As you enter your late 40s and early 50s, it is important that you become aware of several perimenopausal and menopausal issues that affect women, but especially those with attention-deficit/hyperactivity disorder. First, menopause comes with a whole host of symptoms, including memory problems and mood changes, in addition to hot flashes, insomnia, and other physical symptoms experienced by many women. You might find that you have difficulty with short-term verbal memory, word retrieval, and mental clarity. These symptoms are now thought to result from the decreasing estrogen levels that can affect brain functioning. As a woman with ADHD entering menopause, you need to work with a physician who is aware of the interaction between ADHD symptoms and estrogen levels.
Perimenopause begins when estrogen levels start to decrease and occurs several years before actual menopause. It is a time often associated with mood changes and the onset of depression in some women who have had no previous history of the disorder. Perimenopausal women report feeling sad, irritable, tired, and worried, as well as having difficulty sleeping. This depression and the cognitive deficits associated with decreasing levels of estrogen that occur prior to and during menopause may cause a woman with ADHD to have greater difficulty coping with her ADHD symptoms as well. She may find herself becoming less functional with more severe ADHD symptoms as she enters this phase of her life. This is often the reason a woman will seek help for her ADHD for the first time in her late 30s, 40s, or early 50s. At that time, she may seek out a diagnosis from a physician because she can not longer cope with her worsening symptoms. If she has been diagnosed previously and is receiving treatment for her attention deficit hyperactivity disorder, her medications may not seem as effective as her symptoms worsen with menopause, and the dosage may need to be adjusted at this time.
Your physician needs to take all of this information into account and design a holistic approach to assist you in getting back on a more even keel. It may take some trial-and-error to find what works for you, because no two women have the same needs. You might need an increase in your stimulant medication, and you will likely need symptom coverage for 16 to 20 hours per day. In addition, any sleep issues you have need to be addressed. Your doctor should consider prescribing multiple doses and/or combinations of short-acting stimulants and long-acting stimulants to be taken along with a stimulant. Antidepressants and estrogen or thyroid hormone replacement may be warranted if other serious conditions such as depression or hypothyroidism coexist with your attention-deficit/hyperactivity disorder.
You should also make it a habit to practice good self-care during these stress-filled phases of your life. Good self-care includes eating a wholesome, nutritious, well-balanced diet and getting plenty of exercise and sleep. Discuss your symptoms with your physician and bring up the possibility of other treatment options including vitamin supplements, omega-3 fatty acids, alternative therapies, and possible hormone replacement therapy to boost estrogen levels. Above all, be kind to yourself and get all the help and support you can to make this difficult transition time more comfortable.
I was diagnosed with ADHD a year ago. It was a relief to know that something was different about the way I lived, processed information, and why I seemed oblivious to some things, yet very focused on others, etc. I went on medication (Adderall XR) and felt brand new, almost driven to complete tasks that I quickly burned out on before taking medication. Now, some days, it seems the medication doesn’t work as well as before, and some days, I wonder if I even remembered to take my pill I’m noticing the muddled feeling that I had noticed before I started medication creeping back in, even on medication. My physician has increased the dose of my medication but these problems continue. I have noticed some hormonal changes as well. I started on oral contraceptives to try to even out my hormones, with the help of Celexa. Both have helped me with the severe PMS I was experiencing, but not these other symptoms. I am 47, almost 48 now, and feel that my decreasing hormone levels are affecting my ADHD and its treatment.
Selections from the book: “100 Questions & Answers About Attention-Deficit Hyperactivity Disorder (ADHD) in Women and Girls”, Patricia O. Quinn, MD, Director National Center for Girls and Women with AD/HD, Washington, DC, 2011