Does menopause exacerbate symptoms of ADHD (or vice versa)? ADDitude posed this question to more than 1,500 women with diagnosed and undiagnosed ADHD earlier this year in a reader survey. The finding: A whopping 94 percent said yes — their ADHD symptoms grew more severe during perimenopause and menopause.
For more than half of the women, ADHD symptoms grew so severe during their 40s and 50s that they called menopause the period in which “ADHD had the greatest overall impact on their lives.” Only 17 percent said the same about ADHD symptoms in their 20s and 30s, and even fewer before then.
“Perimenopause and the pandemic were an awful combination,” wrote one survey respondent. “Everything fell apart. I couldn’t cope, sought diagnosis, and realize now I struggled all along, but particularly when estrogen was surging and declining.”
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Memory & Overwhelm are Primary ADHD Problems
Mid-life hormonal fluctuations began, on average, at age 45 with perimenopause and continued with the onset of menopause at age 49 for ADDitude survey respondents. During this stage, the most impactful ADHD symptoms were brain fog or memory issues, and overwhelm, both of which 70 percent of women said had a “life-altering impact” in their 40s and 50s. By contrast, only 11 percent of women called memory problems life-altering during their 20s and 30s; half said the same of overwhelm earlier in life.
“I was good at masking and worked really hard to stay on top of things as a child, teenager, young adult, and young mother and in my working life — and I managed to cope,” wrote one mother of four who entered perimenopause at 50 and is now 64. “In my late 40s, no amount of hard work could cover up the struggles and everything got on top of me, increasing anxiety, leading to overwhelm and emotional dysregulation, and exacerbating all the struggles I had all my life.”
Some women said they worried that brain fog and memory problems — symptoms of both ADHD and menopause — would affect their job performance. Others said new and worsened ADHD symptoms, namely emotional dysregulation, affected their relationships during perimenopause and menopause. One ADDitude reader said her symptoms were so abrupt and disruptive that she feared she might have early-onset dementia.
“Brain fog became unmanageable,” wrote one 45-year-old mother of two who entered perimenopause at age 41. “Distractibility increased and my inability to complete work tasks in an appropriate amount of time decreased. I began spending all night working just to keep up. Things that I used to have unconscious strategies to deal with were no longer manageable.”
Given this common experience, it’s not hard to imagine why overwhelm was cited by 70 percent of women as life-altering. The next most debilitating symptoms in menopause were time-management difficulties (called life-altering by 63 percent of women in their 40s and 50s), procrastination (also 63 percent), and distractibility (59 percent). Emotional dysregulation was called life-altering by 56 percent of women during perimenopause and menopause.
“I never experienced rage or brain fog before perimenopause,” wrote one woman. “Overwhelm has been more frequent in recent years, and depression began in my 40s. I definitely attribute some of this to hormonal changes.”
“Motherhood has been a struggle as I try and fail to manage time within daily flow and weekly schedules,” wrote one mother of two who recently entered perimenopause at age 40. “Entering perimenopause, I’m feeling depleted of my own hormones, which is physically and mentally draining me, and exacerbating my brain fog, fatigue, emotional dysregulation, sensory overload, lack of sleep, heightened anxiety, and inability to exercise.”
The Dangers of Missed ADHD Symptoms
Many women reported receiving an ADHD diagnosis later in life. Of those, the average age of diagnosis was 43. Half of women said they had combined-type ADHD with both inattentive and hyperactive/impulsive symptoms, while 40 percent said they had inattentive ADHD. Comorbidities were the rule, not the exception; 89 percent reported at least one diagnosis in addition to ADHD. Of those, 73 percent reported anxiety and 64 percent cited depression. Many other women reported misdiagnosis or incomplete diagnosis as a significant barrier to health and happiness.
“I feel like doctors aren’t listening to me when I bring up ADHD, and they don’t seem concerned,” wrote one 44-year-old mother of three. “They keep trying to say it’s depression and anxiety, but it’s not. I’ve been depressed and anxious in the past — and this isn’t that.”
It is not uncommon for women who have ADHD to be misdiagnosed or undiagnosed — and the hormonal fluctuations that result in brain fog and memory problems during perimenopause and menopause may only complicate the potential for an accurate diagnosis. Do these symptoms point to ADHD or are they simply typical signs of this life transition? It’s often difficult to answer that question.
The fact is that ADHD symptoms fluctuate significantly during a lifetime, with impulsivity and hyperactivity often giving way to disorganization and emotional dysregulation over time. According to the women who answered ADDitude’s survey, the most problematic ADHD symptoms during each stage of life are as follows (in order of severity):
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- Ages 0-9: Emotional dysregulation, inattention/distractibility, and social struggles
- Ages: 10-19: Procrastination, emotional dysregulation, and time-management difficulties
- Ages 20-39: Procrastination, overwhelm, and time-management difficulties
- 40-59: Overwhelm, brain fog and memory issues, and time-management difficulties
- 60+: Brain fog and memory issues, procrastination, and overwhelm
“Age 40 was when I dropped all the plates I’d been struggling to keep spinning; the overwhelm and inability to cope reached a breaking point,” wrote the 44-year-old mother of two who was diagnosed late in life. “Having the responsibility of young children and a stressful job pushed me beyond being able to cope and quit my 20-year career.”
“I was diagnosed with premenstrual dysphoric disorder in my early 30s. Then perimenopause hit around age 40, which started the 10-year emotional roller coaster from hell,” wrote one woman diagnosed with ADHD at age 54. “I only looked into an ADHD diagnosis by chance, but I can now see how and why I had a much harder time than anyone else I know.”
Diagnosis Unlocks Effective Treatment
Diagnosis is a critical factor for managing the most impairing symptoms of ADHD during menopause, according to the 40 percent of respondents who said stimulant medication is effective or very effective in treating their ADHD symptoms. Without a diagnosis, a prescription is not possible.
“Stimulant medication was life-altering for me,” wrote one woman diagnosed with ADHD at age 55.
“I would absolutely recommend ADHD medication to anyone,” wrote one 54-year-old mother of three. “All the other factors like diet, exercise, and improved wellbeing have an impact, but if I go two days without medication, I feel it all start to fall apart.”
Exercise was deemed effective or very effective by 37 percent of respondents; nutrition was similarly labeled by 27 percent; and mindfulness was favored by nearly 30 percent. More than 60 percent of women said they changed their diet, fitness, and health routine during perimenopause and menopause to better manage flaring ADHD symptoms. Many women said they ate more healthfully, some said they exercised more regularly, and others said they cut back on drinking alcohol as they became more sensitive to its effects.
“Meditation and yoga are very helpful when I practice consistently,” wrote one woman. “Meditation was a lifesaver in helping me overcome sleep issues. I’ve been on methylphenidate and it helps as well. Regularly scheduled appointments with friends and family keep me sane. I have a friend with ADD and we try to have daily accountability check-ins. It makes a huge difference.”
Roughly 35 percent of survey respondents also said they take or have taken hormone replacement therapy (HRT), most to address both cognitive and physical symptoms of menopause. Of those, 26 percent said HRT helped with their ADHD symptoms.
“I didn’t have an ADHD diagnosis when I was on HRT,” wrote one woman diagnosed with ADHD at age 61. “On reflection, I was pretty productive during that time, and relatively stable but still had old problems of sleep disturbance, anxiety, grief reactions, and depression. I did make friends, though — and that was unusual.”
Menopause Symptoms and ADHD: Next Steps
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