Perimenopause and what happens when you add ADHD to the mix
Perimenopause can be a tough time for many of us. If you also have ADHD, chances are it feels like a constant uphill battle. Let's dig into why that is and what you can do to make life a little easier
Peri or Meno - which pause is it?
First things first. There’s a lot of confusion around the terminology and both terms, perimenopause and menopause, are often used interchangeably. Which doesn’t help clear things up. Let’s take a look at what both terms actually mean.
Menopause
Menopause is basically when your periods decide to take a permanent vacation. "Meno" refers to your menstrual cycle, and "pause" means your cycle stops. Your ovaries stop producing eggs, and your hormone levels of estrogen, progesterone, and testosterone take a nosedive.
Menopause is defined as the moment when your periods have stopped for 12 months - so strictly speaking it’s just that exact point in time. Once you haven't had a period for a year, congrats, you're postmenopausal!
Perimenopause
For most of us, menopause is not something that happens overnight, we don’t just flip a switch and that’s our ovaries finished. It’s a slow and steady transition that usually kicks off in your early to mid-40s. On average, menopause happens around age 51 but for some, it can be much earlier. There’s no such thing as ‘too young’ for the menopause.
During perimenopause, you might experience symptoms like hot flashes and mood swings (as well as a host of other symptoms but that’s for another day). Your periods might start acting a bit differently – showing up more or less often, or just changing their usual routine.
And what does perimenopause have to do with ADHD?
The hormonal fluctuations of perimenopause can have a negative impact on focus, organisation, and emotional regulation in women with or without ADHD. No wonder then, that the combined effects of ADHD and perimenopause can create a perfect storm.
Some women may be wondering what on earth is going on or why their medication isn’t working anymore. Others may not realise they are neurodivergent until hormone changes during perimenopause bring underlying issues to the surface. This is one of the (many) reasons why so many of us get diagnosed later in life.
Our friend the mighty estrogen
Understanding the role of estrogen is especially significant for women with ADHD. This is because estrogen works hand in hand with some key neurotransmitters, that are also involved in ADHD.
Estrogen lends a helping hand to
Dopamine is central to your body’s reward system and executive functioning
Acetylcholine aids memory and attention
Serotonin is the mood booster that helps you stay focused, emotionally stable, and calm
These neurotransmitters form the backbone of cognitive and emotional harmony and estrogen is a key player in maintaining their efficient performance.
As estrogen declines during menopause you have less of these crucial neurotransmitters available to you. Now, if you have ADHD you’re probably aware that you’re already struggling with a lack of dopamine. Is it any surprise then that thanks to perimenopause you’re feeling worse than ever??
The connection between estrogen and the above neurotransmitters also explains why so many ADHD symptoms overlap with perimenopause symptoms, e.g. trouble focusing, forgetfulness, mood swings, difficulties sleeping, changes to libido, anxiety,…
Feeling overwhelmed?
Dealing with an increase in symptoms, or having new ones appear left right and centre, can be really tough. Sometimes it's hard to put into words how you're feeling about all the changes you're going through. It's totally normal to feel like everything's just too much to handle, especially when it feels like you're not able to do things the way you used to. Please remember, there are things you can do to help and you don’t need to suffer in silence.
What you can do to help yourself
Medication
ADHD medication and HRT are an option for many of us and both can be taken together. HRT tops up the hormone levels that are falling when you become perimenopausal. It usually includes estrogen, progesterone and in some cases, testosterone. Speak to your doctor if you’d like to explore this.
If you’re already on ADHD meds the dose may need adjusting as you start HRT. It can take some trial and error to find the right balance of medications to best manage your symptoms. Try and be patient.
It's possible that your clinician might not be aware of how female hormones can affect ADHD symptoms. This connection has been clearly evidenced in research, you’re not making it up. It's perfectly okay to ask your healthcare provider to consider your hormone levels as part of your overall treatment plan. You deserve to feel your best, and addressing these issues can be a crucial step towards that goal.
If you’re not already using medication to treat your ADHD, and you’re wondering where to begin, Dr Louise Newson recommends trying HRT first:
“The introduction of estrogen could well be enough to help manage your ADHD symptoms – and improve any other symptoms of perimenopause or menopause that you’re experiencing too. It may be best to try starting HRT for a few months and see if this is enough to manage your possible ADHD symptoms. Keeping a detailed record of your symptoms before and after starting HRT will really help you and your clinician figure out what is improving and what is not.”
Other options
There are lots of other options to manage both ADHD and perimenopause symptoms besides medication and HRT.
Don’t try and change everything at once, take it one step at a time. Small changes add up over time and together can make a big difference.
Sleep
Getting a good night's sleep is incredibly important for your overall health and well-being, especially as we age. While we sleep, our body has a chance to repair and recharge from the stresses of the day. Inadequate sleep can leave us feeling forgetful and scattered (ADHD, anyone??). It affects our mood and nutrition and really is the foundation of your well-being. So, be sure to prioritise a good night’s rest.
Stress Management
Feeling stressed is something everybody experiences at times, and it’s not always bad either. If you have ADHD, you might find that not just daily life but your ADHD symptoms themselves are stressing you out! ADHD and stress can be tricky to navigate since one can often trigger the other. While you can't always control your ADHD symptoms, there are things you can do to reduce stress in other parts of your life and take care of yourself.
Movement and Exercise
As you may already know, exercise triggers the release of dopamine in your brain. As we discovered earlier dopamine can help you stay focused and think clearly. Don’t worry if you’re not a fan of exercise. You can incorporate movement into your day by taking regular breaks to stretch or walk around, using a standing desk or wobble cushion, and going for a walk during your lunch break.
Nutrition
Some foods may affect your symptoms in different ways. Research suggests that
A high-protein diet can help improve concentration, so try eating foods like beans, cheese, eggs, seafood, meat, and nuts.
Complex carbohydrates found in a variety of fruits and veg help keep blood sugar levels steady. Try to minimise refined carbs.
Fermented foods like yoghurt, kefir, sauerkraut, or kimchi can help keep your gut healthy and improve your physical and mental health.
Omega-3 fatty acids, found in fish, seeds, nuts, and olive oil, are also important for brain health.
Vitamin D is good for bone health, immunity, and mood. Some studies suggest that it may also play a role in brain functioning.
Limiting alcohol reduces perimenopause symptoms.
Psychological support
Sometimes we need to talk things through. If you feel psychological support would benefit you, reach out to a practitioner who has experience in both ADHD and menopause
Learn to advocate for yourself
This is something I really struggle with but as women with ADHD, we have to learn to speak up for ourselves. Learn about your rights, if you’re in the UK, read the NICE guidelines on menopause before you go to your GP and generally be prepared to advocate for yourself. If you’re not getting the support you need you may need to try again or you may need to try elsewhere.
Find a supportive community
Speaking to others who are in the same boat can be life-changing. Find a local group and subscribe to this community. Hearing that you’re not alone and finding out about what has helped others is simply invaluable.
Until next time.
Julia
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