Some women receive their first diagnosis of attention deficit hyperactivity disorder (ADHD) during perimenopause. I aim to explain how changes in female hormones affect ADHD.
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition often traditionally characterised by symptoms of inattention, hyperactivity, and impulsivity.
However there are gender differences in symptom presentation between male and females.
Female ADHD symptoms
Inattention:
Women with ADHD are more likely to exhibit inattentive symptoms rather than hyperactive-impulsive symptoms. This can include difficulties with concentration, disorganisation, forgetfulness, and daydreaming. These symptoms are often internalised and less disruptive, leading to under recognition by teachers, parents, and healthcare professionals.
In school, girls may be labelled as 'scatter brained' or 'lazy' rather than being identified as having ADHD.
Hyperactivity and Impulsivity:
When hyperactivity is present in women, it may manifest as internal restlessness or verbal impulsivity rather than the overt physical hyperactivity commonly seen in boys. Women may appear overly talkative or interrupt others frequently.
Impulsivity in women might present as difficulty in managing emotions, leading to mood swings and emotional dysregulation.
Emotional and Social Impact:
Women with ADHD often experience significant emotional distress due to their symptoms, including low self-esteem, anxiety, and depression. They may struggle with social relationships and experience a sense of chronic overwhelm.
The social expectations placed on women to be organised and nurturing can exacerbate feelings of inadequacy and guilt when ADHD symptoms interfere with these roles.
For these reasons, ADHD in women is often misdiagnosed.
The impact of the perimenopause on ADHD
Perimenopause, the transitional phase leading up to menopause, involves significant hormonal fluctuations that can impact various aspects of health, including the symptoms of ADHD.
ADHD affects approximately 4% of adults in the UK, with a significant proportion being women. Hormonal cycles, including menstruation, pregnancy, and menopause, can influence ADHD symptoms due to fluctuations in oestrogen and progesterone.
Perimenopause, in particular, is a critical period where these hormonal shifts can exacerbate ADHD symptoms, necessitating a tailored approach to management.
Hormonal Changes During Perimenopause
The perimenopause is the period leading up to a women's last menstrual period. Perimenopause is marked by significant hormonal fluctuations, particularly a decline in oestrogen levels, leading to various menopausal symptoms. Oestrogen & testosterone play a crucial role in cognitive functions, including attention, memory, and executive function, all of which are areas impacted by ADHD.
ADHD Symptoms and Menopause
Cognitive Function:
Attention and Focus: Oestrogen enhances neurotransmitter activity in the brain, including dopamine and serotonin, which are critical for attention and focus. The decline in oestrogen during perimenopause can lead to increased difficulties with sustained attention and heightened distractibility in women with ADHD.
Memory: Oestrogen also supports memory consolidation. Lower oestrogen levels can result in memory lapses and difficulties with working memory, exacerbating ADHD-related forgetfulness and disorganisation.
Emotional Regulation:
Mood Swings: Hormonal fluctuations during perimenopause can lead to mood swings, increased irritability, and anxiety. Women with ADHD may experience a worsening of these symptoms, making emotional regulation more challenging.
Stress and Anxiety: The interplay between hormonal changes and ADHD can increase susceptibility to stress and anxiety. Perimenopausal women with ADHD may report heightened anxiety and stress levels, impacting their daily functioning and quality of life.
Sleep Patterns:
Insomnia: Perimenopause is often associated with sleep disturbances, including insomnia and night sweats. Poor sleep quality can exacerbate ADHD symptoms, leading to increased inattention, impulsivity, and hyperactivity during the day.
Restless Sleep: Fragmented sleep can further impair cognitive function, contributing to the cognitive fog commonly reported by perimenopausal women with ADHD.
Management Strategies
Hormone Replacement Therapy (HRT):
Oestrogen Therapy: HRT can help stabilise hormone levels, potentially mitigating the impact of hormonal fluctuations on ADHD symptoms.
ADHD Medications:
Stimulants and Non-Stimulants: Continuation or adjustment of ADHD medications may be necessary to manage exacerbated symptoms during perimenopause. It's important to monitor the effectiveness and side effects of these medications, especially in the context of hormonal changes.
Lifestyle Modifications:
Sleep Hygiene: Improving sleep hygiene through consistent sleep schedules, a comfortable sleep environment, and relaxation techniques can help mitigate sleep disturbances.
Diet and Exercise: A balanced diet and regular physical activity can improve overall well-being and potentially alleviate some cognitive and emotional symptoms associated with both ADHD and menopause.
Therapeutic Interventions:
Cognitive Behavioural Therapy (CBT): CBT can be effective in addressing emotional regulation and developing coping strategies for managing ADHD symptoms exacerbated by menopausal changes.
Support Groups: Joining support groups for women experiencing menopause and/or ADHD can provide emotional support and practical advice.
Conclusion: The perimenopausal transition poses additional challenges for women with ADHD due to significant hormonal changes. Understanding the interplay between ADHD and perimenopause is essential for developing effective management strategies. A comprehensive approach, including medical treatment, lifestyle modifications, and therapeutic interventions, can help mitigate the impact of perimenopause on ADHD symptoms, improving quality of life for affected women.
References:
Nadeau, K. G., & Quinn, P. O. (2002). Gender issues and ADHD: Research, diagnosis, and treatment. Silver Spring, MD: Advantage Books.
Soares, C. N., & Almeida, O. P. (2001). Hormonal fluctuations and depression. Current Opinion in Psychiatry, 14(1), 29-34.
Haimov-Kochman, R., & Spitzer, N. A. (2009). The cognitive effects of hormonal changes in menopausal women: A review. Menopause, 16(5), 792-801.
Sherwin, B. B. (2005). Oestrogen and cognitive functioning in women: Lessons we have learned. Behavioural Neuroscience, 119(1), 77-84.
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