Why ADHD is Underdiagnosed in Women (Neuro-Spicy Month)

It's Neuro-Spicy Month here at Rethink Your Rules!

Today, Jenny gave a presentation about ADHD at a neurodiversity focused CME.  So, we're revisiting some prior RYR episodes about ADHD. (Especially since they are the most downloaded episodes ever!)

This week, we're taking a deep dive into the reasons many women - especially smart women - don’t find out they have ADHD until their 40’s. (If ever.) 

You’ll learn:
• Common misconceptions about ADHD in general
• How adhd presents in females vs males
• How girls “mask” their ADHD
• The effect of hormones on ADHD

And more!

If you’ve been curious why so many people seem to be getting diagnosed with ADHD lately, or wondered whether you might have it yourself, this episode is a great place to start. 

Mentioned in this Episode:
Neurodiversity: A Conference About People Who Think Differently
Click HERE to register for this free virtual CME event, where you can hear me speak, along with other physician experts in neurodiversity.

Adult ADHD: Resources for Physicians
Jenny's favorite evidence-based resources & simple ADHD self-assessments, curated for physicians.

_________
Need help applying this to your life? Ready for more strategies like this, but personalized to YOU? Set up your free consult and let’s talk about your unique situation and how coaching can help:
https://getcoached.jennyhobbsmd.com/consult
_________

Everything on this podcast and website is for informational purposes only and should not be used as medical advice. Views are our own, and do not necessarily represent those of our past or present employers or colleagues.

Transcript

Kevin: 0:09

Welcome to Rethink your Rules with Jenny Hobbs MD. A fresh perspective on relationships, success and happiness for high-achieving moms.

Jenny: 0:24

This week, I am actually going to be revisiting a topic that is near and dear to my heart, which is ADHD, and even more specifically, thinking about ADHD in women and physicians and in myself and my own journey, and I wanted to bring this topic up again now for a couple of reasons. A few reasons. The first one is that this is one of the most popular episodes when I look back at the downloads of my podcast. And the second reason is that there's some new faces here and you may not even realize that these episodes are buried there that have some really good information about ADHD. And the third reason, and maybe the most exciting, is that I'm actually in the middle of preparing for a really exciting conference where I will be speaking about ADHD in physicians, and I want to be sure that you know about this conference because, although it is a continuing medical education conference that is put on by physicians, and much of the target is physicians and those who work with physicians in the workplace, the conference is actually open to the general public, so anyone is welcome to listen in and, in fact, the topics are very relevant really to anyone who wants to learn more about neurodiversity. So I thought this is a great opportunity to bring back one of the most popular podcasts that I've had and make sure that you have an opportunity to hear it, if you haven't already, and then to also consider joining us for this really cool opportunity to get more information and go even more in depth on this topic. So before I replay the episode in mind, I do want to tell you a bit about this conference. It's kind of unique and kind of cool. It's actually called Neurodiversity a conference about people who think differently, and not only will there be talks on ADHD, like mine, but there also will be talks about autism spectrum disorder and other forms of neurodiversity, and it's a really cool group of physicians, many of whom are neurodiverse themselves, talking about ways that we can work with our neurodiversity strategies for sleep and procrastination and sensory overwhelm and things like that, and then also talking about how we can help our patients who may be neurodiverse. So it's really a very cool eclectic group of people with a lot of practical insight and personal experience.

Jenny: 2:50

And it's entirely virtual and it is actually free. So if you want to show up and watch the CME live from anywhere virtually, you can do that for free and you don't have to be a physician. Now, if you are a physician or someone in the medical field, you can actually apply for CME credits and things like that. It's a truly legit medical education conference and I know for me, the topics that I'm going to be sharing about are things I do speak at when I go to conferences that cost a lot more money than this, and people are there in person, right, and physicians are getting CME credits for it. So it's literally the same content that we would be providing at that type of conference, but it's in a format that is really fun and easily accessible for anyone to attend. So it's a really cool opportunity. I'm so grateful that they asked me to be a part of this and I'll just give you the dates so that you're aware of when it's happening.

Jenny: 3:42

It's going to be this coming June 5th through 7th 2024. And the time is in the evenings, so it can work really nicely around any schedule and, don't worry, I'll put a link in the show notes and everything If you want to check out more about it or register. But again, it's completely free and each evening there's going to be a few speakers and if you decide that you want to have recordings of those speaker talks or if you want to be able to attend a coffee chat with all of us the Saturday afterwards, you really get to know everyone better and explore this in more depth. You can always upgrade to that sort of VIP option. That does cost some money, but assuming that you just want to come and get some great information and think more about how you can handle neurodiversity, maybe in yourself or your patients. If you're a clinician of some kind or if you're someone who works with physicians, you know, if you're in leadership working with physicians, this is a really great opportunity to get some insight into. You know, when someone's behaving in a certain way that maybe seems problematic or pathologic or frustrating, whether or not there might be an element of neurodiversity there that you would want to be aware of as their employer or someone working in physician leadership. So it's going to be a lot of fun.

Jenny: 4:49

Again, it's June 5th through 7th 2024, and that's next month and I'm going to put in the show notes a link that will take you directly to where you can register for that and that actually is an affiliate link for me. So I just want to disclose that that will actually offer me, you know, kind of credit for you signing up and if you end up purchasing the VIP thing, I would get a small amount of money for that. If you don't feel comfortable with that for any reason, you'll also be able to find, you know, the conference page and you can just sign up directly there. That's no problem. The other thing I will put in the show notes is a link to my resources on ADHD, which goes directly to my page, is a link to my resources on ADHD which goes directly to my page and that will provide you a nice free download with lots of information to explore as well. So two different types of links you'll find in the show notes. One is going to be about this really awesome conference called Neurodiversity, a conference about people who think differently, coming up next month in June 2024. And the second link that you are going to see there is a link to my ADHD resources which you can obtain as a free download, and of course, there'll be all the info there to contact and reach out to me if you have any questions.

Jenny: 5:52

And with that I am going to replay one of my most popular episodes, all about ADHD. So take a listen and I hope that you have as much fun exploring this, as I do sharing it. Hey, there it's Jenny. Welcome back to Rethink your Rules. I am super excited to record this podcast. I have been promising this to people for several weeks now.

Jenny: 6:13

I'm going to talk with you about the reasons that ADHD tends to get misdiagnosed in women, and particularly in certain women, and the women that it's most often misdiagnosed in are actually the types of women that I interact with a lot and work with as a coach. So too much moms, high achieving working moms, very smart women in careers like medicine and things like that. Often we are the ones that go undiagnosed, and being able to understand some of the ways that ADHD might be showing up and affecting you can really open the door to a lot of understanding yourself, treating yourself more kindly. It can also, of course, lead to opportunities to treat what might be treatable for you with ADHD. But even if you aren't a person that has ADHD, you don't suspect you have ADHD or you don't think this really applies to you personally.

Jenny: 6:59

If you're one of my, you know too much moms. You most likely work with women who have been undiagnosed for many years and may not even know that. That's why they're doing the things they're doing, and they may be doing things that drive you crazy, and this might give you a little bit of information and insight as to why they might be doing that and giving them a little bit more grace. And, of course, so many kids are now being diagnosed earlier, which is wonderful, and so it may give you a new perspective if you have a friend or family member who's diagnosed. So there's a lot of information here, and when I have gone to conferences with female physicians, this is one of the topics that just really draws everyone and even other coaches who do the same type of work I do. Many of them are really fascinated by some of the data that's out there about ADHD, and so these are women physicians who do coaching right, and some of the data that's out there about ADHD, and so these are women physicians who do coaching right, and some of them even have kids with ADHD. But it's just not always easy to find this information, and so I'm really excited to distill it down for you today, and I just I know this can be so valuable, and if you find it useful and interesting and you know a friend or family member who might also benefit from learning this, please, please, please, share, pass it along, write a review so that more people can see it, because I'd love to have more and more women understanding this and using it to give themselves a little grace and help make our lives better, right?

Jenny: 8:13

Okay, so let's talk about the most common reasons that ADHD goes misdiagnosed or undiagnosed in women. So the first thing you got to think about is that ADHD is still pretty poorly understood in general, not just in women. So, for example, I think, if you think of your mental image of someone with ADHD, most of the time we think of a young boy who can't sit still in the classroom, is very loud and impulsive and can't keep their body still. That's the traditional image we think of. Or we think of someone who can never pay attention to anything, who's all over the place, right? But in fact, some of the things that we know about ADHD is that it's not just that you can't focus on anything, it's that you can't regulate your attention and your focus, right? So when you are interested in something, you are actually hyper-focused and you can't transition out of it, and then, when you are not interested in something or it doesn't appeal to you, you cannot force yourself to focus on it. Do you see the difference there? So one way to think of it is you have an interest-based nervous system. So, rather than saying this is the most important thing to do and I will regulate myself to sit and do this important thing, you know, a person with ADHD's brain is much more likely to just be like listen, I'm bored by that, I don't care that, it's important, I cannot do it, but this thing over here I'm completely focused on right now, and they can't stop focusing on it, even though they could logically tell themselves that it's not the most important thing, or they spend too much time on it, or they should go to sleep or whatever. Right? So that hyper focus on some preferred activities. And then Another thing that is really fascinating that we miss about ADHD is that one of the most obvious and problematic symptoms is actually an inability to regulate your emotional state.

Jenny: 9:57

So emotional dysregulation, so outbursts, extreme tantrums and anger. And this is something that is really hard, not just for kids, but also for adults. Right, because imagine if you have ADHD and you're in a workplace or something like that. Right, it can be very difficult to regulate your emotions, which is seen as a huge problem in many workplaces, not professional, and in fact in the United States. This is crazy.

Jenny: 10:21

Emotional dysregulation is not even included in the diagnostic criteria for ADHD, even though any expert you can look this up any expert will tell you it's one of the fundamental features of the disorder, but we don't actually even use it in our evaluation of whether someone has a diagnosis, which is just crazy. In Europe it actually is in their diagnostic criteria, but for some reason that has never been the case here, so most people don't realize it. So they again. They might have a child who is really super hyper-focused on playing video games and then has a huge emotional reaction to turning them off, way out of proportion to every other kid, right, or can't get themselves ready for school in the morning, but they may not be so physically hyperactive the way that we typically think of ADHD and we'll say, well, they can really focus when they want to focus and we may not even realize that all of that is actually their ADHD, right. And we might have children who are very impulsive and inappropriate and having, you know, hitting and all these big emotional outbursts and ADHD may not be on our differential when we're thinking about what might be causing that, because we don't recognize it's such a fundamental part, okay.

Jenny: 11:27

The other thing that makes it hard to fully understand and diagnose ADHD in general this is in everyone, still not just in girls and women is that inattentive ADHD, without the hyperactive component, is actually extremely common, okay, and it is much harder to diagnose because the symptoms are not as obvious, right, or as problematic. So if you're a teacher and you have someone with inattentive ADHD, but not the hyperactive, they're going to be staring out the window, um, maybe not able to finish their work, maybe just getting worse grades than really makes sense, for you know how intelligent they really are, not completing things whatever. And because they're not physically hyperactive, it's not as much of a problem in a minute minute classroom scenario or with parents or whatever, right, and so it just doesn't get picked up as quickly because it's just not bothering everybody, it's not a big enough problem to go look into and because we again often think that the hyperactivity is such a big part of it when it may not be. So those are just some. There's a lot. I mean, that's a whole nother podcast, but but I wanted to just put those there because all of those reasons definitely apply to women as reasons why women don't get diagnosed, but women have additional reasons beyond that. So in women, the inattentive type that we just talked about, without the hyperactivity, is actually much more common than the hyperactive type, right, the hyperactive type right. And so, again, if you have a girl with a predominantly inattentive type, now you're not really looking for ADHD because she's not a little boy, right, and you're not really thinking about it because she's not physically hyperactive, disrupting the class, and she's just sitting there daydreaming, right, and so you may just completely miss that.

Jenny: 13:06

The other thing about girls is that they display the hyperactive component differently. So for girls, hyperactive might be like hyperactive thinking lots and lots of thoughts, or it might be a lot of energy, right, like not getting much sleep or things like that, or being interested in lots of different things rather than physically jumping around. And one of the big ones is talking a lot. So like, for example, I was diagnosed as an adult, and it's interesting because as a child I wasn't physically hyperactive, but I talked a lot. I still do, as you can tell, and I would get in trouble all the time at school for talking with my friends after the class started. I would get in trouble also for my big emotions and outbursts and things like that, right, and I also was able to focus. Like I love to read books, I still do I could put my nose in a book and never stop, right, I would carry it around reading, right, so I could hyper-focus on a book. And so, because all those reasons, no one would have thought I had ADHD, right?

Jenny: 14:06

So, in addition to all of that, girls tend to display many types of neurodiversity, with a milder form than boys, and so they don't fully understand this. They think it has maybe to do with the way the genes are expressed differently. But so if a girl and a boy both get the genes to create adhd in same family, the boy's symptoms will often be more significant and obvious than the girl's. She might have a milder form, and so that again makes this problem even harder, right? So, in addition to all that, societal factors come into play, because, you can imagine, as girls and women we have a lot of pressure to please other people, to put our needs aside. We are not nearly as free as boys are.

Jenny: 14:51

I mean, this is a huge generalization, but boys tend to be allowed to express themselves a little bit more or to do what feels right to them. They're really taught to follow their instincts quite a bit more than girls. They don't get in quite as much trouble, right, and you might expect a boy to have more physical energy. So teachers and parents may not even realize it, but subconsciously they might be more permissive of that, whereas a girl who is displaying those things is going to be seen quite differently and sort of given more messages to quiet down and the girl sees that her worth and her value is, is very community, it's part of the community being accepted.

Jenny: 15:24

Pleasing other people is a much more fundamental need for girls to feel worthy than for boys in general in our society, right? So so this girl grows up not knowing that her brain is wired differently, right, and just thinking like, well, I just need to cover this up because I get in trouble and I need to please other people and this is how you know how I should be Right, and so girls become very good at compensating and I think it probably is some degree easier for girls to compensate. Certain things, like the school system, are set up in a way that works a little better for the way girls think Right, and so it may be a little easier for them to go ahead and be successful in the school system and to compensate and we call it masking to mask their ADHD symptoms and to kind of get by pretty well. So what's interesting about that is that we are so good at doing this. And then what's the result? Right, the result is that we end up compensating so well for ADHD that we build this whole world of anxiety. So this is what happens.

Jenny: 16:27

We get misdiagnosed with anxiety, right, anxiety. So this is what happens. We get misdiagnosed with anxiety, right, and we often are so good at finding ways to work around our weaknesses that it becomes a way of life and we don't even notice it. I'll give you an example. So like for me I became, I just naturally had systems for everything. So if I have an item, I knew I always put it in this one place because of those, otherwise I would lose it Right and things like that and I would know okay, I'm going to forget to do that. So I better just do it right now. I'm going to do that.

Jenny: 16:55

So I had lists and plans and techniques in place throughout my entire life to make sure I didn't forget things, and things didn't slip through the cracks and I didn't even know how much additional mental energy I was spending on this and how much anxiety that was creating for me and work that was taking to overcompensate for my ADHD until I was in my forties, right. And I when I got diagnosed, you know I they asked me questions about that oh, do you have to have your stuff in a certain place or else you forget it, et cetera. And I was like I mean, doesn't everyone do that? And the person who diagnosed me was working with a lot of people. She was like no, you'd be surprised. Like, and I didn't even know because I was so successfully compensating.

Jenny: 17:32

And it's funny if some of my good friends here, this podcast, who've known me in the past, I did not present like I had ADHD because I was so good at keeping organized and, if anything, people thought I was like very perfectionistic and overly organized and everything was dialed in Right, but that was actually me compensating. So my fundamental personality is not one that is super organized and detailed and perfectionistic about keeping everything in place. That was a persona I acquired to be successful, to compensate for the personality I have, which is much more sort of scattered for lack of a better word and forgetful. And so people didn't know that about me, and that was a lot of effort I was putting in.

Jenny: 18:14

And what's difficult about ADHD as well is that everyone compensates a bit differently, right? So I have a really good friend who also has ADHD, and the way she's compensated is very different than me, right? So she didn't compensate in those ways, but she always shows up to everything super early because she knows she'll forget it the last minute and be late, right? So some people who have ADHD can't plan and organize their time well and get distracted. So if they have an appointment, they literally have to clear their whole day to just like focus on getting to that appointment. Right? And then I'm a person who I do the opposite, right, I am very hard time getting to things on time because I'm constantly putting in one more thing, one more thing, one more thing, right. And so I haven't really created a good compensation mechanism for my time management, and other people with ADHD have, and so, again, all of those differences in the way that we approach it make it a little bit harder to recognize.

Jenny: 19:04

So, when you read these online quizzes which, by the way, I think you should if you think you may have ADHD, because they can be very helpful, but often for me, like an online quiz doesn't actually capture what's going on, because I've already compensated for those things so much and it really required digging back into how I was as a kid and doing a formal assessment with someone before it was picked up, because I did have a type. That's very unusual. So I have probably primarily hyperactive ADHD and that's, again, less common than the kind with inattentive, and in girls particularly, having primarily hyperactive ADHD is very, very uncommon, and so it's just not well studied, not well understood and not well picked up. So I want you to just be aware of all that. So if you're noticing that maybe some of these things might affect you, but it doesn't fit perfectly with what you see online, that may still be something worth exploring.

Jenny: 19:54

I, to be honest, when I went to go get evacuated, I was pretty sure I did not have it. I was quite skeptical, um, and it took me a while to even accept that that was possible. And now I see so many things that have been sort of under the surface, that were struggles for me, that they have ADHD as a kid. So if you think of most of us who are doctors, right, we were pretty naturally intelligent and gifted in. School was relatively easy for us, so we didn't need to use a lot of focus and executive function to be successful throughout school, right, so it was kind of easy. Like that was like me. I would procrastinate, I barely studied everything for the last minute, but it didn't matter because I was naturally just like very quickly able to pick things up. And it was. School was relatively easy for me most, mostly the entire way through, even up into college, et cetera.

Jenny: 20:56

And so I think a lot of us who are in medicine, we were so smart as girls and then we had all those other factors already talked about. There would just be no reason for anyone to notice that we had ADHD. And the other thing I learned when I was going through the diagnostic process is not just smart girls, but also girls who are raised in a very restrictive home environment with lots of rules and curfews and pretty harsh discipline. If they act out, they are even less likely to be diagnosed because they have had to mask as a survival instinct right and they weren't able to act out in the impulsive ways that would have given people clues about their ADHD right or made really poor decisions. A lot of people with ADHD, you know, make really poor decisions as they get into the teen years and beyond, but those of us that were from very restrictive households maybe that didn't happen. As if all of that were not enough to explain why women don't get diagnosed until later.

Jenny: 21:48

The most fascinating part, in my opinion, is that our hormones affect our attention and our symptoms. So it's a whole area of research and study that is massively under research. But what they have begun to discover is that estrogen improves your attention. Okay, this is I'm probably way oversimplifying the people who actually do this research. I think the other hormones all have roles as well, but the simplest way to think of it is estrogen improves attention, so you have different amounts of estrogen at different points in your menstrual cycle. So for women, once they hit puberty, their symptoms of ADHD may be different from week to week or day to day, and so it can be very complicated to understand whether that's really what's going on because, like, maybe one day you sort of meet the criteria more than another day, and this is all so poorly understood that no one in your life is going to be thinking about that.

Jenny: 22:36

And the other thing that's interesting is, as you get into your 40s, you begin to sort of head towards perimenopause, right. And when you're in perimenopause, your estrogen levels start to slowly decrease, and not to the point that you would know it, right. You're not into your later 50s where you really have big time menopausal symptoms, so you may not even be aware of it, right. But you're going along through your 40s and your symptoms of the ADHD you never knew you had are now getting worse and worse, and so your ability to concentrate is decreasing. And so maybe you've been a super smart, successful doctor. You had all your systems in place.

Jenny: 23:15

People thought, oh, she's just anxious, right? So you were compensating and people misdiagnosed you as having anxiety. You're on your SSRI, you're in therapy, you're doing all the things and you start having a harder and harder time managing the competing demands of your job and triaging things, and maybe you're a little bit more emotionally dysregulated than you had been, et cetera, and you're forgetting things, and you may not even know that that's because your estrogen levels are going down and these symptoms that have never really been a huge issue for you are now starting to affect you more. And it's the perfect storm because many people at that point. They're in their forties, they have now had kids and their kids are at school age, right. And so, first of all, they are now managing a household, so they're doing the executive function of keeping everything together, not just for themselves anymore, with all their systems and organization et cetera right, but now they're doing it for their kids and keeping them on track for school and appointments and remembering things, and sometimes, you know, unfortunately a lot of that falls on the wife in the relationship.

Jenny: 24:13

If you have a traditional marriage where, like, you're doing a lot of that for you and your husband, even though you may both be working right, so now the strain on your system and your executive functions is exacerbated further and the way we kind of think of it is like the wheels begin to come off, right. So all those things that worked just fine when you were 20 and the systems you had in place, like you don't have time to do all that, just to keep yourself together because you've got so many more demands on you. And then it gets compounded because ADHD is incredibly heritable, it's highly genetic and kind of. The rule we use is that if your kid has a diagnosis of ADHD, one of the parents has ADHD in almost all cases. So often, if you had undiagnosed ADHD, now you're in your forties, you got a couple of kids often one or more of those kids also has ADHD right, and so they might be acting out in school and having trouble, and they have worse executive function than a kid of the same age. So you've got more to do for them. They get you know that all of that puts more and more pressure on you right To be able to handle all that, and so this is all happening in your forties as your, you know, estrogen is going down and getting worse, and so this is why there's a huge, huge spike in diagnoses of ADHD in women in their forties.

Jenny: 25:28

And it completely makes sense and people don't talk about it. It just breaks my heart because so many of us high achieving, intelligent women have compensated for this for so long. We don't even know it and most of us are. Self-talk is really negative and why can't I figure this out and I should be better than this? And then, on top of that, our workplaces begin to label that, as you know, unprofessional behavior, and it gets referred as a quality issue or a behavioral issue, when really it's your undiagnosed neurodiversity that has so much stigma and misunderstanding behind it, right?

Jenny: 26:07

I mean, I honestly have begun to believe that in medicine, the rate of undiagnosed ADHD in women physicians is probably like 25%. I mean, I think the rate in the general population of ADHD is thought to be about 5% and I have to say I think it must be significantly higher among women in medicine. I would love if I ever become extremely wealthy, I would love to donate some money to researching this right, do a study to find all the undiagnosed cases of ADHD and just really to understand all of these things I said at the beginning that are so poorly misunderstood about ADHD. There's barely any studies on ADHD in women at all, and gosh, I just I wish I had the money and the time to make that happen, but anyway, it just breaks my heart, and so I wanted to start here by making sure that you understand all this, so you notice it in yourselves and other people and we can start understanding how powerful it is to know what's going on with you.

Jenny: 27:00

I think often we think we just need to suck it up and figure it out, and that's what we've always done, and yet our self-talk is so negative. It just gets worse and worse, and I think that we can do better for ourselves and for other people. So, with that, please share this widely, because, as I always say, I'm not going to choose a world you know overnight, but it starts with awareness. We underestimate how important it is that if more people just know this, they might take a brief pause before they judge someone else right. They might take a brief pause to go get the answer to the question of whether their child has ADHD or they do. They might just be slightly more likely to do it. And I really think over time that momentum builds and society changes. We've already seen a huge change in how we look at ADHD, even over the last like 40 years, and I just think I want to be a part of spreading the word and making the momentum on the next set of changes, which I believe is really understanding how it shows up in women. So please help me with that.

Jenny: 27:58

And, as always, if you are a high achieving working mom and you are struggling to enjoy the beautiful life you've built, if you find yourself yelling at your kids, not knowing how to parent your challenging kids, they won't do what you say. They won't listen. If you feel like really misunderstood by your boss. I am here for you. I coach too much moms. A lot of them have ADHD, but a lot of them don't and what we work on is accepting and loving yourself first, and then, from that place, noticing all the thought patterns that you have that are not serving you, and we work on how you can manage your mind, no matter what.

Jenny: 28:33

So you don't have to get divorced. You don't have to change your job. You don't have to get divorced. You don't have to change your job. You don't have to sit there wishing you had different kids. There are so many tools that I can give you so you can feel amazing and lighter, and I'm really excited. I want to take a cohort of you guys through, starting in April, and I have plans for a really fun trip to the sun in August, and I'd love to have you come along with me. I can have you feeling better by the time your kids finish school Lighter, happier, more in control, not so self-critical. It's awesome. So please come talk to me, set up a console and let's get going. Have a good one.

Kevin: 29:07

Hi friends, kevin here, thanks for listening to one of Jenny's great episodes on ADHD. Don't forget to check out the show notes for links to register for the free virtual CME coming up on June 5th through 7th of this year, 2024. Also in the show notes you'll find links to access Jenny's free ADHD resources. We'll see you next week. Thanks for listening to Rethink your Rules with Jenny Hobbs MD. Thanks for listening to Rethink your Rules with Jenny Hobbs MD. Would you like to learn more about how to apply this to your own life through personalized coaching with Jenny? Visit us on the web at JennyHobbsMDcom to schedule a free consultation. If you found value in what you heard today, please consider subscribing to the podcast and giving us a five-star rating so we can reach even more women like you.