Hey, vagina, we're on number two. Yeah, that was good.

Mandi Dixon (: 07:24

And that sort of has led me, I do this in my practice. I mean, I see all areas of women in my practice, but really like the social media, I've really kind of zoned in on more of the ADHD and perimenopause because yeah, I struggle with it. didn't, I have always managed it just fine. Was, got good grades in school, you know, all of that typical stuff. And then it all was starting to fall apart. I'd never.

had to learn how to study. I never had to learn how to build systems because I could just do it. I don't know, it came just, I don't know, I think I did it, but I was probably barely doing it. But then when perimenopause hit, nothing worked. So I was just, what is happening? What is going on? And then I really learned about, you know, the dopamine, how are the estrogen, how that impacts our dopamine and makes it harder and why it sort of reveals what was already there.

Sameena Rahman (: 08:05

Yeah.

Mandi Dixon (: 08:22

in so many ways. And so I love educating women about that, especially women with ADHD, just kind of warning them like this, this can happen in perimenopause and it can be really hard.

Sameena Rahman (: 08:34

Yeah, I mean, we're seeing more and more of it. I I see it like, I feel like almost every day, like some patients will get, you know, maybe I'll put them on menopausal hormonal therapy. They're feeling better. Maybe they're not there yet, but then they're gonna go get some stimulants or something sometimes, or, you know, therapy sometimes. And even I think Louise Newsome and her balance series has been talking more about the ADHD overlap of perimenopause.

Mandi Dixon (: 08:49

Mm-hmm.

Sameena Rahman (: 09:01

Why, I mean, we know you just kind of said why we catch it so much later in life. But I think what happens is we, tell me what you think happens, like in terms of, you know, what's happening both with women in this situation. And then obviously you just mentioned the hormone situation, but.

Mandi Dixon (: 09:17

Well, when you look at the way girls present when they're younger, because that's one of the key characteristics of ADHD is it's present when you're younger. It's a lifelong condition. But the diagnostic criteria is written on research largely from boys, little boys, because they present very outwardly. So they're the ones that got, you know, not only targeted, but recognized when they were younger.

Yeah, so they're hyperactive, they're loud, they're distracted, all of that. And girls, their hyperactivity cannot often be internal. So daydreaming or worrying, even anxiety. So a lot of times their symptoms are more internal than external. So they can fly under the radar. And girls are very good at learning how to mask, learning, you know, there's that, you know, that just that society

rule of, be a good girl, be quiet, just be a good girl and learn the rules. And a lot of girls do that. They learn, they learn how to follow the rules. They learn how to not get called out, but they never let anyone know, you know, the sort of restlessness inside that they feel. And so they are just very easily get missed and very good maskers.

Sameena Rahman (: 10:18

Yeah.

Sameena Rahman (: 10:35

Yeah. Let's talk a little bit about that diagnostic criteria that, you know, people have to have as kids or adults or whatever. What kind of screening do you do for patients for ADHD?

Mandi Dixon (: 10:47

I don't diagnose that. You have to really go to a psychologist and they go through the testing. But the things I look for is just what are they kind of experiencing? A lot of trouble with executive functioning tasks. staying organized. And so for me, you can see this looks organized. But if you turn the camera around, you can see what it really looks like.

Sameena Rahman (: 11:13

Right.

Mandi Dixon (: 11:14

And that's a great example of masking. You know, I look very organized and put together, but underneath it's not. So that's a pretty good example, but a lot of women and girls, don't show anybody that. They just show you what they have put together. So that's one pretty good example. Trouble with just in general or kind of the perimenopause symptoms with it or just in general.

Sameena Rahman (: 11:21

Yeah.

Sameena Rahman (: 11:40

Yeah, just some in general, and then we can talk about the overlap of what Harry Menopause did.

Mandi Dixon (: 11:44

Time management can be really hard. It can be really hard to gauge how long something's gonna take. So typically a way that girls sort of cope with that is they will hyper-focus on that time, sort of become a little bit obsessed with it and then either be really early, so in order to avoid being late. So either they're really late or they're really early. Very rarely are they sort of on time, because they're trying to cope with it, yeah.

Sameena Rahman (: 12:07

Yeah. Yeah.

Mandi Dixon (: 12:13

And another thing is just that ability to hyper-focus on things that they found really interesting and not being able to really focus on things that aren't just interesting.

Sameena Rahman (: 12:23

And before we talk a little bit about perimenopause, I think it's so interesting because I have a lot of experience with both patients with OCD because I deal with a lot of patients who have pelvic floor issues or persistent abdominal arousal, but also like full disclosure, I have a son with OCD. And so it's like, I've delved in so deep to understand this sort of condition. a lot of there's so much overlap with ADHD and OCD too, right? To actually differentiate the two.

Mandi Dixon (: 12:35

Yeah.

Mandi Dixon (: 12:50

very much.

Sameena Rahman (: 12:52

But he was diagnosed with OCD early. so it's kind of like, had he not been, probably would have been, I know it's another board that would ADHD. But can you talk a little bit about that, some of the symptom overlap that we see?

Mandi Dixon (: 13:06

Yeah, with OCD, it's pretty specific with the obsession and then you have to have the compulsion part. So it's like the obsession is something that it can be like a hyper-focused sort of thing where they cannot stop thinking about it. But then you have that compulsion part, where is they feel compelled to do something that then relieves that anxiety. the way that that can look in ADHD is definite or just the overlap where they can look similar is just that obsessive hyper-focus ability.

that a lot of people with ADHD have. But a lot of times with OCD, they will hop or fixate and focus on things they don't want to. It's almost like something they don't want to. With ADHD, it's usually something they're very interested in.

Sameena Rahman (: 13:39

Right.

Sameena Rahman (: 13:51

Yeah, okay, that's a point too.

Mandi Dixon (: 13:52

And people with ADHD can have OCD too. They can, yeah.

Sameena Rahman (: 13:55

Right. Right. And I think it's interesting to the not only the hyper focus, but the executive functioning difficulties. Like they both seem to have that. And I think for like smaller kids, it's really hard to get to a point where you can actually like sort of function in a space with someone that's not neurodivergent. But what happens to women in perimenopause? Like when they're trying to deal with, you know, executive functioning issues and all that stuff.

Mandi Dixon (: 14:22

That's what I hear a lot. For women, typically, like, they start kind of in their 30s. Well, a lot of times it happens with motherhood. some women really struggle in pregnancy and other women with ADHD don't. So I know for myself, I did not struggle in pregnancy. I felt like a genius. I think it must have been all the estrogen. I don't know. was a great time for me, not physically, but mentally I was sharp.

Sameena Rahman (: 14:30

Yeah, sure, Right.

Sameena Rahman (: 14:50

Yeah.

Mandi Dixon (: 14:50

And then afterwards, after I had my sons, it was terrible in terms of, but that's mommy brain. You know, they, can.

Sameena Rahman (: 14:58

Right? Because you just have that accelerated drop of estrogen too, right? Like all of a sudden, and that's why you get like in this perimenopausal state.

Mandi Dixon (: 15:03

So.

And that's, think a lot of women who are late diagnosed with ADHD, they experience that, it's related or they say it's mommy brain, you know, so they don't, it can go missed. And a lot of women just don't go through motherhood. So they could get missed completely with that too. And the, every woman with ovaries goes through perimenopause. So that is a pretty good catch all time for if you were missed before you were likely, you will likely get.

Sameena Rahman (: 15:24

Yeah, that's very tricky.

Mandi Dixon (: 15:36

recognized in perimenopause.

Sameena Rahman (: 15:38

And I think it just goes to show the profound neuroendocrine control. The fact that these hormones, I just spoke to a bunch of my menopause colleagues and friends this past weekend because the term sex hormones really does confine estrogen, progesterone, testosterone into that category of reproduction and post-reproduction.

But if you think about how these hormones really do are so involved in your brain and your neuroendocrine pathways, that it really is, it does them a disservice to just limit them to their reproductive. That's why we wanna call them pet hormones now, just for testosterone.

Mandi Dixon (: 16:22

I've been, I have been seeing that and I have been, I'm making a little PDF downloadable kits for ADHD and perimenopause. And I just went in and changed it to, or I put in HRT, MHT, and you may have heard it called pet therapy now, because I'm like, they need to know. Like if they see that, they're going to be like, what is that? Yeah.

Sameena Rahman (: 16:44

Who does that? So, well, I mean, how, when you talk to patients, because you probably get the same thing where like everyone's like, so like everything's just perimenopause now? Like, that what it is? But it's like, you know, it's a big part of everything that's happening to most patients. And so how do you talk to them about perimenopause versus ADHD or, you know, how do you describe what to them what's happening so they have a better understanding?

Mandi Dixon (: 17:09

I think that, and I don't have any specific research and it may be out there, but I think that neurodivergent women in general have a harder time in perimenopause. I think they're more sensitive overall, just their nervous system is more sensitive. They're more sensitive to hormone fluctuations. So a lot of side effects that can happen with the changing of the hormones, think.

Sameena Rahman (: 17:21

I'm to bring that.

Mandi Dixon (: 17:35

Someone I listened to yesterday described it as they're kind of like an orchid whenever you are treating them with hormone therapy. So delicate in a way, but just have to handle it, guess, with a little bit of extra care because they are a little more delicate with the sensory issues. So I've noticed that with myself and with other neurodivergent women. And I really...

stress the importance of finding a menopause specialist. If your OB says she can do it or he can do it, maybe go to somebody that really is trained because it can be a delicate thing. I've seen people, somebody will say, we can start you on hormones and they have a horrible experience and they say, no, I'm not doing that again. That was awful. I'm not doing that. So I always want to try and encourage them to find a real

real specialist in that area because they could be a little more sensitive to the changes. But in the end, it really helps to get things balanced.

Sameena Rahman (: 18:36

Right.

Sameena Rahman (: 18:41

And I mean, just speaking about that sensitivity that you're talking about, there's so many sensory issues that I see in these patients, right? Like, I mean, I have some of these, I just can't stand the way he eats anymore. Don't crunch near me. Like, mean, I myself, like, you know, I'm used to a high level of noise because I have three kids and two dogs, but sometimes I'm like, I have to get out of this house right now because it's too much noise for me. And I never had that experience before hitting period menopause.

Mandi Dixon (: 18:44

Mm-hmm.

Mandi Dixon (: 19:10

I myself too, I have really struggled with it a lot. have two boys and a dog and it seems to be very, very loud. it, the biggest, think before I realized how much, know, just that it was like a sensory issue to me. It was more about be quiet, be quiet, be quiet. And now it's like, okay, maybe they're not being incredibly loud, but it's really sensitive to me. So I will go into the bedroom, you know, where it's quiet and they know like I'm not being

Sameena Rahman (: 19:26

Yeah.

Sameena Rahman (: 19:39

Yeah.

Mandi Dixon (: 19:39

rude or anything. I'm just trying to regulate myself.

Sameena Rahman (: 19:43

Exactly, yeah. My six year old calls it scary peri. If I start like getting really mad, I'm like, stop, I can't handle the noise. And they're like, oh mom. And then she's like, is this scary peri? And I'm like, yeah, it's scary peri. She goes, mama, you can go downstairs or out for a walk if you want. And I'm like, thank you, thank you.

Mandi Dixon (: 19:54

Gary Perry. Yeah.

Mandi Dixon (: 20:03

One of the things that I've heard so recently several times is the exhaust fan in the bathroom, and the overhead, what is it? The cooking exhaust. I really thought I was the only one. I hate the sound of the cooking one and I will always go turn it off. And every time I walk into our bathroom, my husband has the bathroom exhaust and then the one in the toilet. And I'm like, smack, turning them off. I can't stand to hear it.

Sameena Rahman (: 20:10

yeah.

Sameena Rahman (: 20:14

Cooking, Yeah, yeah, yeah.

Nah.

Sameena Rahman (: 20:31

I know I feel that same way too and I'm just like yeah and yeah it's totally a sensory thing you know so and must be neurodivergent as well but anyway.

Mandi Dixon (: 20:39

it is.

Mandi Dixon (: 20:44

Well, I think also what comes with neurodivergent is the rejection sensitive dysphoria. That's something that we struggle with early on and always, and that can feel really intense. So that's where any criticism or perceived criticism or any kind of, you know, any kind of, yeah, criticism, it can feel rejection. Yeah, it can feel just like in your bones sort of feeling really.

Sameena Rahman (: 21:09

That's so.

Sameena Rahman (: 21:13

with a song.

Mandi Dixon (: 21:14

hurts you, yeah. So I tell women just, you have, yes, I think it's something that we've always dealt with and we've, can sort of learn, but when you add in that estrogen layer that can make you cry at the drop of a hat, then it can really just be a whole body experience, you know, just really in your feelings.

Sameena Rahman (: 21:17

So you think there's more of that in perimenopause or you think, yes, that makes sense.

Sameena Rahman (: 21:29

Yeah.

Sameena Rahman (: 21:36

that's so interesting. Because I feel like, yeah, I've definitely had those moments myself. I've had patients describe those to me where like, and he said this to me in a joking way. And he's like, I used to be able to joke with you about this, and now I can't. Because it'll bring you to tears or just, you know, we don't know when you're going to flip a switch, you know? I mean, you know, like people have joke about it, but I feel like it's so devastating for patients, right? Because I feel like really not

Mandi Dixon (: 21:40

Yeah.

Sameena Rahman (: 22:03

feeling like yourself is such a profound way of talking about it. And we know that there's studies, I've talked about the study that was done that, you know, like, I think was like greater than 60 % of women within the last three months felt like they didn't feel like themselves in period menopause. And that was like the general complaint they had. And they couldn't pinpoint what it was. Sure, there was irritability. Sure, there was like mood disruption, depression, anxiety symptoms. But again, like, I just feel like it speaks volumes of how hormones affect our mental health, you know?

Mandi Dixon (: 22:19

and

Mandi Dixon (: 22:32

They absolutely do. I know that Louise Newsome talks about this a lot, but I call it with my patients and clients, kind of like ugly perimenopause. It's the really, really ugly kind that you, and I've felt moments of that early on. And it's where people send you the perimenopause jokes, the reels, and it is not funny to you. Like it is just not funny because you are super duper struggling. And there's a lot of women that have that.

Sameena Rahman (: 22:41

Yeah, that's good.

Sameena Rahman (: 22:48

Yeah.

Sameena Rahman (: 22:54

Yeah. Yeah.

Mandi Dixon (: 23:00

ugly perimenopause and that I think needs to be taken extremely seriously. That's something you really can't brush off or, you know, just sort of walk off. I guess a lot of people think, it's just a mood, but that that can be the really serious, dangerous kind that really needs absolute attention and can be helped.

Sameena Rahman (: 23:17

Absolutely.

Right. No, because you definitely have those patients who, you you know, they're on the verge of something. Right. And even though they might have not have ideation right now, like you don't know what might trigger them. You have to keep checking in with them. I'm sure the therapist you check in with them like, you know, weekly or whatever.

Mandi Dixon (: 23:26

huh.

Mandi Dixon (: 23:37

Yeah, I mean, the highest rates of suicide in women is, I think, 46 to 54. And that is no coincidence. It's just not. So it can be very, very serious. When I do talks and education events, I really stress that to people. If you have a friend or an aunt or a cousin, and she's around this age and she doesn't want to come out anymore, she's turning down dinner invitations, just go check on her. Let her know what menopause is.

Sameena Rahman (: 23:46

Right. Yeah.

Mandi Dixon (: 24:07

let her know that there's help because you just never know.

Sameena Rahman (: 24:10

That's so good actually because there's so many people who become more to themselves and like, you I can just think about even my mother passed away, but like I can think about her transition and how she became a little more to herself and not, you know, and it was in midlife, you know.

Mandi Dixon (: 24:17

Yes.

Mandi Dixon (: 24:29

I think the overstimulation happens with everybody just being really overstimulated. And if you have a sensitive nervous system, everything can feel like too much. So it's easy just to not go out because you and you're not realizing like that's what I'm avoiding is the overstimulation, but it just feels like, I I don't want to go anywhere. I'm good.

Sameena Rahman (: 24:51

And this goes back to that sensory area, the sensory stuff. Do you think that when you have your clients, patients find out, like maybe they didn't know this was like hormonal and then you tell them, you know what, this is common in perimenopause, this is one of our common symptoms. Do they feel more empowered or do they feel overwhelmed with it? Like I have my own feeling on how they feel, but I kind of feel like some, well, do you tell me what you think?

Mandi Dixon (: 24:53

Okay.

Mandi Dixon (: 25:17

Definitely, it's always I get the same comment, well, what do we do? What do we do? What do we do? What do we do? And I try and be as specific as possible or as clear as possible. And I always say, look, address your menopause symptoms first. If you don't wanna do hormone therapy, at least learn about it. Learn about what your body, what's going on in your body in menopause. The best thing you can do is educate yourself.

read, read things and I'll try and put out as much education as I can about it. Thank you. And just learning, learning, learning about what's going on. Learn that there's long-term health risks to whenever your hormones go away. So learn what that looks like. And if you still don't want to do it, just then you're making that choice, but at least it's an informed choice. But yeah, it can feel very overwhelming for a lot of people.

Sameena Rahman (: 25:48

No, you do a great job. You do a great job.

Sameena Rahman (: 26:11

And I think, yeah, and that's kind of how I see some of my patients too, especially, you know, because it's not just, a lot of times I would say the mood and the mental health stuff is like top on their list, Like that's the irritability, the anxiety, the depression, you know, the complete anger or disdain for their significant other at this point, you know? And so I think that like that is a prominent issue. And then you compound it like, okay, yeah, let's talk about the lifestyle stuff.

Mandi Dixon (: 26:33

Mm-hmm.

Sameena Rahman (: 26:40

and you tell them you walk them through sleep, you know, stuff and trying to get your diet and exercise right. But you know, the more things you tell them to do, the more overwhelmed they get sometimes, right? Cause it's like, so I now have to make sure I do this and this preparation before I sleep and do this for my vagina. you know, I think a lot of times it becomes overwhelming for them, but I always say that like naming it as part of the situation is very empowering for many of

Mandi Dixon (: 27:06

Yeah, and I tell them, start with the hormone issues first, because a lot of times when you get that going and you feel better, you have more energy, you have a little more clarity, you're a little more patient, then you're gonna feel a little more empowered if you wanna go get the ADHD diagnosis, if you wanna go through that process and start that medication, or you wanna start an exercise class, or you wanna do a hobby, or do whatever, just start with one thing and...

work on that, then you can address and move because, and I think that's really the most important one is the hormone part because that often makes you feel so much better. Yeah. Yup.

Sameena Rahman (: 27:45

Yeah, I agree. Because sometimes you can restore their sleep and then they're motivated to do X, and Z. It's just you have to sometimes get them out of that loop of constant anxiety, worry, up at night, that kind of stuff. But speaking of all this stuff, I want to go back to the first thing we talked about, which was the idea of men owned divorce. And so you and I are both quoted in this article. But obviously, this is not a news. It's a trending topic.

Mandi Dixon (: 27:51

Mm-hmm.

Mandi Dixon (: 27:59

Yup.

Mandi Dixon (: 28:07

Yes.

Sameena Rahman (: 28:14

because menopause is trending, I guess. talk to me about how much of that you see in your office in terms of people who are just realizing I'm not going to put up with the same way.

Mandi Dixon (: 28:29

I would say I haven't seen a big amount of it, but I have talked to just friends and the, would say treated it, you know, in in session, not, not a whole lot of it, but just in conversations in general, I've had a lot of conversations with women about it. I think that a lot of the issues are already there. I think women put up with way more than they should. A lot of women do. They,

Sameena Rahman (: 28:34

Yeah.

Mandi Dixon (: 28:58

become more tolerant of things that, and I think that hormonal veil that we have makes us a lot more accommodating to things. Just biologically, have to, you know, it's there for us to be mothers and carry a baby and breastfeed a baby or, you know, all of those biological things. And that makes us more accommodating. And I have this little theory that I say like,

Let's say that you're a mom and you have a husband and you have a couple of kids and you go on vacation every year to the same spot. And the first year you go, like there's four pillows, but one of them is really crappy. So who's taking that crappy pillow? It's mom, right? Because she doesn't want crappy kids. She doesn't want cranky kids and she needs her husband to be rested so he can help. So mom takes the crappy pillow. So the next year they go to the same place. Well, that's mom's pillow, right? So mom takes it. It was, say 10 years of this. And then

Sameena Rahman (: 29:50

Nothing.

Mandi Dixon (: 29:54

They're like, hey, mom, here's your crappy pillow. And then she's like, I don't want this pillow. Why would you think I wanted this pillow? don't know. Why would anybody? You just don't speak up because you're sort of more accommodating. And then it just compounds. And then you need your good night's sleep. And you are angry that everyone thinks that you like this bad pillow. It's because you kind of never said anything, I guess, before. So the issues.

Sameena Rahman (: 30:03

Yeah.

Sameena Rahman (: 30:17

Yeah, yeah.

Mandi Dixon (: 30:22

a lot of times are always there. It's just you can put up with them and then you're just like, no, I'm not putting up with this anymore. And I think sometimes how the other family members, if it's the spouse handles that is really where the divorce hinges.

Sameena Rahman (: 30:30

Yeah.

Sameena Rahman (: 30:39

That's true, yeah. Because I was telling the story to the mutual reporter we spoke to and I was telling her that had a patient who basically was starting to go through perimenopause and I was helping a treater and then she lost her dad in the process and went through significant life, losing a parent is like a life altering event. And so she realized the way her husband responded to her loss.

was something that she was not compatible with anymore. And it was like the clarity, cause I always say like, know, men go through like midlife crises, but I feel like women, they're treated, they have midlife clarity, you know? It's like all of a sudden you realize I don't have to, I'm not gonna spend the remainder of whatever life. Cause you also realize how precious life is when you lose someone, And so, and so then you're like, do I want the rest of my life to be this? And so some people are,

Mandi Dixon (: 31:09

Wow.

Mandi Dixon (: 31:19

They definitely do.

Mandi Dixon (: 31:28

Sameena Rahman (31:35.438)

with their careers are like, no, I'm going to pivot. I'm going to start my own practice. Some people with, like for me, just pivoted out of insurance because I was like, I'm not going to spend my life fighting with insurance. And I'm peri-menopausal now and I'm just tired of having the, and I'm also an empath. So it really, take home everything with me. And so it's like, I'm tired of all of this. So, but you also realize once you lose a parent that like,

Mandi Dixon (: 31:58

the

Sameena Rahman (: 32:03

Life is precious. You really want to be able to enjoy what you have and not have the burden of things that are making you just unhappy and mentally unhealthy.

Mandi Dixon (: 32:13

Yeah, things that are draining to you. think that was, nevermind, I think I lost my thought there for a second.

I had a great thought. here it is. It's back. I think that when you say does menopause cause divorce, I think menopause, and we say it's trending, but it's trending in a good way as in the menopause empowerment. You can understand that you're, you know, how you're feeling and not have to put up with feeling bad. You can advocate for yourself, educate for yourself, go seek treatment to feel better because you deserve that.

Sameena Rahman (: 32:38

Mm-hmm.

Mandi Dixon (: 32:50

And I think that trickles off into relationships, just the menopause empowerment moment. And you feel bad in your relationship and you're feeling empowered, you're reading stuff online, you know, and it's like, wait a second, I don't have to put up with that. I don't have to put up with menopause and I don't have to put up with somebody talking down to me. So I think in that way, you know, menopause can cause it, but it's more of revealing. Yeah, the clarity.

Sameena Rahman (: 33:05

Yeah.

Sameena Rahman (: 33:09

Yes.

Sameena Rahman (: 33:18

I think, who's that comedian, Leanne? You know the comedian, she's like a midlife, she talks a lot about midlife in her. And she said that she realized that she was losing so much estrogen and she didn't care anymore and da da. And she's like, I just became a man. That's what I did. I realized I just became a man. she was, I put myself first and did all this stuff. It's so funny.

Mandi Dixon (: 33:43

That's so funny. Yeah, then it's so true. It's so true.

Sameena Rahman (: 33:47

I think part of what you probably do too is how do you help your patients distinguish what's relational, what's the hormones, what's the ADHD? How do you navigate that with them?

Mandi Dixon (: 34:02

sort of look at look at it from a holistic thing not so much this is this this is this this is this but this is you and these are all these different areas of you and look at it just sort of from that and you know the hormones can treat these symptoms to make you feel better and the ADHD medication if you need that can treat this but also the lifestyle part can treat so both of those absolutely

and just look at it from more like zooming out like a holistic lens. Like this is you, what can we do to improve overall quality of your life?

Sameena Rahman (: 34:41

And speaking of improving people, like I know one of the things that you specialize in is EMDR, which, you know, for the listeners that maybe not as familiar with what it means and what it is. Do you use it a lot in perimenopause and can you explain what it is and a little bit as much as you can in terms of how you do it?

Mandi Dixon (: 35:00

Yeah, so EMDR is eye movement desensitization reprocessing. And it's a, it's a long, long word, but it's very, I would say a very simple kind of therapy. It's not traditional talk therapy. And I tell my clients, you can, when we get down to the actual EMDR process, you can speak, if you speak a different language, you can speak a different language. I do not need to know what it is you're saying. It is, in talk therapy, it's very important that I know what you're saying.

But in this, not, it's me almost facilitating this environment through, we use bilateral stimulation. So that's activating the left side and the right side of your brain, which is what your brain does whenever you're sleeping in REM sleep. So your eyes go back and forth, the rapid eye movement. So we use external ways to simulate that. You can do it like this. So you just follow that with your eyes.

Sameena Rahman (: 35:52

Mm-hmm.

Mandi Dixon (: 35:57

I don't like that. A lot of my clients don't like that, but I have little tabs that they hold and they vibrate so they can sit on them. They can hold them in their hands. You know, it just, when you do it, it, it does this and can hold them in your hands and your eyes. You'll feel your eyes go kind of back and forth. It's weird. But walking is also a form of bilateral stimulation. That's why you feel so good after you take a walk. It, your, your brain sort of, yeah, it does that. So we set that up and then I sort of,

prompt them with these issues or we go through this thing about trauma. It's a trauma. It's a way to reprocess trauma or traumatic experiences, memories, sensations, set them up with that. And then their brain actually goes through the process. And if they trust the space they're in, they trust themselves, their brain will sort of take them there. So, and I'm interacting with them, but not in a talk therapy way. It's in a very

Sameena Rahman (: 36:49

that's so intricate.

Mandi Dixon (: 36:55

they're doing the work. I'm just sort of holding this.

Sameena Rahman (: 36:57

So they're doing the sort of bilateral stimulation and then they're just it on their own.

Mandi Dixon (: 37:01

Mm-hmm.

Yeah, they're, they're reprocessing. Yeah. Their brain will reprocess that memory, that sensation, that moment.

Sameena Rahman (: 37:11

Do you have them think about it? if they're addressing a certain trauma, do you say like,

Mandi Dixon (: 37:14

There's a whole protocol that we go through sort of before that builds up to that. And then, but the actual, what is it, the reprocessing, they do it themselves. I'm there with them, but their brain does it.

Sameena Rahman (: 37:29

And how long does, like, what is the length of time that most people are doing EMDR, like before they feel like they've come past a point of trauma?

Mandi Dixon (: 37:42

Really, the first sessions, I would say, are more about, you have to take a lot of history. So you have to go through some sessions before you actually get to the reprocessing. But the reprocessing, it's something can be done in an hour and a half or shortly, and they feel better. But a lot of times it will bring up other moments or other things and you have to have more sessions. And sometimes their brain will not fully process it.

Sameena Rahman (: 38:01

really? Okay.

Mandi Dixon (: 38:11

you know, come back. So it's, different for everybody.

Sameena Rahman (: 38:13

Okay, I bet to the degree of trauma they have too and like how much adverse child experiences, all those things play in.

Mandi Dixon (: 38:18

Absolutely. Yeah.

Mandi Dixon (: 38:23

And that, yeah, that plays into a lot of the preparation to sort of get you lead up to that moment. Cause you have to have a lot of protocols in place for safety, places if their brain goes somewhere that they don't want to, things we can come out of it, they can fall back on to feel safe. And then what happens when they leave my office, they have to have such, know, and something suddenly comes back. So you have to have, be prepared for all of that. Make sure that they're.

in a good place to sort of go through this, but it's very, powerful. But in terms of just the bilateral stimulation, so not the actual reprocessing, a lot of my clients just love to hold the bilateral stimulators, the little tappers we call, just during a session and we talk and they love it. We do some guided.

Sameena Rahman (: 38:54

That's great.

Sameena Rahman (: 39:11

that makes them more open then like as they're doing it.

Mandi Dixon (: 39:14

It opens a part of your brain, I don't know. It's like it calms your nervous system down and allows you to feel that as the best. It's just how you feel if you're talking with your friend on the phone and you're taking a walk. Like how it just sort of flows out. It's the same kind of thing, but we just do it in therapy. We do a lot of like guided meditations with the tappers. So that sort of just adds an extra layer of calming and regulation.

Sameena Rahman (: 39:27

Yeah.

Okay.

Mandi Dixon (: 39:42

It's so effective, especially for neurodivergent women, especially for women in perimenopause who are super just, you know, er. I love it.

Sameena Rahman (: 39:45

Yeah.

Sameena Rahman (: 39:49

Well, yeah. And I find it's been helpful for a lot of my patients who have suffered in lifelong pelvic pain or sexual pain because of pelvic floor issues and other things. Sometimes it's so interesting that, for instance, I treat a condition called neuroproliferative-provoked vestibulodynia. That's where they're born with too many nerve endings at the opening. And so they have lifelong sexual pain. They can't have any kind of penetration of either exam or tampon or anything.

And so for a lot of patients right now, you know, once we've gone past the point of pelvic therapy and everything, they, they eventually end up needing a vestibulectomy. So it's a surgical procedure. So we've removed the agent that we feel like is causing them this lifelong pain. And then they go through pelvic floor therapy for 12 weeks after. And then a lot of times I see patients and on exam, there's no pain, but they can't have, they still can't have pain-free sex because

Mandi Dixon (: 40:47

the trauma.

Sameena Rahman (: 40:48

And so I referred them for EMDR and that's something that's been very helpful for them actually.

Mandi Dixon (: 40:51

Yes.

Mandi Dixon (: 40:54

That's amazing. Yeah, a lot of people are scared of EMDR because they think they will have to relive those moments, talk about the traumatic moments. And it's really not, you focus on the of the sensations in your body when you think of the trauma and then that's what you sort of reprocess. So I could see that would be very effective for the painful sex.

Sameena Rahman (: 41:18

Yeah. No, so it's been very interesting actually. So I think that's pretty cool. So I want to be cognizant of your time because I know we're getting close, but I started this thing called vaginal antivertig a few sessions ago, which is like your hot take, right? So, you know, whether or not it's your truth bomb or your hot take or whatever, like you want the listeners to know about perimenopause, ADHD, menopause, whatever topic or all three even, like whether or not they're questioning marriage.

or whether or not they have ADHD, what's your hot take or your vagilante verdict for the listeners?

Mandi Dixon (: 41:59

I I said this previously that if you are neurodivergent, you need to know that you probably gonna have a rough time in perimenopause, a harder time. You can be harder to treat in terms of hormone therapy. So you really need to find a specialist, somebody that is really trained and knows what they're doing and just be prepared that in...

Sameena Rahman (: 42:18

Mm-hmm.

Mandi Dixon (: 42:21

You may need tweaking, you may need some adjustments, but it doesn't mean you're broken. It doesn't mean you're too much, you're too dramatic, you're too sensitive. All of those things that we typically think that we are. It's just your nervous system is a little more sensitive and it requires a little more finesse. And so get yourself an expert if, don't be, you know, gaslit into saying you're just too dramatic because you're not.

Sameena Rahman (: 42:48

Yeah, because that's sort of the history of our acceptance of women and their suffering, right? Is it's that women are hysterical, they're just too much, they're like dramatic, whatever. I love that. I love that you give them that, know, so that they know, because it is probably a process. And I'll say from the medical perspective, like oftentimes we do like try hormonal therapy, but for many patients, especially if they've known to have postpartum issues or previous anxiety or, you know, depression symptoms,

Mandi Dixon (: 42:50

Thank

Exactly.

Sameena Rahman (: 43:16

A lot of times they will need some sort of central medications beyond hormones. But what we find is that they work really well together. But it's never like that. A lot of patients, it's not just SSRIs, but sometimes they'll need both. that's where I come in. I bring them the hormones and try to get them regulated in that capacity.

Mandi Dixon (: 43:22

Yeah, absolutely.

Mandi Dixon (: 43:40

And I'm a big advocate for that too. say like when I talked about the ugly perimenopause, if you have the ugly form of perimenopause and SSR, I can do wonders and it's not going to necessarily bring you out of that, but almost think of it as a safety net. It's a safety net so you don't dip into that really ugly place that you maybe can. And maybe if you have to take it for the rest of your life, then you do. If it avoids you getting to that ugly place, then it's worth it. So I always.

Sameena Rahman (: 44:02

Yeah.

Sameena Rahman (: 44:05

Yeah.

Mandi Dixon (: 44:10

tell them that too. can be very beneficial.

Sameena Rahman (: 44:13

Yeah, that's what I see for a long time. And sometimes they're like, I'm never coming off of these because I know what happened when I tried, you know? So there's a time and place for everything. And I think all of these things, therapy, cognitive behavioral therapy, EMDR, medications have a place for patients, but you have to just figure out, you have to navigate it really well.

Mandi Dixon (: 44:17

Yeah. huh.

Mandi Dixon (: 44:32

And you need somebody that I guess will listen to you and take the time and really care about you. And there are people out there that will do that. And they're absolutely worth it to have somebody take care of you like that.

Sameena Rahman (: 44:41

Yeah, absolutely.

Sameena Rahman (: 44:47

Absolutely. Yeah, thanks. Thank you so much, Mandy. That's awesome. I love this conversation that we're having and raising this awareness for some of these really important issues that a lot of women experience. So I do appreciate you being on today. Yeah, this is fun. And so thanks for listening today, guys. I'm Dr. Smeena Rahman, gyno girl. Thanks for listening to another episode of Gyno Girl Presents Sex, Drugs, and Hormones.

Mandi Dixon (: 45:03

Thank you so much for having me.

Sameena Rahman (: 45:15

Remember, I'm here to educate so you can advocate for yourself. Please join me on my next episode. Yay. That was good, Mandy.

Mandi Dixon (: 45:21

Yay!