Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that affects people’s behaviour. It presents with symptoms from childhood and continues into adulthood.
ADHD affects an estimated 2.5-5% of adults (some believe this is an underestimation). Women and girls are less likely to be diagnosed with ADHD than men. This may be due to several factors, including the male bias historically, the influence of female hormones and the way that ADHD symptoms present in women.
Many midlife women with ADHD were overlooked during childhood and never received help and support as a consequence. They often feel that they have always felt 'different' and that things were harder for them. Some will have been misdiagnosed with mental health disorders such as anxiety, depression and eating disorders.
The extra effort ADHD women put into living in a neurotypical world can lead to overwhelm and sometimes burnout. Exacerbation of ADHD symptoms in perimenopause and menopause may trigger recognition in women that they may have ADHD, which they have often masked and managed all of their lives.
How does menopause impact ADHD?
During menopause, your ovaries produce less oestrogen as they stop releasing eggs and your periods eventually stop. However, this decline in oestrogen can impact other chemicals and hormones in the body which in turn, affect the symptoms of ADHD. This is why during menopause, you may feel like you are having more difficulties than usual or that existing symptoms get worse.
Menopause and perimenopause can worsen ADHD symptoms
Oestrogen and dopamine
Dopamine and norepinephrine are important neurotransmitters in the brain's reward system. They are involved in:
- Attention
- Arousal
- Organisation
- Impulsivity
- Emotional regulation
- Focus
- Pain processing
- Sleep
The level of dopamine is already lower in women with ADHD, but the current understanding is that lowering oestrogen during menopause further reduces dopamine availability.
Oestrogen also affects blood flow and energy supply to the brain. As oestrogen levels decline and fluctuate during perimenopause and menopause, the following ADHD symptoms can become more troublesome for a woman:
- Difficulty paying attention
- Restlessness (internal and external)
- Emotional dysregulation
- Brain fog
- Forgetfulness
- Impulsivity
Serotonin and acetylcholine
Fluctuating oestrogen levels can also contribute to the significant mood and cognitive functioning problems that many women, whether they have ADHD or not, can experience during perimenopause and menopause.
In a menstrual cycle, oestrogen is at its highest during the menstrual phase and this correlates to an increase in serotonin levels. Serotonin is another neurotransmitter which helps regulate many body functions including mood, emotions and digestion. During the luteal phase of the menstrual cycle where oestrogen is lower, serotonin also declines.
In perimenopause and menopause, where menstrual periods are erratic and then stop altogether, oestrogen levels permanently reduce. This change can also impact serotonin and acetylcholine (another neurotransmitter) levels, which can lead cause:
- Depression
- Mood swings
- Low sex drive
- Anxiety
- Sleep issues
- Memory problems
Overlapping symptoms
As well as the hormone and neurotransmitter changes in the body that occur during menopause, many menopause symptoms and ADHD symptoms mirror one another which can compound the things you already struggle with such as:
- Brain fog
- Poor memory
- Difficulty concentrating
- Sleep disturbances
- Mood swings
Further, many women who have been managing or masking their ADHD up until menopause may find that navigating menopause symptoms as well causes overwhelm, resulting in ADHD symptoms becoming more obvious and their cognitive function becoming impaired.
The effectiveness of ADHD medications may change during perimenopause and menopause
ADHD medication can be effective in managing ADHD symptoms during menopause. However, some women may find that their medication needs to be adjusted as their hormone levels change because their medication does not work as well as it once did in helping with ADHD symptoms.
Premenstrual dysphoric disorder (PMDD) and ADHD
PMDD is a hormonal health condition which is one of the very severe forms of the premenstrual syndromes (PMS). It causes a range of symptoms in the week or two before your period such as mood instability, anxiety, depressive mood, sleep problems and physical discomfort.
It disproportionately affects women with ADHD, with an estimated 46% experiencing PMDD. PMDD and menopause symptoms can occur in tandem during perimenopause and when dealing with these on top of ADHD symptoms, it’s not uncommon for women to feel debilitated.
Undiagnosed ADHD and menopause
It is estimated that 50-75% of all women with ADHD are undiagnosed. Of those who receive a diagnosis later in life, the average age of diagnosis is 43. With menopause symptoms and ADHD symptoms often overlapping, it can become harder to obtain an accurate diagnosis.
Do I have to have a formal diagnosis of ADHD to see an ADHA menopause specialist doctor?
No, you don’t. There are very long waiting lists to get an ADHD assessment on the NHS. An ADHD menopause doctor will not diagnose ADHD. A thorough discussion about your life and symptoms will direct your management plan, which should be a joint patient-doctor decision.
What can help?
There are a number of things that women with ADHD can do to manage their symptoms during perimenopause and menopause, including:
ADHD medication
ADHD medications (stimulants and non-stimulants) can help manage ADHD symptoms like inattention, impulsivity, and hyperactivity. During menopause, these symptoms might feel intensified due to hormonal fluctuations, so consistent ADHD medication can help women maintain focus and regulate their emotions. Adjusting medication under a doctor's supervision is important if menopausal changes affect its efficacy.
HRT/ hormonal support
Hormone replacement therapy (HRT) can help stabilise hormones and alleviate some of the shared symptoms of menopause and ADHD. It can address many menopausal symptoms such as mood swings, hot flushes, and cognitive changes. Since oestrogen levels drop during menopause and oestrogen plays a role in brain function, HRT can also support mental clarity, reduce brain fog, and stabilise mood, which is especially beneficial for women with ADHD.
Exercise
Regular physical activity has been shown to improve focus, memory, and mood by releasing endorphins and boosting dopamine levels, which are often deficient in people with ADHD. There is even some evidence that a single session of exercise can cause immediate improvements in ADHD symptoms and cognitive function.
Exercise also helps manage menopause symptoms like hot flushes and sleep disruptions. Incorporating aerobic exercise, yoga, or even strength training can significantly enhance both mental and physical well-being.
Eating a balanced diet
A well-rounded menopause diet rich in nutrients supports both hormonal balance and cognitive function which can also be impacted by ADHD.
Omega-3 fatty acids, found in fish and flaxseeds, help with brain health, while foods rich in phytoestrogens, such as soy and flaxseeds, can naturally balance hormone levels. Maintaining stable blood sugar by eating balanced meals can also prevent energy crashes and mood swings, common in both ADHD and menopause.
Getting enough sleep
Sleep disturbances are common during menopause and can exacerbate ADHD symptoms, making it harder to focus and regulate emotions. Establishing good sleep hygiene, such as going to bed at the same time every night, wearing loose, comfortable pyjamas, creating a calming bedtime routine, and minimising screen time before bed, can improve sleep quality and insomnia and reduce night sweats in menopause. ADHD medication and HRT may also help reduce disruptions in sleep patterns.
Mindfulness
Mindfulness practices, such as meditation or deep breathing exercises, can help women with ADHD improve their ability to focus and manage impulsivity. Mindfulness can also reduce stress and anxiety during menopause, promoting emotional balance and reducing the impact of hormonal shifts on mental health.
Talking to a therapist or CBT with a practitioner with experience and knowledge about ADHD
Cognitive Behavioral Therapy (CBT) with a practitioner experienced in ADHD can provide women with practical strategies to manage ADHD-related behaviours, such as disorganisation or impulsivity, during menopause. CBT for menopause can also help address the emotional impact of this significant life transition, offering coping strategies for mood swings, anxiety, and stress. Therapy can also reinforce healthy routines around sleep, diet, and exercise, ensuring holistic management of both ADHD and menopausal symptoms.
Do women with ADHD need specialist help in the perimenopause and menopause?
There are some symptoms of ADHD and perimenopause/ menopause which present similarly, and trying to identify the underlying cause for symptoms can be challenging.
There are many options for the treatment and management of ADHD and perimenopause/menopause symptoms. The nature of ADHD means that hormonal advice needs to be tailored to the individual in terms of symptoms, treatment preferences and patient goals.
As menopause specialists, we approach each patient as an individual and without judgement. We understand that being a woman with ADHD can feel isolating and that many aspects of life are an uphill struggle.
If you are a woman with ADHD or who is experiencing ADHD symptoms during perimenopause or menopause, remember that you can still live a full and productive life. Talk to a health professional with ADHD experience and knowledge – don’t suffer in silence.
“I had seen a Menopause Consultant but felt I needed a second opinion due to my migraines, ADHD and other medical issues that I felt would be affected by HRT. Dr Ping was extremely knowledgeable and helpful – her advice in/after my consultation was invaluable." - Menopause Care patient.
At Menopause Care, we have menopause doctors who specialise in ADHD and menopause. Their person-centred approach can help you manage the symptoms of both and improve your overall well-being. To find out more, book a consultation with a menopause doctor.
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