ADHD, Perimenopause & Menopause (Blog Episode)

Hello, my friends, and welcome back to our space of empowerment and understanding.

This week, we close our series with a focus deeply rooted in the experiences many of us face or will face: the journey through perimenopause to menopause, especially through the lens of ADHD.

Most women go through menopause around the age of 50-51, but the beginning of perimenopause can be 10-15 years before this, so knowing what to expect can make a difference to our experience of the biggest change in our lives since puberty.

The Unspoken Challenge: ADHD & Menopause

Women with ADHD have fluctuating hormone levels that affect our dopamine production every month, so that we rarely reach a ‘steady state’ unless we use hormonal contraception that has other side effects.

Our journey with ADHD is unique, filled with various challenges and milestones. Yet, as we age, particularly as women, we encounter a significant yet often overlooked challenge: hormonal changes during menopause and their impact on ADHD.

The interplay between declining estrogen levels and ADHD symptoms is profound. Research indicates that as our estrogen declines, so does our dopamine production, making our ADHD symptoms feel so much more noticeable. This link between estrogen and dopamine is crucial for understanding and managing our ADHD during these transformative years - it’s not in our imaginations and employers as well as families and friends need to understand why we need to change how we live, often radically, to be well.

Beyond Medication: Holistic Management Strategies

While HRT and medication are common routes to managing menopause symptoms, they're not our only options. With fluctuating medication supplies and the unpredictability of HRT availability, it's vital to explore other aspects of our lives we can control or influence to improve how we feel during menopause and perimenopause.

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Diet and Exercise: Foundations of Well-being

A focus on a balanced diet, rich in omega-3 fatty acids and proteins, can significantly impact our cognitive functions and emotional regulation. Exercise too shifts in focus. Resistance and muscle-building exercises become crucial, helping counteract menopause-related physical changes and maintain our mental health.

The Crucial Role of Sleep

Quality sleep during menopause can be elusive but is foundational for managing ADHD symptoms effectively. Establishing a consistent sleep routine and creating a conducive sleep environment can make a significant difference in our well-being. Instead of relying on sleeping tablets which lead to ‘unconciousness’, we need to focus on creating real sleep where our brains can be ‘cleansed’ and the long term health of our most vital organ can be supported. Using all of these strategies - to improve diet, exercise, mindfulness and self compassion all add together to improve our sleep routines. You can read more in this blog post.

Embracing Mindfulness and Self-Compassion

In navigating menopause with ADHD, cultivating self-compassion and engaging in mindfulness practices can be transformative. These practices can lower stress levels, improve emotional regulation and make it easier to manage the unpredictable route of the physical changes in our bodies as we age.

You can listen to the audio podcast episode here:

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Further Reading:

de Jong M, Wynchank DSMR, van Andel E, Beekman ATF, Kooij JJS. Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage. Front Psychiatry. 2023 Dec 13;14:1306194. doi: 10.3389/fpsyt.2023.1306194. PMID: 38152361; PMCID: PMC10751335.

Shieh A, Karlamangla AS, Karvonen-Guttierez CA, Greendale GA. Menopause-Related Changes in Body Composition Are Associated With Subsequent Bone Mineral Density and Fractures: Study of Women's Health Across the Nation. J Bone Miner Res. 2023 Mar;38(3):395-402. doi: 10.1002/jbmr.4759. Epub 2023 Jan 17. PMID: 36542065; PMCID: PMC10023299.

Yelland S, Steenson S, Creedon A, Stanner S. The role of diet in managing menopausal symptoms: A narrative review. Nutr Bull. 2023 Mar;48(1):43-65. doi: 10.1111/nbu.12607. Epub 2023 Feb 15. PMID: 36792552.

Pines, "Midlife ADHD in women: any relevance to menopause?", Climacteric, Link

Leranth C, Roth RH, Elsworth JD, Naftolin F, Horvath TL, Redmond DE Jr. Estrogen is essential for maintaining nigrostriatal dopamine neurons in primates: implications for Parkinson's disease and memory. J Neurosci. 2000 Dec 1;20(23):8604-9. doi: 10.1523/JNEUROSCI.20-23-08604.2000. PMID: 11102464; PMCID: PMC6773080.

Conde DM, Verdade RC, Valadares ALR, Mella LFB, Pedro AO, Costa-Paiva L. Menopause and cognitive impairment: A narrative review of current knowledge. World J Psychiatry. 2021 Aug 19;11(8):412-428. doi: 10.5498/wjp.v11.i8.412. PMID: 34513605; PMCID: PMC8394691.

Gava G, Orsili I, Alvisi S, Mancini I, Seracchioli R, Meriggiola MC. Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy. Medicina (Kaunas). 2019 Oct 1;55(10):668. doi: 10.3390/medicina55100668. PMID: 31581598; PMCID: PMC6843314.

Miller VM, Naftolin F, Asthana S, Black DM, Brinton EA, Budoff MJ, Cedars MI, Dowling NM, Gleason CE, Hodis HN, Jayachandran M, Kantarci K, Lobo RA, Manson JE, Pal L, Santoro NF, Taylor HS, Harman SM. The Kronos Early Estrogen Prevention Study (KEEPS): what have we learned? Menopause. 2019 Sep;26(9):1071-1084. doi: 10.1097/GME.0000000000001326. PMID: 31453973; PMCID: PMC6738629.

Martel MM, Klump K, Nigg JT, Breedlove SM, Sisk CL. Potential hormonal mechanisms of attention-deficit/hyperactivity disorder and major depressive disorder: a new perspective. Horm Behav. 2009 Apr;55(4):465-79. doi: 10.1016/j.yhbeh.2009.02.004. Epub 2009 Mar 2. PMID: 19265696; PMCID: PMC3616481.

Saleh RNM, Hornberger M, Ritchie CW, Minihane AM. Hormone replacement therapy is associated with improved cognition and larger brain volumes in at-risk APOE4 women: results from the European Prevention of Alzheimer's Disease (EPAD) cohort. Alzheimers Res Ther. 2023 Jan 9;15(1):10. doi: 10.1186/s13195-022-01121-5. PMID: 36624497; PMCID: PMC9830747.

Maki PM. Critical window hypothesis of hormone therapy and cognition: a scientific update on clinical studies. Menopause. 2013 Jun;20(6):695-709. doi: 10.1097/GME.0b013e3182960cf8. PMID: 23715379; PMCID: PMC3780981.

E. Antoniou, N. Rigas, Eirini Orovou, Alexandros Papatrechas, Angeliki Sarella, "ADHD Symptoms in Females of Childhood, Adolescent, Reproductive and Menopause Period", Medical Science Monitor, Link

Pamela S Smith, "Menopause, Amino Acids, Nutritional and Neurotransmitter Influences on ADD/ADHD", Book Chapter

C. Epperson, S. Shanmugan, Deborah R. Kim, Sarah B. Mathews, K. Czarkowski, J. Bradley, D. Appleby, Cláudia Iannelli, M. Sammel, T. Brown, "New onset executive function difficulties at menopause: a possible role for lisdexamfetamine", Psychopharmacology, Link

Bettina Camara, C. Padoin, Blanca Bolea, "Relationship between sex hormones, reproductive stages and ADHD: a systematic review", Archives of Women's Mental Health, Link

Roger A. Lobo, "The 2022 hormone therapy position statement of The North American Menopause Society", Menopause, Link

[Author not listed], "The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society", Menopause, Link

Zec RF, Trivedi MA. The effects of estrogen replacement therapy on neuropsychological functioning in postmenopausal women with and without dementia: a critical and theoretical review. Neuropsychol Rev. 2002 Jun;12(2):65-109. doi: 10.1023/a:1016880127635. PMID: 12371603.