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Menopause, a natural phase of life for half of humanity, is marked, from a strict biological standpoint, by declining levels of the female sex hormones estrogen and progesterone. However, despite its quite dramatic consequences for many women’s bodies and lives—impacting memory, mood, emotional regulation, body temperature, sleep, and libido—this period of the female reproductive life still receives relatively little attention. Even though women report varying degrees of symptoms and impairment, ranging from mild symptoms that go unnoticed during perimenopause to severe discomfort jeopardizing both careers and family relationships, menopause seems to be viewed by many as “just a natural process women have to endure.” For us at Letterlife however, this phase of life is not something to be swept under the rug or endured silently. Also, we understand that menopause can present additional challenges for those living with ADHD, given the significant symptom overlap.
Currently, there is very little scientific research that can conclusively demonstrate what many women with ADHD report: that they experience menopause differently and more profoundly than women without a diagnosis. However, considering what we already know about the challenges associated with ADHD and the impact of estrogen deficiency on executive brain functions, even in women without ADHD, it might not be too daring to think that women with ADHD are more vulnerable during menopause.
During perimenopause, which can last up to 10 years before menopause itself, many women experience symptoms resembling, and sometimes confused with, the executive difficulties that many with ADHD grapple with. This can include struggling to focus or concentrate, feeling scatterbrained, brainfogged and easily distracted, worrying about memory lapses, or getting into conflicts with family and coworkers due to increased difficulty regulating emotions. In fact, we do know that menopause per se, triggered by the fluctuating levels of estrogen and progesterone, can lead to “ADHD-like” symptoms.
Let’s start with a brief recap of the hormonal players in this scenario: Estrogen is the primary female sex hormone responsible for sexual development in girls and women. However, estrogen plays numerous other roles in the body and interacts with neurotransmitters like dopamine, a key player in ADHD, acetylcholine, important for memory function, and serotonin, linked to mood and emotional well-being. Although we are far from fully understanding the complex relationships here, it appears that high levels of estrogen are associated with improved executive functions, while low or fluctuating estrogen levels are linked to various cognitive deficits and psychiatric symptoms.
Our hormones change throughout life, affect the brain and body in various ways. For those who want a more in-depth exploration of how female sex hormones influence the body throughout life, stay tuned for an upcoming blog on this topic in the coming weeks!
Now, let’s focus on the years around menopause, which, much like the period around puberty, involve significant hormonal fluctuations. As estrogen levels gradually decrease during “perimenopause,” menstrual cycles become irregular, occurring both more frequently and at longer intervals than before. On average, this period begins around the age of 47 and can last anywhere from four to ten years. Biologically, this involves the brain’s two “control hormones”: follicle-stimulating hormone (FSH), which stimulates the ovaries to produce estrogen, and luteinizing hormone (LH), which triggers ovulation. These hormones initially increase and then decrease, causing significant swings in both estrogen and progesterone levels during these years. Menopause is defined as not having a menstrual period for 12 consecutive months. Biologically, it signifies that estrogen and progesterone levels are gradually declining and production is ceasing. On average, women reach menopause at around 51 years of age.
As previously suggested, menopausal symptoms can vary widely during different phases of perimenopause and menopause, differing significantly between individual women. Often, both the age of menopause and the severity of symptoms are hereditary, making it possible to gain insight by simply asking your mother or other female relatives. Decreasing estrogen levels are linked to symptoms that can be pronounced and significantly impairing at times but are expected to subside a few years after menopause.
Common physical symptoms include:
Anxiety and restlessness
Impaired memory, concentration, and verbal ability.
Sounds like a real adventure, doesn’t it? Especially if, like me, you’re juggling a household full of irate teenagers, a demanding job, and perhaps even aspire to spend some carefree time you’re your partner and friends occasionally. All while you feel like a mix of a raging monster and a vulnerable elf.
But what’s the deal with menopause and ADHD, you might wonder? Unfortunately, as mentioned earlier, there isn’t a wealth of solid research on this topic yet. Nevertheless, progress is being made. A study by Farangis Dorani and colleagues from 2021 , scientifically confirm what women with ADHD have known and shared for generations: that their ADHD symptoms are significantly impacted and exacerbated during the menopausal years. The exciting part here is that in healthcare, we must collaborate across professional boundaries. Just as in our interdisciplinary research group, GODDESS ADHD (Gender-informed research to Overcome Diagnostic Delay and Emotional dysregulation through Self-awareness and Self-efficacy in female ADHD), gynecologists specializing in hormonal treatment and various gynecological conditions need to work together with psychiatrists who understand ADHD and common comorbid psychiatric conditions.
If the symptoms and challenges posed by hormonal changes during the menopausal years seriously threaten your health and quality of life, discussing various treatment strategies with your healthcare provider may be valuable. This could include everything from hormonal treatment that not only alleviate menopausal symptoms but also affect women’s risk of coronary artery disease, osteoporosis, and dementia, to adjusting your ADHD medications or considering selective serotonin reuptake inhibitors (SSRIs) for severe and debilitating depression or anxiety. Many individuals manage quite well without medication and benefit from cognitive-behavioral therapy (CBT), dialectical-behavior therapy (DBT), and psychoeducation. Simply by recognizing, describing, and understanding the transitional symptoms that come and go during menopause, they can become easier to handle and endure. Additionally, mindfulness-based exercises have also been shown to alleviate menopausal symptoms. Perhaps most importantly, lifestyle changes and healthy habits (exercise, sleep, stress reduction, etc.) form the foundation of self-care, regardless of any other interventions you may have access to or choose. Do you remember, and have control over the seven most important lifestyle factors for ADHD? If not revisit the blog about ADHD 24:7 from a couple of weeks ago!
So, in conclusion: You’re not going crazy. Menopause is real, and you can experience symptoms for up to 10 years around the actual menopausal phase. Depending on the severity of your symptoms and how much they affect your life, there are various strategies and treatment options to discuss with your healthcare provider. But remember, there are no medications or therapies that can replace self-awareness, self-compassion and self-care with good, balanced lifestyle factors. And tell us what you’d like us to blog about in the future. All suggestions are welcome!