ADHD and: Menopause

Hormonal changes during menopause can make managing ADHD symptoms more challenging, and their impact can vary from woman to woman.

In this episode, Dr. Monica Johnson breaks down the connection between ADHD and menopause. Hear how these two factors interact and influence each other. And get practical strategies for how to manage this life change. 

We love to hear from our listeners. Email us at podcast@understood.org.

• A guide to hormones and ADHD

• ADHD and: Hormones

(00:38) What is menopause?

(06:59) How to manage menopause and ADHD

Dr. J: For women with ADHD, menopause brings about its own unique set of challenges. Hormonal changes, brain fog, emotional swings, and oh yeah, the constant pressure to constantly keep it all together.

This is "ADHD and," where we talk about everyday life and ADHD. I'm your host, Dr. J. I'm a licensed psychologist who works with people with ADHD. Today, we're talking about ADHD and menopause.

Before we dive deep, let's first understand the basics. What exactly is menopause? Menopause is a natural physiological process that marks the end of a woman's reproductive cycle. It occurs when the ovaries stop releasing eggs, producing hormones, and when menstruation ceases permanently. There are three different phases that I wanna mention.

The first is perimenopause. So, this begins several years before menopause, and this is characterized by irregular periods, hot flashes, night sweats, and mood changes. Estrogen levels fluctuate significantly during this period of time.

The next phase is menopause, and this occurs when a woman has not had a period for 12 consecutive months. Estrogen levels decline significantly. Hot flashes, night sweats, and other symptoms may persist or even worsen during this period of time.

And then finally, postmenopause. So, this is the period after menopause, estrogen levels remain low, hot flashes and other systems typically subside during this time. New health concerns such as osteoporosis or heart disease may emerge due to the drop in estrogen. So, yeah, you get to swap out blood-soaked tampons for sweat-soaked sheets, hooray.

But in all seriousness, it's a natural and normal process. And if we're prepared, hopefully, we can go through the change, as my elders would call it, without losing our sanity. Now let's explore what happens when ADHD and menopause collide. The impact can be more profound than you might think.

The main issue with ADHD is a lack of frontal lobe innervation via the mesolimbic pathway. You may be going, "Dr. J, what are these big words?" I know, I don't like being technical either. But if I had to read all of it, you've gotta listen to it. And when we're talking about hormones, sometimes things are gonna get academic. Innervation is the process of supplying nerves or stimulating a nerve, organ, or muscle into action. There is an issue with dopamine being able to innervate that part of the brain.

The frontal lobe is heavily involved in all of our executive functionings that we perform. Estrogen helps make more dopamine. When estrogen crashes, so does dopamine. Thus, your frontal lobes is less stimulated and as a consequence, your executive functioning weakens. Dopamine deficits lead to ADHD symptoms and this includes neurotypical individuals as well. So when estrogen plummets in menopause, ADHD-like symptoms are on the rise.

In fact, I read a study that said cognitive decline during menopause for neurotypical individuals could potentially be offset by ADHD meds. This is one of the reasons why I often tell patients that just because you benefit from a particular medication, it doesn't mean that you have the underlying condition that it was originally created to help with.

There are many off-label uses for medications, and also there's a lot of symptom overlap between the different mental and physical health struggles that we all face. For example, you can give a guy Midol and he will feel better. It doesn't mean he has a period. For a neurotypical person, menopause symptoms can look like ADHD. And for a woman with ADHD, menopause may temporarily worsen your symptoms, especially if they were already poorly managed.

Here are the common hormonal changes during menopause. Irregular periods, vaginal dryness, hot flashes, night sweats, sleep problems, mood changes, trouble finding words or remembering, which we talk about as brain fog, thinning hair, dry eyes, skin, and mouth, weight gain due to metabolic slowdown, and bone density loss. Now, I don't know about you, but if I was wet and hot in areas that are normally dry and dry in areas that are normal wet and hot, I'm probably gonna be in a bad mood.

But in case that wasn't enough, these hormonal changes make you more likely to have roller coaster moods, unwanted emotions, and can increase the memory and concentration problems that are already an issue within ADHD. So, the short answer is yes. Menopause can make your ADHD symptoms worse. The studies show that ADHD symptoms intensify during the onset of menopause, and then later quality of life and symptoms stabilize.

To be more specific, one study found that 61% reported that their ADHD symptoms had the greatest impact on their lives between the ages of 40 and 59. The largest group of respondents, 43%, were first diagnosed between the age of 41 and 50. The reported prevalence of inattention, disorganization, poor time management, emotional dysregulation, procrastination, impulsivity, and poor memory increased over the lifespan.

More than half indicated that a sense of overwhelm, brain fog, memory issues, procrastination, poor time management, inattention, distractibility, and disorganization had a life-altering impact during the critical perimenopausal-menopausal window. Menopause looks to be very difficult for about two-thirds of people with ADHD. After the age of 60, only 3% reported that this was the most difficult time in their life indicating that the menopausal period seems to be the hardest.

Now I know this is probably feeling like some real downer information. You're thinking "Times are already hard and you're telling me that they're only gonna get harder," at least for a spell. Yeah, that is what I'm saying. We all have our crosses to bear, so to speak, and I'm here to help you beef up so this load doesn't feel so heavy.

So, what can women with ADHD do to manage these menopausal symptoms? Let's talk about some practical strategies for surviving and thriving during this phase of life.

The good news is that all the types of interventions that we already have been talking about are exactly what you need to be doing here. Incorporating regular aerobic exercise into daily routines can serve as a complementary strategy for managing ADHD symptoms. Activities such as running, swimming, or cycling for at least 20 minutes per session have been shown to yield positive outcomes.

Studies indicate that acute aerobic exercise can lead to immediate improvements in executive functions in people with ADHD. These benefits are thought to result from exercise-induced enhancements in brain function and structure, particularly in areas related to attention and behavioral regulation. Physical activity increases the availability of neurotransmitters, such as dopamine and norepinephrine in the brain, which play a critical role in attention and executive functioning.

Additionally, exercise promotes neuroplasticity, leading to structural and functional brain changes that support cognitive and behavioral improvements. While exercise should not replace traditional treatments like medication and behavioral therapy, it can enhance overall treatment outcomes and improve quality of life for women with ADHD.

Psychological research has also explored the interaction between diet and ADHD, looking for nutritional interventions that may influence symptom management. While dietary modifications are not universally recommended as primary treatments, certain approaches have shown potential benefits for some people with ADHD. A study found that increased consumption of fruits and vegetables was inversely related to the degree of attention deficit in children, suggesting that a healthy diet may support better attention and emotional regulation.

Omega-3 fatty acids, which are essential for brain health, have been studied for their role in ADHD management. A meta-analysis concluded that omega-3 supplementation offers a modest benefit in reducing ADHD symptoms. It is important to note that the effects were less pronounced compared to standard pharmacological treatments. In summary, while dietary interventions may offer benefits for some women with ADHD, They are not universally effective and should be considered as part of a comprehensive treatment plan.

Consultation with health care professionals is essential to tailor dietary strategies to your unique needs. Which leads me to a general point that I wanna make. You may need to have a treatment team for the best outcomes. This may include a psychologist, psychiatrist, PCP, or gynecologist, amongst others. There is often a lot of nuance during this time when our body and our mind is going through developmental changes.

You may not need all of the types of doctors that I mentioned, but having anyone who works with you on your mental health and physical health communicating with each other can yield better outcomes and ensure that the interventions are tailored to you and your medical history.

The last thing I'm gonna mention today is getting on a good sleep routine. This is often a struggle for women with ADHD and menopause can make it worse. Therefore, you don't wanna give up on improving your sleep habits. Here's some basics to get you started. If you wanna know more about sleep, leave a comment and let me know.

The first thing I wanna mention is to maintain a consistent sleep schedule. You wanna go to bed and get up at the same time every day. And this includes weekends. Engaging in this habit helps to regulate your circadian rhythms. Second is to create a relaxing bedtime routine. So, you wanna engage in calming activities before bed. This can be things like reading, meditation, or gentle stretching. You wanna avoid stimulating activities or intense or stressful discussions. In fact, don't read or view any news before bed.

And then lastly, you wanna limit your exposure to blue light at night. You wanna reduce screen time, and so, I mean across the board, phones, tablets, TV, all of it. At least one hour before bed, turn off those screens. Limiting screen time is not only going to help you with sleep, but other issues that are related to ADHD. Use your sleep routine as a catalyst for reducing your overall screen time.

That's it for this episode of "ADHD and." The algorithm is now convinced that I am perimenopausal, so comment below with more questions. Give me things to research. I want it to be confused. Or maybe you know something I don't. Have the tech bros tapped into my uterus? Brings a new meaning to Ham Radio.

If you enjoyed today's episode, check out our episode on ADHD and hormones, where we explore how hormonal changes can impact ADHD symptoms. Thanks so much for watching "ADHD and," and I'll catch you on the next one.

This show is brought to you by Understood.org, a nonprofit organization dedicated to empowering people with learning and thinking differences, like ADHD and dyslexia. Learn more at Understood.org.

"ADHD and" is produced by Tara Drinks and edited by Alyssa Shea. Our video producer is Calvin Knie. Samiah Adams is our production manager. Briana Berry is our production director. Neil Drumming is our editorial director. Our audio engineer and Music Composer is Justin D. Wright. Our executive directors are Laura Key, Scott Cocchiere, and Seth Melnick. And I'm your host, Dr. J.