Hormones, Menopause, and ADHD
Changes in hormones can cause cognitive issues in women during menopause that mimic attention deficit hyperactivity disorder (ADHD/ADD). Overlapping symptoms include memory deficits, difficulty concentrating, inattention, and mood swings. Estrogen modulates key neurotransmitters that affect cognition. Dopamine is important for executive functioning, and the ability to plan, focus, remember and juggle multiple tasks. Acetylcholine enhances memory, and serotonin regulates mood. Higher levels of estrogen modulate all three of these important neurotransmitters linked to executive functioning, mood, and attention.
ADHD Research suggests that ADHD is undiagnosed or misdiagnosed in up to 50-75% of girls and women with symptoms. Females with ADHD often present with symptoms that overlap those of anxiety and depression and lack classic symptoms of ADHD-related hyperactivity frequently seen in males. There is no research on whether women with ADHD are more affected, or differently affected, by menopause-related hormone changes, or whether menopause could be a mechanism for “adult-onset” ADHD in women. Because low estrogen levels are known to negatively impact executive functioning in women without ADHD, it makes sense that women with ADHD may be even more vulnerable to menopause-related changes resulting in new challenges when performing tasks that involve planning, focus, memory, and multitasking.
Research on healthy women without ADHD who were treated with ADHD stimulant medications for menopause-related cognitive impairments showed improvements in executive functioning. Other pharmacologic treatments that target estrogen and/or the neurotransmitters responsible for cognition and mood may prove useful for women with ADHD. Those medications may include stimulants, hormone replacement therapy (HRT), antidepressants, or memory-boosting medications targeting acetylcholine.
Non-pharmacologic treatments for women with ADHD in menopause include psychotherapy, psychoeducation, mindfulness training, and lifestyle changes that reinforce healthy habits. Women with ADHD considering treatment options should consult their healthcare team that ideally includes a practitioner skilled in menopause-related hormone changes and a psychiatrist specializing in adult ADHD.
