Menopause and ADHD

For many women with ADHD, entering the perimenopause can cause a worsening of their ADHD and many others do not realise they are neurodivergent until hormone changes at perimenopause bring many issues to the fore that they may have struggled with for years. Margaret was one of these women and she tells her story here.

“When I was 47, something started to change. Sore breasts began making sleep uncomfortable. Most days I felt unwell, and fatigue became more apparent. I was drained, irritable and frequently low despite being on an antidepressant for 3 years. I was also having to cope with a challenging home environment due to my children’s needs and struggles (due to diagnosed and undiagnosed neurodivergence).

“Everything hurt including my sense of self. Then came hot flushes that engulfed me with nausea and dizziness. I tried red clover, phytoestrogens and sage leaf tablets, with varying degrees of success. Increasingly, I felt trapped in a complex web of symptoms, I struggled to regulate my attention and my emotions and I felt stuck in something that I couldn’t find my way out of. I used mindfulness, CBT approaches, essential oils and supplements. To add insult to injury, then the devastating migraines began.

“I’ve always been informed about my health since my life was impacted by endometriosis and adenomyosis at age 13. I was aware you sometimes follow your mother in terms of the age of onset for perimenopause and I realised that this was what was probably happening to me. My mum had a breakdown with her perimenopause though, and at the time this was not recognised as the cause. It is now clear to me she is also neurodivergent, but this has not been recognised either and this period was devastating – for her, for my father and my 13-year-old self.

“Looking back at myself and my experiences – and for any hints of what had been hiding in plain sight – I had always felt tired but had curious bursts of energy and extroverted enthusiasm, lots of ideas and was very sociable. But life felt like a gargantuan juggling act. Periods of fatigue and mini burnouts where low mood would occur was a repeating cycle in my teens. I attributed a lot of the fatigue to my endometriosis which ekes life out of you through pain and other symptoms.

“Since childhood I have had on loop in my head the question, “what is wrong with me?”, as  I found it hard to retain and recall factual information making learning and exams very challenging. Because of this, I didn’t have the opportunity to show my abilities in school. There’s been a lot of lost potential. Thankfully I found my niche and motivator in Social Work and have since gained 2 Master’s degrees.

“Now in my perimenopause, I kept forcing myself to wade through treacle, striving to get to a better place. I struggled with multiple daily tasks, lacked motivation; I would forget things and be in a spin with any planning required. Eventually I’d get things done but experienced little satisfaction from it. I couldn’t understand myself anymore and started internalising these struggles as failures and character flaws.

“My GP and I discussed the possibility of perimenopause, and she agreed my symptoms did indicate this was what was going on and that HRT would be the next step. I was relieved there was a way forward. I was prescribed two pumps of estrogen gel (I’d had a Mirena coil for some years to help my endometriosis). Within a few weeks I experienced some positive impact from the estrogen: no more sore breasts, aching bones and feeling unwell. 

“However, I still had 50 things going on in my head simultaneously all vying for attention, which I could not switch off or prioritise. I would forget the detail of conversation. Instructions for complex games or construction toys I found harder to follow. I got more frustrated with myself and tasks I had to do. I lost interest in shopping and cooking.

“I felt I was deteriorating cognitively, to the point where I tested myself for early onset dementia (I had a part time job for a charity working with people with dementia at the time). I no longer recognised myself. I reassured myself I wasn’t disorientated but ‘time blindness’ however, would get the better of me. This meant I thought I could fit more into a certain amount of time than I could, and would find it difficult to plan far enough ahead.

“My migraines accelerated with the triad of lockdown, home schooling, and working. I rarely recovered fully from the last one before the next one began. When things took a turn for the worse, following a nasty drugs interaction called serotonin syndrome, I realised I had to resign. I felt I had lost so much as a result of the perimenopause.

“Feeling utterly useless about my cognitive capacity, a friend suggested I may be neurodivergent and ADHD. At this point I realised with hindsight from childhood and adulthood that yes, maybe I am ADHD. I couldn’t wait to try to find more answers to my struggles and engrossed myself in research – my hyperfocus has some benefits at times. With a sense of urgency and impulsiveness, I booked an assessment with a private psychiatrist online – I hadn’t realised there’s a legal Right To Choose process in England via the NHS – and received a formal diagnosis of ADHD.

“I discovered through my own reading that my estrogen changes had been impacting my undiagnosed ADHD through the neurotransmitters of dopamine, (a core component of ADHD and executive functioning), serotonin (linked to mood) and acetylcholine (linked to memory). My two male psychiatrists did not discuss or link the impact of perimenopause with my ADHD. I have since been raising this issue with my consultant to improve awareness. He tells me the majority of his patients are experiencing perimenopause.

“Despite what you may have thought and read, recent international consensus is that ADHD does not affect males more than females, it’s just that ADHD is harder to identify in girls and women because it is often more internal and hidden and the diagnostic criteria are more orientated to a male presentation. Gender norms and stereotypes also significantly disadvantage women with ADHD in terms of receiving recognition and diagnosis. There seems to be more understanding of men not being able to juggle the mental load and multitasking needed for work, family and home life that modern life requires.

“New research from ADDitude online magazine, which I participated in, showed that 94% of women with ADHD said they experienced more severe ADHD symptoms in perimenopause, stating

“For more than half of the women, ADHD symptoms grew so severe…that they called peri/menopause the period in which ADHD had the greatest overall impact on their lives”.

“For a lot of women with ADHD, perimenopause is a brutal and life changing experience.”

“I know some women have had success with HRT bringing control to their ADHD symptoms. I have had some success with it, in combination with my ADHD medication. I am currently on my 4^th type of ADHD meds and my 3^rd type of HRT due to shortages. I still feel that I have not returned fully to myself and wonder what combination I could try next to gain some further help with my executive function (planning, organisation, working memory, attention and other thinking skills). There is so little information out there. Might testosterone be needed? Perhaps that is my next step in keeping on moving forward.

“ADHD’ers are tenacious and resilient. I can’t imagine how I would be if it weren’t for my HRT. I might never come off it. I am so grateful. It’s just occurred to me that without the changes that happened at perimenopause, I might not have realised I was neurodivergent ADHD, so that is a blessing. I now have a road map for myself and I get to use my experience for good to help others.”

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