How does menopause effect ADHD and could it lead to a diagnosis?

Attention deficit hyperactivity disorder (ADHD) is a condition that can lead to hyperactive or impulsive behaviour as well as difficulty concentrating and focusing. These symptoms overlap with those many women experience during the menopause transition.

The low oestrogen levels that contribute to menopausal symptoms like brain fog and mood swings may also make ADHD symptoms worse.

We’ll explore this in more detail below, as well as examining whether ADHD and related menopause symptoms might improve after menopause, and whether menopause could highlight previously undiagnosed ADHD.

We’ll also look at some of the treatments for ADHD and menopause symptoms, from medications to psychological approaches and lifestyle changes.

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Can ADHD symptoms get worse during menopause?

During perimenopause – the years leading up to menopause – levels of reproductive hormones like oestrogen go up and down. Following menopause – the point 12 months after your last period – oestrogen settles at a permanent low.

These changes in oestrogen can impact the levels and functioning of the neurotransmitter dopamine, which is involved in your emotional responses, memory, focus and organisational skills.

An imbalance of dopamine can contribute to a variety of cognitive and emotional menopause symptoms, ranging from ‘brain fog’ – difficulty focusing or performing tasks that require concentration or thinking – to anxiety and mood swings.

Women with ADHD already have lower levels of dopamine, so when oestrogen levels change it can make symptoms worse.

If you have ADHD and still have periods, you may notice that your symptoms are worse at certain times of your cycle, such as just before your period when oestrogen is low. On the other hand, women with ADHD often find it improves during pregnancy when oestrogen levels are higher.

If you have ADHD and are gong through perimenopause or have reached menopause, low oestrogen could be adding to your symptoms and making them worse. It may feel as if your medication is not working as well.

If you think menopause may be exacerbating your ADHD, it can be useful to keep a diary tracking your symptoms, including when they happen and how they are changing. This can help your doctor decide on the treatment and support that’s best for you.

Does ADHD get better after menopause?

Many emotional and cognitive menopause symptoms, such as mood swings and brain fog, are worse during perimenopause when your hormone levels are fluctuating.

Perimenopause usually lasts between 4 and 8 years but your hormones are at their most erratic during early and mid-perimenopause.

If this is what’s causing these additional symptoms, it’s possible they may subside as you approach menopause and your hormone levels start to stabilise.

When it comes to the severity of your ADHD symptoms themselves, it may be a different picture. Low oestrogen has been linked to low dopamine and in turn worse ADHD, and oestrogen is at its lowest after menopause.

In this case, you may need help from your doctor to decide whether your medication needs adjusting and what other treatments or lifestyle changes might help.

We’ll look at some of these options in the section below.

Can menopause reveal undiagnosed ADHD?

Research involving menopausal women with ADHD is very limited but experts say that, anecdotally, patients may notice ADHD symptoms for the first time during the menopause transition.

In these cases, they are likely to have had mild or borderline ADHD for their whole lives without necessarily realising it.

Although it’s unclear how often menopausal changes lead to a ‘late’ diagnosis of ADHD, it does happen.

If you think you may have ADHD at any point in your life, you should talk to your doctor. To help you understand whether you symptoms suggest ADHD, you can use a symptom checker.

Treatments for ADHD and menopause

Whether it’s ADHD, menopause or a combination of the two that’s causing your symptoms, there are a number of medical treatments, psychological approaches and lifestyle changes that can help.

HRT and ADHD

Hormone replacement therapy (HRT) boosts your levels of reproductive hormones like oestrogen that are lost through menopause.

It can help to relieve many of the most common menopause symptoms – and that includes emotional and cognitive issues like mood swings and brain fog.

If these are making it harder to cope with your ADHD symptoms, HRT could help.

When it comes to HRT’s effects on ADHD itself, research is scarce – but given that low oestrogen can lead to low dopamine and this is associated with ADHD, it’s possible that increasing your oestrogen levels could improve things.

In fact, there’s some evidence that combining oestrogen replacement with certain ADHD medications can increase their effects.

ADHD medications and menopause

Women with ADHD are generally prescribed the same medications when going through menopause as they would be at any other time.

Intriguingly, though, research suggests that menopausal women who haven't been diagnosed with ADHD can also benefit from ADHD drugs in addressing their cognitive symptoms.

Studies have shown that atomoxetine, which influences certain neurotransmitters, can improve attention and memory in perimenopausal and postmenopausal women. The stimulant lisdexamfetamine, meanwhile, can help with verbal memory and ‘executive functioning’ – the set of mental skills that helps you plan, stay focused and control your emotions.

Psychological approaches

Observing, being aware of and understanding the sorts of symptoms that are common to ADHD and menopause can help you to manage them.

There are several approaches that could improve things:

• Cognitive behavioural therapy (CBT): CBT is a talking therapy that can help you break out of negative thought patterns. It can improve mood swings and self control in menopausal women, and may boost other cognitive skills.
• Mindfulness: Practices like meditation, breathing exercises and yoga can anchor you ‘in the moment’, helping you to balance your emotions and reduce stress.
• Learning more: Educating yourself about the causes and effects of your cognitive and emotional ADHD and menopause symptoms can help you to recognise and cope with them better.

A healthy diet

While there are no official dietary guidelines for women with ADHD, getting the right balance of nutrients can help keep your brain functioning properly.

The Attention Deficit Disorder Association recommends eating plenty of fruits and vegetables, along with whole grains, healthy fats, such as extra virgin olive oil, and good sources of protein, like beans, pulses and oily fish.

This sort of eating pattern – often knows as the Mediterranean diet – can also help to improve your mood during menopause.

Limiting refined carbohydrates and ultra-processed foods, meanwhile, can prevent the blood sugar crashes that sometimes lead to mood swings and difficulty concentrating.

Regular exercise

Exercise can help with a range of cognitive and emotional symptoms experienced by menopausal women, such as mood swings, anxiety and stress.

It can also improve ADHD symptoms by boosting levels of neurotransmitters including dopamine. Some people with ADHD also find it easier to concentrate while they’re working out.

One review of multiple studies involving children and adolescents with ADHD found that aerobic exercise – activities like brisk walking, running or cycling that get your heart pumping – was linked to a moderate to large improvement in attention, hyperactivity, impulsivity, anxiety and executive function.

Summary

There’s an overlap between some of the symptoms of ADHD and menopause. Both can contribute to issues like trouble focusing or controlling your emotions. This means women with ADHD can find themselves with more to cope with during perimenopause and after menopause.

Because the low oestrogen that causes many menopause symptoms impacts levels of dopamine in your brain, it may also make your ADHD symptoms worse. On some occasions, this could lead to women who were not previously diagnosed with ADHD being given a diagnosis.

Although cognitive and emotional menopause symptoms may improve as you head towards the end of perimenopause, this is not likely to be the case for ADHD symptoms.

However, there are a number of treatments that may help with both menopause and ADHD.

Your doctor can advise you on whether HRT and ADHD medications are right for you.

You can also manage your symptoms with non-pharmaceutical approaches, such as CBT and mindfulness, eating a healthy dieting and getting regular aerobic exercise.

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