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Changes to your attention-deficit/hyperactivity disorder (ADHD) symptoms were probably not on your perimenopause bucket list. But the major hormone changes that occur leading up to menopause can make ADHD symptoms more noticeable or harder to manage.
“My ADHD HAS GOTTEN SO OUT OF HAND. I can barely function anymore!!” one ThisIsMenopause member wrote.
In this article, we’ll talk about the effects that menopause-related hormone changes can have on ADHD.
During perimenopause, your production of the hormone estrogen declines significantly. Changes in your estrogen levels affect the hormone progesterone, so you experience fluctuations in both hormones at the same time.
The drop in estrogen can also lead to a decrease in dopamine, a neurotransmitter often called the “feel-good hormone.”
Research suggests that people with ADHD process dopamine differently in their brains. When estrogen levels fall during perimenopause, dopamine levels can drop even more in women with ADHD than in women without ADHD.
Health experts believe this substantial drop in dopamine is one reason why some women experience worsening ADHD symptoms in menopause.
Estrogen and progesterone fluctuations may also impact ADHD symptoms. High progesterone levels can be associated with low energy and a low mood.
Estrogen affects the function of a neurotransmitter called acetylcholine, which helps regulate learning, memory, and sleep. As estrogen levels fluctuate during menopause, acetylcholine changes can contribute to an increase in ADHD symptoms like insomnia and trouble concentrating.
It’s no secret that estrogen fluctuations can impact ADHD in women. In fact, many girls are first diagnosed with ADHD during puberty because puberty-related hormone changes can amplify ADHD symptoms and make them more noticeable.
Estrogen fluctuations and their resulting changes in dopamine and progesterone can have specific effects on how you think and feel, causing changes in how you experience ADHD symptoms. Here’s a quick overview of some of their effects:
Trouble paying attention is often a main symptom of ADHD and is often more obvious in people with the inattentive type. Separately, difficulty concentrating is also a symptom associated with perimenopause and menopause.
Although research into how menopause affects ADHD symptoms is lacking, doctors believe falling dopamine levels in perimenopause can make it harder for women with ADHD to focus and stay on task.
Changes in acetylcholine associated with estrogen may also contribute to a reduced attention span and trouble focusing.
Many women with ADHD have even greater trouble focusing in menopause than women without ADHD.
If you’ve never been diagnosed with ADHD before, menopause-related hormone changes may bring your attention problems to a point that you can no longer write off as general disorganization.
Mood swings and increased irritability are common symptoms that can appear during perimenopause. Although mood swings aren’t on the list of ADHD symptoms, many people with ADHD have trouble managing their emotions or tend to feel their emotions more intensely.
Because dopamine is a feel-good chemical, it’s largely responsible for positive and pleasurable feelings.
When dopamine drops, related to estrogen fluctuations in perimenopause, women with ADHD can experience increasing emotional dysregulation, irritability, anxiety, and depressed feelings.
People with ADHD are already at an increased risk of sleep problems like insomnia. Whether or not ADHD is present, sleep problems also often tend to appear in women approaching menopause.
Decreasing progesterone and estrogen can influence sleep. These changes can lead to menopause symptoms like hot flashes and night sweats, which can contribute to sleep problems.
While these symptoms aren’t necessarily worse in women with ADHD, they can intensify the sleep issues you already have with ADHD.
Some neurodivergent women, including those with ADHD, are more sensitive to sensory input like touch and temperature. With declining progesterone in perimenopause, you may become even more sensitive to sensory input.
This can make menopause-related sensations like hot flashes feel stronger.
ADHD is an executive function disorder, which means it impacts the way you think, plan, solve problems, and multitask.
Women with ADHD tend to have increasing problems with executive function during perimenopause. Symptoms like brain fog and forgetfulness can become so intense that some women mistake them for early signs of dementia.
As with trouble focusing, increasing executive function symptoms in menopause are likely linked to declining dopamine. They may also be linked to estrogen-related changes in acetylcholine, which can affect your ability to learn and recall memories.
Menopause and ADHD already share many similar symptoms, including intense moods, trouble concentrating, and sleep issues. If you haven’t already been diagnosed with ADHD, you might assume your symptoms are solely related to perimenopause, but that might not be the entire story.
It’s not uncommon for women to receive a diagnosis of ADHD for the first time during perimenopause or menopause because the hormone fluctuations have made ADHD symptoms more intense and noticeable.
Consider talking to a healthcare provider about an ADHD evaluation if changes in your executive function, moods, or sleep become overwhelming and impact your daily life.
Some key differences can clue you in to whether your symptoms come from perimenopause alone or underlying ADHD or associated conditions like depression and anxiety.
These include:
Additional menopause symptoms — Symptoms like hot flashes and irregular periods indicate that you’re approaching menopause. ADHD generally isn’t linked to these.
When symptoms start — If you’ve never experienced trouble paying attention until your mid-40s or so, perimenopause is the more likely cause. ADHD symptoms usually first appear in childhood, but they may feel more noticeable as you approach menopause.
Symptom consistency — Perimenopause symptoms tend to fluctuate with your hormones, whereas ADHD symptoms remain more consistent.
Your healthcare provider can help you manage your ADHD and perimenopause symptoms at the same time. This might involve lifestyle changes to address changes in your moods and thought patterns, including sleep improvement strategies and nutrition for better brain health.
If you have ADHD and are in perimenopause, talk to your doctor about how menopause treatment options like hormone therapy (also called hormone replacement therapy) might affect your ADHD symptoms.
Your ADHD treatment may not be as effective at managing symptoms as it once was if your ADHD symptoms have intensified during perimenopause. Changes in estrogen, progesterone, dopamine, and acetylcholine can make it feel like your ADHD treatment has become less effective.
If your ADHD symptoms feel unmanageable with your current treatment, your doctor may decide to raise your ADHD medication dosage, recommend a different ADHD medication, or make other adjustments to your ADHD treatment plan.
They may also prescribe selective serotonin reuptake inhibitors (SSRIs) and other types of medications to help with new or worsening mental health symptoms.
Talk to your doctor or psychiatrist if your ADHD symptoms feel less manageable during this stage. They can adjust your treatment to address ADHD and menopause concerns at the same time.
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