How menopause and hormones impact ADHD symptoms in women

If your ADHD symptoms seem to have leveled up out of nowhere, you’re not losing it. Hormones play a much bigger role in ADHD than most of us understand, especially during perimenopause and menopause.

Today, we’re chatting with licensed counselor Mandi Dixon about why focus, memory, sleep, and emotional regulation can suddenly fall apart in your 40s. We also dig into why ADHD meds may stop working the way you’re used to — and what actually helps when carefully built systems stop cooperating.

For more on this topic 

• Listen: ADHD and hormones

• Read: A guide to hormones and ADHD

• Read: ADHD and periods

• Explore: The Menopause Society

Episode transcript

Cate Osborn: Hi everybody, and welcome back to "Sorry, I Missed This". The show where we talk about all things ADHD, relationships, communication, intimacy, and more. As always, I'm your host, Cate Osborn. In this episode, we sit down with licensed counselor and menopause expert Mandi Dixon to talk about ADHD, menopause, and the incredible impact that your hormonal cycle has on your ADHD symptoms, struggles, and the way that you navigate your life.

Not a lot of people know this about me, but the reason why I got diagnosed with ADHD the day before my 30th birthday was because my hormonal cycle was so upset after I lost an ovary due to an ovarian torsion. The aftereffects of that hormonal shift were so profound that I felt like my life was falling apart. At the time, I had no idea that I had ADHD, and I also had no idea that So, you can imagine how afraid I was and how confused I was with the changes that were going on in my brain and my body. Fun fact, this experience is the entire reason why I have this show and why I do the work that I do, because once I discovered that there was such a profound connection between ADHD and our hormonal cycle, I got mad and I got frustrated at the fact that so many women are living in the dark about their own brains, about their own bodies, about their own hormonal cycles. And so I thought, well, somebody's got to talk about it, and it might as well be me.

Mandi, welcome so much to the show.

Mandi Dixon: Thank you so much for having me.

Cate: So, assume that I know nothing about perimenopause and menopause. I do know a fair deal, but for our dear listeners who might not know, can you talk us through just what it is and why it impacts our hormones in the way that it does?

Mandi: So, during our regular reproductive years, we have a hormone cycle which is our menstruation cycle, and our hormones go up and they go down in a very, you know, flowy way, and that's a normal, predictable way, if you have a normal cycle. And so what happens whenever we start to reach our late 30s, our early 40s, is our fertility starts to decrease and it has to do with our egg supply and our hormones and all of that.

Mandi: And so it starts acting funny. I'll just say that. The levels of hormones, they start to decrease. Estrogen for one can wildly fluctuate. So everything just starts acting a little funny, and that's normal. And then as you enter early menopause or late perimenopause, that's whenever the estrogen and the progesterone get to a very, very low level or no level. You stop ovulating, you stop releasing eggs, which just means that you are no longer able to reproduce.

Mandi: Which one year of no periods is technically menopause. Everything before that, up to 10 years before that, is perimenopause, which is just your body kind of gearing up to prepare for that.

(03:12) ADHD and hormone cycles

Cate: One of the things that I found that was fascinating to me when we talk about the connection between ADHD and hormones and our menstrual cycle is the fact that even during the luteal phase, which is the phase, dear listener, in your period when your estrogen and your progesterone and all of those are lower naturally in your cycle outside of perimenopause and menopause.

That is also another time that a lot of women with ADHD find that their medication is less effective and their ADHD symptoms are much, much worse. And then you layer on top of that that a large percentage of women with ADHD also have PMDD and that kind of thing. It just becomes — I get really mad that we don't talk more about how hormonal cycles are just inextricably linked to ADHD. I wish somebody would have told me that a little bit sooner, you know what I mean?

Mandi: I wish someone would have told me that as well. I mean, I remember watching my mom struggle so much and all she would say was just it's PMS. But it would completely debilitate her. Then, when I started experiencing it myself — so I was on birth control most of my 20s and 30s, so I didn't have those wild fluctuations and that's one thing that birth control, if you can tolerate it, kind of helps with.

So, I didn't really notice it until I was in my late 30s and I had flashbacks to my mom and I was experiencing the same things that she was. And I was begging someone for answers, like, what is this? And all they could really say was PMDD and really just all you could do is either take birth control or take Prozac. And I just felt like there has to be something else to this. Like, that it can't just be this.

So, what I've noticed with me and from people I've talked with who have suffered with PMDD, it's PMDD angrily transitions into perimenopause. And so it's similar, but you have a lot more physical things happening and it becomes unpredictable, which with PMDD the one kind of silver lining is that you can somewhat predict it and you can kind of prepare, but with perimenopause it starts becoming really unpredictable.

Cate: And even more frustrating is the fact that at least when we are in a regular cycle, right? Like when our hormones are fairly consistent, there's a regularity to it, right? Like I know that I'm going to get a headache like once a month at a certain time. I know that I'm going to get a lot more irritable. I'm going to get a lot more depressed. My executive functioning is going to go downhill.

But when it also then transitions into that wildly unpredictable differential of symptoms and stuff all the time, that can be immensely destabilizing around the structures and systems that you've built around your ADHD just to exist on a daily basis. And I find that to be deeply unfair, frankly.

Mandi: It very much is and I'll say I think with the younger women, they are at least a little bit more knowledgeable about their menstrual cycles and in particular about ADHD. But for women, I would say my age and older and maybe even a little younger, it's almost no knowledge that they have about their menstrual cycles even. They probably a lot of them don't know the word luteal phase.

And so they are really just being completely blindsided by first of all, perimenopause, their cycles, and then this ADHD link that they may or may not even know that they have. So, literally so many women tell me I felt like I was falling apart.

(07:08) Cognitive changes and ADHD-like symptoms

Cate: I hear all the time, my ADHD got so much worse in my 40s. My ADHD got so much worse in my 50s from women who aren't necessarily realizing that menopause is involved. Can you talk us through just those connections and why that might be?

Mandi: So, we know from the little research that we have on women and hormones and ADHD, which I want to stress is very little. But, we do know that estrogen impacts our dopamine. And so if you have ADHD, you rely on your dopamine system much of it, and your dopamine is very much impacted. And so that's where a lot of those executive functioning skills just sort of slip away and our ability to do things the way that we used to, like use those systems that we built, they just don't work anymore.

And so that's why a lot of women will say my ADHD got so bad. And I'll say for even women that don't have ADHD, they can experience a lot of ADHD-like symptoms in perimenopause because that estrogen impacts their dopamine as well, but they use theirs differently than we do. So, we feel it much more intensely, but they feel it too.

Cate: Mandi, can you talk to us a little bit about how menopause changes ADHD or ADHD is impacted by menopause? Like what are the actual things that we're talking about when we're having this sort of like larger conversation?

Mandi: The one thing that I hear so much is the cognitive function. So, the brain fog, the word retrieval ability, that's a big one, forgetfulness is a big one. A lot of women think that they may have dementia. I just want to say that because it's so common. I hear it almost every day. Somebody will say I thought I had dementia or early stages of it.

And that can be particularly terrifying if you have ever had a family member or known somebody who has suffered with that. So there's the cognitive issues that can get worse. There are sensory sensitivities that can really, really get turned up.

So we have estrogen receptors all over our body and one of the biggest ones is in our skin. And so whenever that estrogen starts to decrease, many women who are already sensory sensitive as far as their skin, you know, clothes may become unbearable — some certain fabrics, certain textures. There's a lot of women that can't handle sounds anymore, certain sounds, certain smells, that's a big one too.

You know, there are things that we can tolerate. Maybe we don't like them, but we can tolerate them. You're in line next to a woman or somebody at a grocery store and they have a really strong perfume on and, you know, it's bothering you, you don't like it, but you can stand there. That ability to tolerate it, it completely disappears. So, it's you actually leaving the store because you cannot physically tolerate it.

So, the cognitive, the sensory sensitivities, our sleep gets impacted so much when our progesterone starts to decrease. So that in turn makes a lot of things worse. And the biggest one too is the emotional regulation.

So, those estrogen fluctuations and the progesterone sort of decline, it really helps us control — not I'll say control our emotions, but harness them in a way. And when that starts to fluctuate, our emotions can get really terrible. I'll just say that.

(11:13) Diagnosis and intimacy

Cate: Well, the emotional dysregulation component of it is so huge. And then, I always get really interested in then how does like rejection sensitivity show up? How does masking show up? How does, you know, the sort of internal judgments that we put on ourselves around getting more easily frustrated or more easily flustered or whatever it may be?

I think it's so easy to spiral into negative self-image because of stuff that is, like, frankly, really out of your control. And if you don't know that it's impacting you and you don't know that it's impacting your ADHD, of course you're going to be having a harder time.

It's really funny that you mention the dementia thing because that is literally how I got diagnosed with ADHD was I had an ovarian torsion and so I lost an ovary. And so the hormonal shift was so profound that I really did think that I had dementia. And then I went and they were like, no baby, you've — it's been ADHD the whole time. And I was like, okay.

But yeah, like that was my personal journey into finding out that I had ADHD and also one of the reasons why I got so interested in like ADHD and hormones and sex and intimacy and all of the stuff that I do now, was because nobody, even in my, you know, very basic '90s kid understanding of ADHD, nobody talked about hormones or sex or intimacy or any of those things. No. But talk to me about how menopause, ADHD can impact things like sex and intimacy.

Mandi: For a lot of us, we become a lot more tired. Our energy levels decrease. For a lot of women this happens in, you know, your 40s, your 50s, where a lot of women are, you know, at the height of their career, they're really in a groove, they may have children, they are carrying just a whole lot on their shoulders and then all of these physical changes start to happen, all of these cognitive changes start to happen.

And libido desire interest, it is one of the things that so many women notice too. And it can show up in even just the loss of estrogen can cause a lot of physical discomfort too. So it can make sex painful. And if a woman doesn't understand, she may just, you know, avoid that and not really realize that it's because it's uncomfortable or painful.

Cate: I'd love to hear you talk a little bit about how ADHD meds can impact and influence menopausal symptoms.

Mandi: What many women have shared with me is that their ADHD medication doesn't work as well whenever they start to get older, much like if you're younger you notice that in your luteal phase. And so they will talk to their doctor and sometimes they will just raise their dose or they'll switch ADHD medications and sometimes that can help.

But what this little research that we have has sort of been able to show us is that whenever you add in hormones such as menopause hormone therapy, hormone replacement therapy, that's the same thing, it can really act together with the ADHD medication. So when they're used in conjunction, it can have the best effect.

Cate: I know that there's been some really interesting research done lately on hormone replacement and how if you start earlier, there can be benefits, there can be, like, issues that happen. Can you tell us a little bit about what like the menopause society right now is kind of teaching about those kind of options?

Mandi: Yeah, so we have really good data, really good research that shows that if you start menopause hormone therapy within 10 years of menopause, that can reduce your risk of osteoporosis. And we know that we all experience bone loss when we go through menopause.

And there is a lot of emerging data that shows that it may or may not work to prevent cardiovascular issues later in life, as well as brain issues which, you know, could be cognitive. There's no definitive answer there, but we know for sure about the bones.

Cate: Interesting. Yeah, I never — I don't spend a lot of time thinking about my bones.

(14:55) Sensory elements and accommodations

Cate: I'm just so curious too about just the sensory elements of menopause and how, especially if you are a person living with sensory issues, if you are a person, you know, with AuDHD or whatever, like that can make that experience so much more difficult to navigate. Like you talked a little bit about clothes, but even things like hot flashes and that kind of stuff, they can be really difficult, right?

Mandi: Absolutely it can be. And I think people think of menopause and hot flashes together. A lot of women don't experience hot flashes in menopause. A lot of women have night sweats and they don't equate that to being a hot flash, but it is just when you're sleeping. And that can make sleeping unbearable where you're waking up a lot, so that can affect your sleep.

But even if you are experiencing a hot flash, we know as neurodivergent women we tend to experience those sensory sensitivities much more intensely. And having a hot flash, you almost you can't predict it, it can happen in inopportune times, it can be embarrassing. Women feel like they maybe can't get a — can't get control of it.

Or, you know, a lot of women have them in the very severe way where it's, you know, just pouring sweat and dripping and they have to remove themselves from whatever situation.

Cate: So, if a dear listener right now is listening to this and they're feeling like they're failing or they're falling apart, what do you most want them to know?

Mandi: Well, that you definitely are not alone. There are a lot of women that feel that way too. And it doesn't have to be that you are falling apart. There are so many ways that you can treat the symptoms. If you look at there's two separate things going on. So, there is the ADHD and then there is the perimenopause or menopause. And they make each other worse.

Treat the symptoms because there are so many symptoms of ADHD, there are so many symptoms of perimenopause and menopause. No two people really experience the same thing. And so if you look at your most bothersome symptoms or any symptoms and then look at the different ways to treat those, and there is a lot of different ways.

Cate: If I am a person who is just now entering perimenopause, if I'm just now entering menopause, what are some ways that I can figure out what I need? How do I where do I even start in terms of figuring out different accommodations or or symptoms that I might get relief from?

Mandi: Yeah, we know that we have estrogen receptors in so many different of our systems of our bodies. And so whenever we start to see a decline in that, different areas can be affected. So one of the things that I recommend women do is get a symptom tracker. You can print those off online.

But really take a look and notice what symptoms maybe you had that day or that you're experiencing that night and you can rate them on a scale of like one, two, or three. Or zero, I guess to three. Anyway, and then just keep track of that for a couple of weeks and you'll start to notice patterns like maybe irritability is at a three over half of the days.

Or maybe sleep issues you're waking up at 3:00 AM. That's one of the times whenever women seem to wake up is at 3:00 AM. Maybe you're doing that most of the days. So those are the symptoms that you would want to talk with a menopause specialist about or if you're not going to go that route, those are the issues that you would really want to focus in on.

Cate: Awesome. Mandi, thank you so much for being here. Thank you so much for your time. And dear listeners, we will see you again soon. 

Thank you for listening! Anything mentioned in the episode will be linked in the show notes, with more resources. Have a question, comment, burning story you'd like to share? Email us at SorryImissedthis@understood.org. 

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Cate: "Sorry, I Missed This" is produced and edited by Jessamine Molli.

Video is produced by Calvin Knie and edited by Jessie DiMartino. Our theme music was written by Justin D. Wright, who also mixes the show. Production support provided by Andrew Rector.

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