Symptoms, Challenges, and Coping Strategies
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If you have attention deficit hyperactivity disorder (ADHD) and you’re going through menopause, life can get pretty challenging to manage. While ADHD is commonly thought of as a disorder that affects children, it affects about 4 percent of American adults, according to the National Institute of Mental Health. ADHD impacts how different parts of the brain work together and manage executive functions like focus, concentration, impulse control, and emotional regulation.
But exactly how ADHD symptoms manifest appear to be different in males and females, which may affect diagnosis. The hormonal changes that women undergo during menopause may also have an effect on ADHD symptoms.
ADHD Is Often Missed in Women
One of the chief difficulties faced by women going through menopause with ADHD is that many may not even know they have the later condition. In childhood, boys are significantly more likely to be diagnosed with ADHD, with a diagnosis rate of 13 percent, compared with 6 percent in girls, according to the Centers for Disease Control and Prevention (CDC). But this doesn’t necessarily mean more boys have ADHD. Research suggests that girls tend to experience ADHD symptoms differently from boys, leading to underdiagnosis.
“Girls with ADHD tend to present with more internalizing symptoms like inattention, disorganization, and distractibility,” says Allison Deutch, MD, a clinical associate professor of psychiatry at the NYU Grossman School of Medicine in New York City. “Internalizing symptoms are more subtle and may delay diagnosis.” Boys, on the other hand, often exhibit more externalizing symptoms such as oppositional, disruptive, or hyperactive behavior, which may lead to higher rates of referral for diagnosis and treatment.
Even hyperactive symptoms in girls may be interpreted differently, Dr. Deutch explains. “For example, talking excessively, having difficulty staying on task, fidgeting, daydreaming, becoming quick to anger, may be dismissed as ‘personality traits’ rather than signs of a disorder,” she says.
In adulthood, the ratio of men to women with ADHD narrows, per a review published in October 2020 in PLoS One, and why exactly this happens is a topic of ongoing research.
But many women whose ADHD was missed as children continue to go undiagnosed, at least in part, because they’ve learned to successfully mask their symptoms, according to Shauna Pollard, PhD, a licensed psychologist based in Atlanta.
“Undiagnosed women often realize at an early age that they felt different, even if they didn’t quite understand why,” she says. “The ones who are overlooked diagnostically are often the women who learned how to present as someone who doesn’t have problems with staying focused, being organized, and managing time effectively. These women may work extra hours at work to keep up or struggle with perfectionism and shame about their symptoms.”
Hormone Changes May Play a Role
Another challenge of coping with ADHD during menopause is that hormonal changes may exacerbate symptoms. During perimenopause (the period of time leading up to menopause) and menopause, estrogen and progesterone levels drop. When this happens, other chemicals in the brain become affected as well.
Many women going through this transition find themselves experiencing brain fog or becoming increasingly forgetful, and doctors say these hormonal and chemical changes are likely the culprit.
“Reduced estradiol is thought to play a key role in the onset of executive dysfunction during the menopause transition by modulating the effects of dopamine and glutamate in important regions of the brain responsible for cognitive functioning,” Deutch says.
Some research suggests that these hormonal changes also worsen ADHD symptoms. But data in this area is lacking, and more research is needed to better inform our understanding of how hormonal changes associated with menopause interact with symptoms related to ADHD, notes Deutch.
Adopting Strategies to Manage Symptoms
Living with ADHD while going through menopause can feel overwhelming. Adopting effective strategies for managing symptoms can help. Consider the following.
- Behavioral strategies “Behavioral strategies are a core component of ADHD symptom management at every developmental stage,” says Deutch. To stay focused and organized, consider using tools like calendars, planners, and timers, suggests Harvard Health. Decluttering your home, office, and workstation can also significantly reduce distractions. Deutch recommends the mantra: “a place for everything and everything in its place.”
- Talk therapy Cognitive behavioral therapy (CBT), or talk therapy, is the gold standard psychotherapeutic approach for ADHD, according to research published in Frontiers in Psychiatry. Through CBT, people with ADHD can get help learning how to develop coping strategies, improve time management, and address emotional challenges. Therapy can open up a safe space to talk through the difficulties of both ADHD and menopause.
- Medication If you’re not already taking medication for ADHD, talk to your doctor to see if this may be right for you. There are two types of medications that treat ADHD: stimulants and nonstimulants. Stimulants, including medications such as methylphenidate or amphetamine (Ritalin, Vyvanse, and Adderall) are most commonly used, per Mayo Clinic. These drugs may be beneficial to some women in more ways than one, as studies have found that stimulants like Vyvanse may play a role in the management of executive dysfunction associated with menopause. But some people cannot tolerate stimulants, and in these situations, nonstimulant medications like atomoxetine (Strattera) and certain antidepressants may be used.
- Exercise Don’t underestimate the benefits of physical activity when it comes to management of ADHD and menopause symptoms. “Not only has exercise been shown to improve ADHD symptoms and boost mood, it also has added health benefits for menopausal or post-menopausal women,” Deutch says. For example, a study published in March 2020 in PLoS One of more than 1,000 women ages 45 to 55 found that those who had low physical activity levels experienced worse menopausal symptoms, including vasomotor (hot flashes), psychosocial, physical, and sexual symptoms than those with moderate or high physical activity levels.
- Treat other mental health conditions ADHD often occurs with other mental health conditions like depression and anxiety, particularly in women, as a paper published in May 2023 in the Journal of Attention Disorders noted. Treatment for psychiatric conditions may improve ADHD symptoms, notes Deutch. For example, the CDC states that depression and anxiety can make it more difficult to focus. Additionally, “treating ADHD symptoms can, in some instances, lessen the burden of comorbid psychiatric conditions,” Deutch says.
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