The Role of Menopause in Women with ADHD

Understanding ADHD and Perimenopause

What I know about ADHD and perimenopause symptoms now, in addition to low mood and an anxiety disorder, makes sense. But at the time, I just kept pointing the finger at myself.

Early Symptoms and Medical Interventions

My periods were still absolutely awful. I was still under the gynecologist, and they offered me a hysterectomy. I requested an ablation and then never had a period again.

Life Stressors and Rejection Sensitivity Dysphoria

Lots was going off for me in my life. There was a lot of village politics, and I can remember just not sleeping at all, worrying about what people were thinking of me, that it must be me, that I am a horrible person (I now understand this to also be a symptom of ADHD called Rejection Sensitivity Dysphoria, where we are really sensitive to rejection). It just kept going over and over in my busy head night after night, day after day until there was one week where I literally just did not sleep at all. I was irritable, exhausted, forgetful, and anxious, and felt so low at the same time. I couldn’t concentrate on anything at all and I went from loving to read to literally not being able to read a page of a book.

The Impact of Hormonal Imbalances

I remember a lovely friend who is a nurse coming to the door one day, and she said, “Are you ok? You look absolutely shattered and like you have not slept” – And I hadn’t.

The fact of the matter was that my head was so busy, the negative self-talk so huge, what I now know were hormonal imbalances (perimenopause) making everything feel huge and unmanageable. When everything is out of control, ADHD symptoms are at their strongest. PLUS, in addition to this, the effect of hormonal fluctuations.

Seeking Help and Diagnosis

It did literally get to a point one night where I just sobbed and sobbed and said I didn’t even know who I was anymore – I literally felt like my head had blown off and I had completely lost myself. This was the point I went to the doctors, was diagnosed with low mood and anxiety, went on antidepressants, and started my healing journey which led me to where I am today.

Realizing the Connection with Perimenopause

However, what I didn’t know then was that I was obviously perimenopausal and did not put the low mood, anxiety, and the way I was feeling down to this at all. It didn’t really cross my mind until I had further investigations and it came to light. No wonder I had felt this way. The hormones from the IVF, postnatal depression, and perimenopause were a bad enough combination, without adding perimenopause to the list.

Diagnosis of ADHD and Hormonal Influence

So when I got diagnosed with ADHD and learned how this affected you in perimenopause and menopause and postnatal, it all just made sense. For women with ADHD who already face a number of unique challenges, these become even more pronounced during periods of significant hormonal fluctuation such as perimenopause and menopause, postnatal, PMS, and puberty. When I learned this, I could clearly see why I felt like my head blew off – literally.

Why ADHD Symptoms Become More Pronounced

I am going to try and explain why the ADHD symptoms become more pronounced at this time. ADHD is a neurological disorder, which affects how our neurotransmitters in our brain work.

The Role of Oestrogen

Oestrogen increases the production and effectiveness of the neurotransmitter dopamine. Dopamine is essential for attention, motivation, and the feeling of reward or pleasure. When our oestrogen levels drop, our dopamine levels drop. When we have ADHD, we typically have lower levels of dopamine anyway, so you can see how this ends up being a DOUBLE WHAMMY. Our oestrogen levels drop post-pregnancy, during perimenopause and menopause, and during PMT. This is why for women with ADHD these times can be particularly challenging.

The Cycle of Shame and Burnout

The fact that we are feeling this way without even realizing why leads to further shame and not feeling enough, which is already usually very high in women with ADHD due to the effects of ADHD on our executive functioning and the feeling of ‘why can’t I just?’ The ADHD drive and strive may kick in, trying to push through and pretend it is all ok, leading to burnout and pure exhaustion.