Overview of ADHD Symptoms in Women during Menopause and Hormonal Changes

Many women undergoing perimenopause and menopause may experience cognitive changes that resemble symptoms of attention deficit hyperactivity disorder (ADHD or ADD). However, it is unclear how menopausal hormonal changes impact females with ADHD due to a lack of specific studies. This is a significant medical issue.

To understand menopause and its symptoms, one must first grasp the role of estrogen in the development and regulation of sexual and reproductive functions in females. Estrogen also controls the function of several critical neurotransmitters, and decreased levels of this hormone have been linked to cognitive deficits and psychiatric conditions such as depression and Alzheimer's disease.

The menstrual cycle involves hormonal fluctuations affecting the body and mind in various ways. During the follicular stage of the menstrual cycle, which occurs from day six to 14 of the cycle, estrogen levels progressively increase before dropping sharply after ovulation around day 14. During the latter half of the menstrual cycle or the luteal phase, which spans the last two weeks of the cycle, estrogen levels decrease as progesterone increases. Learning to understand how these fluctuations impact ADHD symptoms is crucial.

It has been observed that ADHD symptoms are the lowest during the follicular phase, when estrogen levels are at their highest. ADHD medication may be more effective at this point in the cycle, although this theory remains unproven by research. Meanwhile, decreased estrogen levels during the luteal phase contribute to premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS) that is more prevalent in women with ADHD than in those without.

The period leading to menopause, the climacteric years, is characterized by intense hormonal fluctuations as overall estrogen levels steadily decrease. Total estrogen and progesterone levels begin to drop erratically, and both follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which stimulate ovulation, also vary substantially. FSH and LH levels initially increase as estrogen levels drop and eventually decrease significantly, remaining low in postmenopause. During this period, women may experience intense mood and cognitive problems, regardless of ADHD diagnosis.

Menopause signals the end of a woman's reproductive years, with menstrual periods ceasing due to decreasing estrogen and progesterone levels. The postmenopause stage follows and typically begins 12 months after the last period. The median age for menopause onset is 51.

Although there is currently no specific research on how menopausal hormonal changes impact women with ADHD, existing knowledge on estrogen and menstrual cycle fluctuations may provide insight into the menopausal transition for women with ADHD. Such understanding is necessary for clinicians to provide effective treatment and care for this group.

Click to participate in our survey on the impact of menopause on ADHD symptoms among women.

Research has been unable to find scientific distinctions between perimenopause, menopause, and postmenopause, thus all three stages fall under the umbrella of menopause. Despite varying experiences, declining estrogen levels are associated with an array of symptoms across all stages, which can worsen or improve over time with most physical symptoms subsiding in a few years.

Physical and cognitive symptoms associated with menopause can differ for each individual woman. However, while there is no known research on menopause and ADHD, many patients report worsened pre-existing symptoms during menopause, even presenting with new onset symptoms. An overlap in clinical presentation between ADHD and menopause is clear, indicating a possible link between the two, including shared underlying brain mechanisms.

While the relationship between menopause and ADHD hasn't been widely studied, research on women without ADHD that were treated with ADHD medication for onset cognitive problems and ADHD-like symptoms related to menopause found that atomoxetine and Vyvanse improved executive functioning in healthy menopausal women. The latter also activated executive brain networks, showing that some women may benefit from ADHD medication to treat cognitive impairments during menopause.

Treatments and interventions for women with ADHD during menopause that target neurotransmitters affected by the loss of estrogen may help alleviate symptoms. Gynecologists, and psychiatrists should work together to provide optimal care for these patients. While some may look towards natural approaches such as phytoestrogens, herbs, and other supplements, research hasn't yet firmly established their effectiveness in treating menopause symptoms. Those preferring this route should consult naturopathic doctors.

Estrogen loss during all three stages of menopause affects crucial neurotransmitters that affect cognitive function and emotion, leading to physical and cognitive changes from mild to severe in some women. However, we can't predict who will or won't experience impairments or why. Menopause symptoms also mimic ADHD symptoms, leading us to believe that menopause may even be a mechanism for “adult onset ADHD”

Research hasn't yet established whether women with ADHD are more or differently affected by menopause. However, given the challenges associated with ADHD and the impact of estrogen loss on executive functioning in non-ADHD women, it's safe to assume that women with ADHD are more vulnerable to challenges during menopause. Hence, treatments for menopausal women with ADHD should consider the various factors discussed here.

The content for this article was derived from the ADDitude Expert Webinar “Menopause and ADHD: How Estrogen Changes Impact Dopamine, Cognition, and Women’s Health”  with Janette Wasserstein, Ph.D., which was broadcast live on November 18, 2021.

SUPPORT ADDITUDE Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.