23 – ADHD, Perimenopause & Menopause: Other Options – embracing your crone energy?

Key Takeaways

Estrogen Decline Dramatically Reduces Dopamine Production in ADHD Brains

Research reveals a critical connection between estrogen and dopamine that has profound implications for women with ADHD during menopause. As estrogen levels decline during perimenopause and menopause, dopamine production decreases correspondingly.

Studies show that within two to three years of menopause onset, up to 50% of estrogen-producing cells that also facilitate dopamine production may be permanently lost if hormone replacement therapy isn’t initiated within the first year after the final menstrual period.

This biological reality explains why many women with ADHD experience a dramatic worsening of symptoms during perimenopause, often beginning in their thirties rather than forties. The luteal phase medication adjustments that help during regular menstrual cycles are not enough when overall estrogen production is declining.

This creates a compounding effect where ADHD symptoms intensify precisely when women face increased life responsibilities and stress, making early recognition and intervention crucial for maintaining quality of life.

The MENDSS Framework Provides Structured Lifestyle Support for Menopause Management

Dr. Kathleen Nadeau’s MENDSS framework offers evidence-based lifestyle interventions that can significantly impact menopause symptoms and ADHD management when medication options are limited or unavailable.

The framework emphasises five key areas: mindfulness practices, exercise modifications, nutrition optimisation, sleep hygiene, and stress management. While these interventions are simple in concept, they require sustained implementation that can be challenging for individuals with ADHD executive function difficulties.

The framework recognizes that lifestyle interventions aren’t “easy fixes” but rather require systematic support and gradual implementation. For women with ADHD, these changes may be most successful when approached with coaching support or structured programs that account for executive function challenges.

The interconnected nature of these elements means that improvement in one area often supports progress in others, creating positive momentum for overall wellbeing.

Exercise Requirements Change Significantly During Menopause for ADHD Women

Menopause necessitates a fundamental shift in exercise approach, moving away from primarily cardiovascular exercise toward a combination of resistance training and moderate aerobic activity.

This shift addresses both the metabolic changes of menopause and the specific brain health needs of individuals with ADHD. Resistance training becomes critical for maintaining muscle mass, bone density, and metabolic function as hormonal changes accelerate muscle loss and increase osteoporosis risk.

Research shows that while cardiovascular exercise remains important for brain health and executive function support, weight-bearing resistance exercise provides the foundation for long-term health during and after menopause. The recommendation is for at least two to three sessions of resistance training weekly, combined with regular aerobic activity.

This balance supports both the physical changes of menopause and the neurochemical needs of ADHD brains, which benefit from exercise-induced increases in dopamine, norepinephrine, and BDNF.

Sleep Disruption During Menopause Requires Proactive Management Strategies

Menopause creates a complex sleep challenge for women with ADHD, as the physiological sleep disruptions of hot flashes, joint discomfort, and hormonal fluctuations combine with ADHD-related sleep difficulties.

The timing is particularly challenging because menopause increases the need for restorative sleep precisely when sleep becomes most elusive. Traditional sleep medications don’t provide the same neurological benefits as natural sleep, making behavioral interventions crucial.

Effective strategies focus on sleep protection through consistent sleep-wake timing, immediate morning light exposure, and electronic device management. The approach requires front-loading success by creating optimal conditions before sleep problems escalate.

This includes maintaining consistent bedtimes and wake times even on weekends, seeking natural light within the first hour of waking, and implementing physical barriers to late-night device use that can become habitual for ADHD brains.

Therapy and ADHD Coaching Serve Different Functions During Menopause Transitions

The distinction between therapy and ADHD coaching becomes particularly relevant during menopause, as women navigate both practical life management challenges and deeper emotional processing of life stage transitions.

Cognitive Behavioural Therapy (CBT) has received criticism within the ADHD community because its thought-first approach may not align with how neurodivergent individuals experience emotions and sensations. Many people with ADHD experience bodily sensations and emotions before conscious thoughts, making CBT’s cognitive restructuring approach feel invalidating or ineffective.

ADHD coaching operates from a strengths-based, partnership model that assumes individuals are already whole and capable, focusing on practical skill development and behavior change strategies.

During menopause, coaching can be particularly valuable for adapting routines, managing the practical aspects of symptom changes, and maintaining self-compassion during a challenging transition.

The coaching relationship provides structured support for implementing lifestyle changes while processing the emotional aspects of this life stage without pathologising the normal experience of menopause.

Professional Medical Support Becomes Essential When Symptoms Persist or Escalate

While lifestyle interventions can significantly impact menopause and ADHD management, certain symptoms require professional medical evaluation and intervention.

Persistent mood changes, debilitating anxiety, sleep disruption that doesn’t respond to behavioural interventions, or ADHD symptoms that become unmanageable despite lifestyle modifications warrant medical consultation. The key is finding healthcare providers who understand both ADHD and menopause complexities rather than dismissing symptoms as normal aging.

Medical evaluation should include comprehensive assessment of thyroid function, iron levels, blood pressure, and other physiological markers that can be affected by menopause and impact ADHD symptoms.

In some cases, treating ADHD symptoms with appropriate medication enables the executive function improvements needed to implement beneficial lifestyle changes, creating a positive feedback loop of improved health and wellbeing. The goal is creating a comprehensive support system that addresses both the neurological and physiological aspects of this life transition.

The Concept of “Crone Energy” Represents Empowerment in Post-Reproductive Life Stages

The transition from the “mother” to “crone” life stage in traditional feminist frameworks represents a shift toward wisdom, autonomy, and freedom from reproductive expectations.

For women with ADHD, this transition can be particularly powerful as it offers an opportunity to shed masking behaviors and external expectations that may have been exhausting to maintain. The menopause transition, while challenging, can also represent liberation from monthly hormonal fluctuations and the opportunity to establish new life rhythms.

Embracing this life stage requires developing self-compassion and rejecting societal messages that equate aging with decline or irrelevance. For ADHD women, who may have spent decades feeling “different” or struggling to meet neurotypical expectations, the crone stage can offer permission to fully embrace neurodivergent ways of being.

This transition benefits from support, whether through coaching, therapy, or peer communities, as women navigate both the practical and emotional aspects of this significant life change.