Is It ADHD or Perimenopause?

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

Is It ADHD or Perimenopause?

ADHD (attention-deficit/hyperactivity disorder) holds the stereotype of the “disruptive boy” but remains underdiagnosed and treated in women. Many women struggle and aren’t diagnosed until later in life, increasingly in their 40s during perimenopause. It turns out that hormonal changes can exacerbate ADHD symptoms. But is your brain fog and irritability an ADHD flare, perimenopause, or both?

Today’s article will explore ADHD in women, overlapping symptoms with perimenopause, and an integrative approach to brain health in mid-life. Keep reading as we discuss:

• What is ADHD?
• ADHD in women
• The connection between ADHD and perimenopause
• Why and how to work with a skilled integrative practitioner

Let’s dive in!

What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition with difficulties in inattention, hyperactivity-impulsivity, or both. ADHD likely has a genetic component, as it tends to run in families.

Symptoms are typically present in childhood and tend to improve over time. ADHD may co-exist with other conditions, including mood disorders, autism spectrum disorder, learning disorders, and more.

ADHD symptoms may include:

• Distraction, difficulty focusing
• Hyperactivity
• Difficulty controlling behavior
• Overwhelm
• Brain fog
• Emotional dysregulation – irritability, low tolerance for frustration, mood changes
• Procrastination
• Disorganization

Beyond the primary symptoms, ADHD can cause functional, social, and health issues over time. These may include:

• Academic and workplace difficulties
• Low self-esteem
• Challenges with time management
• Risk-taking behavior, including sexual behavior
• Relationship conflicts
• Isolation
• Substance misuse
• Excessive computer use
• Compulsive gambling or shopping

Additionally, ADHD may present differently in females vs. males.

ADHD in Women

The bulk of ADHD research is in boys and men, and it’s typically diagnosed in childhood as the outward presentation may be more obvious.

More males are diagnosed than females, at least in part due to the lack of ADHD recognition in girls/women. Although awareness is starting to change, more boys still get referrals for testing and three times more diagnoses than females.

Females with ADHD present differently than males; they tend to have fewer behavioral problems, and the hyperactive symptoms may be less severe. Additionally, symptoms may be more internalized instead of outward. Inattention may look like low motivation, high overwhelm, and disorganization.

Given these statistics and presentations, many girls are likely to grow up without a diagnosis or treatment, which can lead to long-term health and social issues. It may also be why more women are starting to get diagnoses in midlife. Adult women may have more awareness around their symptoms. As they become educated about ADHD, they may take the initiative to seek support instead of waiting for a practitioner to pick up on it.

It’s important to note that our culture reacts differently to girls/women with ADHD. Because of different social standards, boys may be more likely to receive a referral for support with their behavioral issues. At the same time, girls are more likely to adopt coping mechanisms to mask or compensate for their behavior.

Further, hormonal changes may exacerbate ADHD symptoms during the menstrual cycle, pregnancy, and perimenopause/menopause, which can make navigating midlife changes more challenging.

ADHD and Perimenopause Connection

The brain runs on estrogen, and fluctuations in its levels impact brain function. Drops in estrogen may be an ADHD trigger. One study in college-age women with ADHD showed symptoms were worse around ovulation (when estrogen spikes and then drops) and pre-period, when estrogen and progesterone decline.

Perimenopause is another time of rapid hormonal change. As estrogen declines in late perimenopause and menopause, brain-related symptoms are common. And, as we’ve discussed, ADHD symptoms may flare or increase. Some women will even be diagnosed with ADHD for the first time during this period.

Some possible shared symptoms between ADHD and perimenopause include:

• Irritability
• Mood swings
• Sleep disruptions
• Brain fog
• Difficulty concentrating
• Mental fatigue
• Difficulty multitasking
• Problems with short-term memory
• Problems with word recall
• Decreased stress tolerance
• Overwhelm

The bottom line is that we can’t overlook the hormonal role in brain symptoms; whether you have ADHD or not, you deserve care and support in perimenopause.

Work with a Skilled, Integrative Practitioner

From an integrative perspective, we treat the individual woman, not the diagnosis. Just as there isn’t a universal perimenopause plan, there isn’t a one-size-fits-all treatment for ADHD. And if you happen to have ADHD during perimenopause, it’s a good time to revisit your management plan and add additional support if needed. By supporting hormonal health in perimenopause (with bioidentical hormone therapy and other integrative tools), you may help calm your symptoms.

The primary Western medicine tools for ADHD are behavioral therapy and medications to address dopamine and norepinephrine neurotransmitters. At TārāMD, our holistic approach extends beyond these tools and considers genetics, the environment, lifestyle, and root causes such as nutrient deficiencies or toxin exposures. While we discuss your ADHD treatment, we also provide comprehensive perimenopausal care.

Your personalized plan may include:

• Mind-body techniques
• Stress management strategies
• Sleep support
• Movement
• Detoxification
• Methylation support
• Gut health protocols

You’ll also work with the TārāMD Nutrition team to lay a solid nutrition foundation. Research suggests that a nutritious dietary pattern helps to ease ADHD symptoms, and this is what we’ve seen in practice as well. What you eat influences gut health and the gut-brain axis, supports hormonal balance, and provides critical brain nutrients. Here are some examples of nutrition interventions that may help:

• Optimizing tyrosine (an amino acid from protein) and vitamin B6 helps the body produce sufficient dopamine.
• Choosing whole foods in place of processed foods and sugars helps balance blood sugar, feed the gut microbiome, and increase nutrient density.
• Ensuring balanced minerals, including magnesium, iron, zinc, and copper. Imbalances or deficiencies are common in ADHD. Research suggests that low magnesium status alone may contribute to ADHD symptoms.
• Optimizing vitamin D and omega-3 fats in the diet (or through supplements) to support brain health.
• The list goes on!

Women are undertreated for ADHD and perimenopause and often find their concerns brushed aside, especially as they get older. So, instead they live with the challenging brain symptoms, finding ways to cope or hide what they’re going through. That’s unacceptable.

You deserve personalized healthcare from a team that listens and believes what you say. We can help you uncover what’s going on and what’s driving your symptoms to create a personalized plan for ADHD, perimenopause, or both. If you’re ready for integrative care, please reach out today.

References:

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