Midlife ADHD in women and the impact of menopause

Menopause is a natural biological process that marks the end of a woman's reproductive life. It occurs when a woman's ovaries stop producing eggs and her menstrual periods stop. It is a significant transition that can bring about various physical and emotional changes in women, often at a time when they are at the peak of their careers, with caring responsibilities for growing children and elderly parents. For women with Attention Deficit Hyperactivity Disorder (ADHD), menopause can have a particularly profound impact. It may in fact be a time when women seek an ADHD assessment for the first time, as they my have compensated for their ADHD in various ways which become less effective due to the impact of menopause.

Many women complain of cognitive and executive function difficulties around the perimenopause (brain fog, word-finding difficulties, issues with memory, judgement, organisation).

If you are a woman with ADHD you may experience significant worsening of your symptoms around this time.  You may have noted that your symptoms were worse in the luteal phase of your cycle when you were having periods ( this is the phase between ovulation and the onset of your period)

It is well known that oestrogen and progesterone’s actions on the brain can influence affect (the expression of mood), emotions, behaviour and cognitive function.  In addition to the hormonal changes, menopause can bring about a host of physical symptoms, such as hot flashes, night sweats, and sleep disturbances. These symptoms can further compound ADHD symptoms by disrupting sleep and increasing fatigue.

As well as being important in female reproduction, sex hormones influence the same intracellular signalling systems that are dysregulated in ADHD.

ADHD is a neurobehavioral disease characterised by excessive hyperactivity, inattention, and impulsiveness; There is a common misconception that it only occur in children and adolescents, but we now know that it can persist into adulthood in up to 50% of cases that were diagnosed in childhood. Its estimated to occur in 5–6% of children and adolescents and 2–5% of the adult population have ADHD.

Typical features of adult ADHD include a subjective feeling of being unable to switch of ones mental activity, feelings of restlessness and difficulty engaging in quiet, unstructured time, boredom, difficulties concentrating, mood swings, disorganization, and sensitivity to stress.

People can experience difficulty completing tasks, with poor problem-solving, difficulties with planning ahead and time management. Impulsivity can leads to problems in teamwork, abrupt initiation and termination of relationships, and a tendency to make impulsive decisions.

Women with ADHD who are going through menopause may benefit from seeking support and treatment to manage their symptoms. Hormone replacement therapy (HRT) may be an option to help alleviate some of the hormonal imbalances associated with menopause. Additionally, cognitive-behavioral therapy (CBT) can be an effective tool for managing ADHD symptoms and improving executive function. They may find that they require higher doses of stimulant medication to manage their ADHD, or require a review to assess whether they could benefit from an alternative medication or combination thereof.

Managing ADHD and menopause symptoms can be challenging, but there are several strategies and tips that can help women cope with these changes. Here are some tips for managing ADHD and menopause symptoms:

1.Maintain a regular sleep schedule: Sleep is crucial for managing ADHD symptoms and menopause symptoms. Establish a regular sleep routine, avoid caffeine and alcohol before bedtime, and create a calming bedtime routine to help you wind down.

2.Exercise regularly: Exercise is a natural way to boost mood, improve sleep, and manage stress, all of which can help alleviate ADHD and menopause symptoms. Aim for at least 30 minutes of moderate exercise each day, such as brisk walking, swimming, or yoga.

3.Practice mindfulness and relaxation techniques: Mindfulness and relaxation techniques, such as deep breathing, meditation, and yoga, can help reduce stress and anxiety, which can worsen ADHD and menopause symptoms.

4.Eat a balanced diet: Eating a healthy and balanced diet can help manage ADHD and menopause symptoms. Focus on consuming plenty of fruits, vegetables, whole grains, and lean proteins, and limit processed and sugary foods.

5.Stay organised: Staying organised can help reduce feelings of overwhelm and improve productivity. Use a planner, set reminders, and break down large tasks into smaller, more manageable ones.

6.Consider hormone replacement therapy (HRT): HRT can be an effective treatment for managing menopause symptoms, including hot flashes and sleep disturbances. Talk to your healthcare provider to determine if HRT is right for you.

7.Seek support: Living with ADHD and menopause symptoms can be challenging, and it's essential to have a support system in place. Consider joining a support group, working with a therapist, or talking to friends and family about your experiences.

In conclusion, managing ADHD and menopause symptoms can be challenging, but there are several strategies that can help. By maintaining a regular sleep schedule, exercising regularly, practicing mindfulness and relaxation techniques, eating a balanced diet, staying organised, considering HRT, and seeking support, women can effectively manage their symptoms and improve their quality of life