ADHD and Menopause

Growing up, Margaret Reed Roberts felt different from other children. An extrovert by nature, she was active, expressive, and energetic. However, she struggled with retaining information at school, experienced fatigue, and battled low moods as a teenager. “I felt very alone in my overactive, internal world,” says Reed Roberts, 51, a social worker in Cambridge, England. “I felt I was treated differently and sometimes felt very misunderstood.”

Five years ago, Reed Roberts entered perimenopause and faced a slew of symptoms, including hot flashes, migraines, and sore breasts. Her constant thoughts became more overwhelming, leading to increased irritability and frustration. Brain fog left her struggling to remember words and dates, turning multitasking into an "impossible feat." Despite being articulate and intelligent, she found herself unable to prioritize and became overwhelmed.

Concerned about cognitive decline, Reed Roberts tested herself for early-onset dementia while working with dementia patients. The results were negative, but she was still searching for answers. A close friend suggested that she might have attention deficit hyperactivity disorder (ADHD). After seeing a psychiatrist at age 48, Reed Roberts was formally diagnosed with ADHD. “Forty-eight years of my life, I was living in a way where I didn’t have my needs understood,” she recalls.

ADHD Symptoms Worsen During Menopause

Margaret Reed Roberts' experience isn't unique. A 2024 survey of 1,500 women with ADHD found that 94% reported worsening symptoms during perimenopause and menopause. Seventy percent said brain fog and memory issues had a “life-altering impact” in their 40s and 50s. The average age of diagnosis for respondents was 43, indicating that many women had lived for decades with undiagnosed ADHD.

Women with ADHD are more likely to battle depression and have higher suicide rates than those without ADHD. Women with undiagnosed ADHD are even more at risk, especially when combined with the symptoms of perimenopause and menopause, according to Ellen Littman, PhD, a clinical psychologist specializing in ADHD.

Understanding the ADHD-Menopause Connection

ADHD is characterized by patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning. Genetics play a significant role, as ADHD often runs in families. Research on ADHD and menopause is sparse, but anecdotal evidence suggests that ADHD symptoms worsen during perimenopause and menopause due to hormonal fluctuations.

Estrogen, an essential hormone, modulates dopamine and serotonin, crucial neurotransmitters for cognition, memory, and mood. During menopause, estrogen levels can drop by 65%, exacerbating ADHD symptoms. A June 2021 study in Materia Sociomedica found that more than half of women with ADHD reported that menopause had the greatest impact on their symptoms.

Challenges in Diagnosing ADHD During Menopause

Many cognitive and emotional symptoms of ADHD overlap with those of menopause, complicating diagnosis. Family history can provide clues, as ADHD is highly inheritable. However, women’s concerns are often dismissed by healthcare providers, especially during menopause. Clinicians may misdiagnose ADHD symptoms as depression and prescribe antidepressants instead of addressing the underlying issue.

Reed Roberts' experience with male psychiatrists who were unfamiliar with the ADHD-menopause link underscores this challenge. Women with high IQs and ADHD often hide their struggles, leading to late diagnoses and misinterpretations of their symptoms.

Navigating ADHD and Menopause

Stimulant and nonstimulant medications, psychotherapy, and behavioral therapy can help improve ADHD symptoms. Hormone replacement therapy (HRT) might also benefit menopausal women with ADHD, though specific research on HRT's effects on ADHD is lacking. HRT can improve physical and emotional symptoms of menopause if started within ten years of menopause and before age 60.

Experts recommend that women with ADHD in perimenopause and menopause see a psychiatrist and an OB/GYN with menopause training. Bringing articles on ADHD and menopause to appointments can help women advocate for their needs.

Coping strategies for ADHD symptoms include:

• Daily exercise

• Yoga, meditation, and deep breathing

• Cognitive behavioural therapy

• Setting daily, weekly, or monthly goals

• Making to-do lists

• Rewarding yourself for completing tasks

With a combination of HRT and medications, Reed Roberts has seen improvement and moved forward. Support groups and engaging in ADHD activism also help her manage her symptoms. She encourages other women with worsening ADHD symptoms to seek help, noting that diagnosis is a "roadmap to yourself."