ADHD and menopause

When people talk about their experience with menopause, they often mention hot flashes, mood changes, and trouble sleeping. But what about the effects of menopause on people with ADHD?

Menopause marks the end of a gradual decline in the levels of hormones your ovaries produce. Typically, your health care provider will say you’ve reached menopause when you haven’t had a period in a year. The average age of menopause is around 51, but the hormonal changes typically begin years earlier.

Health care providers may be familiar with moodiness and anxiety as well as hot flashes that can come in the time before and after menopause. But they may be less aware of the changes that can increase ADHD symptoms.

Hormonal changes and ADHD

Hormones are chemicals that act like messengers to help different parts of your body work correctly. During your menstrual cycle, your hormone levels naturally rise and fall in a pattern. These hormones include progesterone, estrogen, and testosterone. They work together to help prepare your body for pregnancy. If you don’t get pregnant, the cycle starts over again. 

For some women, the pattern of ADHD symptoms worsening at certain times begins at puberty. This is when hormones begin their fluctuating monthly cycle. 

Estrogen can increase the amount of a “feel good” brain chemical called dopamine that helps with mood and focus.¹ Researchers believe that people with ADHD have lower levels of dopamine. So when estrogen levels dip, and dopamine levels do, too, it can make ADHD symptoms worse.

As you get older, your ovaries make less estrogen and progesterone.² Your periods become more irregular, and the time between them increases. This stage is called perimenopause. Symptoms like hot flashes, trouble sleeping, and mood changes are common.³ 

Some health care providers may look at your hormone levels at a singular point in time and say they’re “fine.” And that can be true. Your hormones might be normal for your age or for what part of your cycle you’re in. But it’s often not high or low hormone levels that cause ADHD symptoms. It’s the natural dip in hormones that comes after ovulation and later as you reach the end of your reproductive years that leads to the symptoms that so many women with ADHD describe. 

Researchers have found that when estrogen drops, like in the week before your period and during perimenopause, ADHD symptoms can be more severe.^4,5 You may struggle more with working memory^5,6 and inattention.^6,7 Planning out your day and completing tasks at work may be more challenging. 

Once you’ve reached menopause, your estrogen levels won’t fluctuate. They’ll remain low. You may still have the ADHD symptoms that come with low estrogen levels, but you may not notice them as much since your estrogen level no longer fluctuates.

Hormonal changes may also affect impulsivity. You may have a harder time coping with stressful situations.^4,6 Plus, poor sleep, which is common in the years before and after menopause, can add to ADHD-related sleep problems. Getting too little sleep makes it even harder to focus. 

Managing ADHD and menopause

The good news? There are treatments that can help you manage many of the symptoms you may experience in the years before and after menopause. These include both medications and lifestyle changes.

Hormone replacement therapy

Because menopause symptoms are linked to changing hormones, health care providers sometimes recommend hormone replacement therapy (HRT). HRT can include taking estrogen, progesterone, or testosterone. But estrogen is often used for menopause symptoms such as hot flashes.⁸

Some studies suggest that estrogen replacement therapy can improve working memory after menopause.⁵ But more research is needed. 

HRT is a good option for many women. But it may not be appropriate for some, due to health concerns. Talk it over with your health care provider.

Adjusting your ADHD medications 

If your ADHD medication doesn’t seem to work as well in the years before and after menopause, it may be time to talk to your prescriber. Low estrogen can make your ADHD symptoms worse and may make your ADHD medication less effective.⁶ Your prescriber can help adjust your medications as needed. 

Melatonin supplements 

Poor sleep is a common complaint from people in the years before and after menopause. Unfortunately, poor sleep can also increase your ADHD challenges, like trouble with working memory and managing emotions. 

Melatonin is a natural hormone that increases once the sun goes down and it gets dark out. The rise in melatonin helps make you feel sleepy around bedtime. But using computers and digital devices in the evening can shut off the increase by giving off blue light.

If you have ADHD, your body may make melatonin at the wrong time of the day. Talk to your health care provider about whether melatonin supplements could help.⁹

Therapy

Going through menopause can be especially challenging if you have ADHD. Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) may help you manage your emotions. They can also help you learn coping skills for ADHD. 

If hormonal changes make your ADHD symptoms worse, it’s important to go easy on yourself. Remember that you’re not creating these challenges, and you may not always be able to control them. But with the right support, you may be able to manage them better.

Summary

Menopause is usually marked when you haven’t had a period for a full year. It happens because of a gradual decline in the amount of the hormone estrogen your ovaries make.

For many women, the decade leading to menopause causes symptoms like hot flashes, mood changes, and sleep issues. The hormonal shifts can also make ADHD symptoms worse. These include problems with memory, focus, and impulse control. 

There are a few options for managing ADHD and menopause-related symptoms. Hormone replacement therapy (HRT) is often used to treat hot flashes and sweats, for example. But it can also help with memory and focus. 

Adjusting ADHD medication can address changes in ADHD symptoms during this stage. And therapy may be able to help with handling emotions and building coping skills. 

With the right support, you can better manage both ADHD and menopause symptoms.