Increasing numbers of women are being diagnosed with ADHD in their 30s or 40s. Several have also reported that pre-existing symptoms have become worse and more disruptive in perimenopause and menopause. Photo / Getty Images
Could the onset of perimenopause exacerbate ADHD symptoms?
All her life, Rosie* felt there was something wrong with her. “I couldn’t really ‘get it together’ like most other people did, and I just felt different.”
For as long as she could remember, she’d had a head full of “constant, indecipherable chatter”. “Someone else said all the metaphorical tabs on the computer are open at once but you can’t remember why or which you’re meant to deal with first. It manifests in a feeling of real overwhelm when things pile up and that’s when I shut down and kind of crash.”
By the time she reached her 50s, she felt exhausted by living in a constant state of chaos. When one of her children was tested for ADHD, everything suddenly made sense. “I was reading up about their issues that I thought, s***, that sounds like me!” She was diagnosed with ADHD at 52.
Like Rosie, it was only when Kate* had her daughter tested for ADHD that she realised she had it herself. As a kid, she’d been a daydreamer and easily distracted. At 43, she realised she was trying to teach life skills such as self-regulation, organisation and sticking to routines that she couldn’t model herself. After a two-year “rollercoaster” of trialling various drugs, she landed on a brand and dosage that worked. Her social anxiety subsided and she could juggle work and parenting “like a normal person”.
But by her late 40s, she noticed her medication wasn’t working as well as it had been. Her depression was creeping back in and she could feel herself distancing from her friends and family. “I was crying every day when no one was around. I think the turning point for me was when I was composing my final message in my head to my loved ones. I realised it was serious and that I needed help.”
The onset of perimenopause had seemed to exacerbate Kate’s ADHD symptoms. But when her doctor prescribed hormone replacement therapy patches, things improved straight away. “My ADHD medication felt like it started working again and I wasn’t stuck in decision fatigue or paralysis anymore.”
Christchurch-based clinical psychologist Petra Hoggarth, who specialises in adult ADHD assessment, says increasing numbers of women are being diagnosed with ADHD in their 30s or 40s. Several of her clients have also reported that pre-existing symptoms have become worse and more disruptive in perimenopause and menopause.
According to ADHD New Zealand, research estimates that about 5% of the population, or 280,000 people, have ADHD but only 1-2% are diagnosed. But the association isn’t able to provide statistics on exactly how many menopausal women are being diagnosed. A spokesperson tells me that’s because it’s drastically underfunded, with only one part-time staff member.
However, when ADDitude, a US magazine dedicated to the disorder, surveyed more than 1500 women with diagnosed and undiagnosed ADHD last year, 94% said their symptoms grew more severe during perimenopause and menopause. More than half of the women described menopause as the period when ADHD had the greatest overall impact on their lives.
Hoggarth says the dramatic decrease in estrogen levels during these phases brings about changes and reductions in neurotransmitters including dopamine and serotonin. Because ADHD and menopause symptoms mirror each other, it can be tricky to untangle where one ends and the other begins.
“Women with and without ADHD can experience increased cognitive challenges, mood swings and emotional dysregulation during perimenopause and menopause. Those with ADHD are experiencing this on top of their pre-existing ADHD symptoms.”
For decades, ADHD was considered something that happened to boys, which they would eventually grow out of. To this day, boys are diagnosed around twice as commonly as girls, even though psychologists now believe the split is 50/50. Complicating matters, girls tend not to display the typically male behaviours of aggression and hyperactivity. As Terry Matlen, vice-president of the National ADD Association in the US, told ADDitude: “They’re the ones sitting in the back, looking out the windows, twirling their hair. People write them off as space cadets.”
In one of several examples of what the World Economic Forum calls the “gender health gap”, there is very little research on menopausal women and ADHD.
“There is a historical bias in medical research towards studying men which has led to a lack of data on all general health and women-specific health topics,” Hoggarth says. “We are still using criteria developed on boys, which doesn’t map well onto adult women. We are dealing with multiple levels of exclusion when it comes to this topic.”
By the time Tracy* entered her late 40s, she’d spent a lifetime masking an inability to focus and apply herself. “I would cram for exams or get up at 5am to meet deadlines, finding the hyperfocus I needed to get shit done, in between bouts of beating myself up for being ‘lazy’ and procrastinating.”
Nevertheless, she managed to keep “all the plates spinning”. But then she hit perimenopause. “Fluctuating estrogen levels added cognitive decline, brain fog, headaches, mood swings and the worst insomnia of my life to the mix. None of my coping mechanisms worked anymore and the wheels started to come off.” She had, and probably had always had, ADHD.
“It takes a while to get your head around the full picture of what having ADHD entails,” Tracy says, “because it’s different for everyone, and you’ve lived with the symptoms so long, you just think it’s your flawed personality. Take RSD, or rejection sensitive dysphoria, which makes you abnormally sensitive to criticism or rejection. This is common in people with ADHD and it makes a lot of situations really painful, but you grow up thinking, ‘I just need to harden up’ (you can’t), and ‘why are other people so mean?’”
Like all the women I spoke to for this article, Tracy found getting a diagnosis time-consuming and extremely expensive. At the moment, the only option is to go private, and appointments (plus the required yearly follow-ups) can cost thousands of dollars.
“It was hard to even get on a waiting list,” Tracy says. “It was a six-month wait to see a psychiatrist and totally unaffordable for anyone on a low income.”
But getting an answer, even one that comes four decades too late, can be a great comfort. “At least I know now that my brain works differently and recognise what’s happening, and that I need to get support,” Tracy says. Her advice is to “take all the things. Maybe your mum or grandma could ride this out with a few years on the couch watching daytime soaps or a long sojourn at the bach, but most of us have to keep working, and the best way to get through this is by taking all the help you can get.”
Rosie says its important to bond with others going through the same thing. “Join some kind of support group (I just joined a Facebook one) to show you are not alone in your struggles and ‘strangeness’. Register that a lot of your struggles have huge external influences. It may be a journey, but enjoy forgiving yourself for ways you acted in the past when you were just trying to live.
“Be kind to yourself! Do small things like exercise. Just a short walk will do. Loud music and dancing is good. Try to rest and get enough sleep. Have a laugh. Go for a swim. Eat food that you like and that is mostly good for you. If you need HRT, go for it. But you are not going crazy and you are not alone.”
Kate agrees. “Just as ADHD awareness skyrocketed a few years ago, I think the same has been happening with menopause and perimenopause. More and more people are talking about it, comparing stories and helping each other. I’m lucky enough to have found a family GP who is amazing. She understands what I’m experiencing and I feel heard. It shouldn’t be rare to have a doctor who supports you but it took me 44 years to find one.”
Hoggarth says it’s vital that we expand our understanding of ADHD in women, especially when it comes to the influence of hormones.
“Improved research can lead to better diagnosis, more effective treatments and enhanced quality of life for women with ADHD.”
The good news, she says, is that, a few years into menopause, most symptoms reduce markedly. Hoggarth’s own mother thought she was developing early-onset dementia during menopause when she started having difficulty with her memory and finding words. But the problems were transitory. “So there’s that to look forward to.”
“I don’t go along with the ‘oh wow, it’s a superpower’,” Rosie says. “My life would be easier if I didn’t have it. But I do think there are positives, especially in terms of being passionate about things: empathy, creativity and spontaneity, for example. And I recognise now, quite incredible stamina and energy when the focus is there.
“I’ve always felt I was powerful in some way too, even when I was a little kid. Not in a spooky way, but in a sense of a deeper understanding of things beneath the surface of life. I think this might be common in people who are neurodiverse. Like the gaps in how our brains function also let other things in because there’s not the usual filter. This should be celebrated I think.”
* Names have been changed
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