Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by symptoms of inattention, hyperactivity, and impulsivity. While traditionally associated with children, ADHD is increasingly recognised as a condition that persists into adulthood, affecting many women throughout their lives. Perimenopause—the transitional period before menopause—brings its own set of hormonal changes and challenges, which can exacerbate or alter the presentation of ADHD symptoms. The interplay between ADHD and perimenopause is complex, encompassing physiological, psychological, and social challenges.
ADHD, PERIMENOPAUSE & BEYOND
ADHD tends to manifest in three ways: inattentive, hyperactive-impulsive, and combined presentations. Symptoms include difficulties with focus, organisation, time management, impulsivity, and restlessness. These symptoms can lead to significant impairments in daily functioning, impacting professional, academic, and personal lives. For women, ADHD often goes undiagnosed until adulthood, partly because symptoms can be subtler and are sometimes attributed to personality traits or life stressors.
Symptoms Common Among Women with ADHD Include:
-
Difficulty sustaining attention, forgetfulness, procrastination, trouble following instructions
- Restlessness, fidgeting, impulsivity, interrupting others, difficulty waiting, excessive talking
- Mood swings, sensitivity to stress, low self-esteem, emotional reactivity, chronic fatigue
- Relationship difficulties, workplace struggles, health issues
Perimenopause is marked by fluctuations in estrogen and progesterone levels, leading to a host of physical and emotional symptoms, including:
- Hot flashes
- Night sweats
- Mood swings
- Cognitive changes
These hormonal fluctuations can last for many years, typically occurring in women between their early to mid-40s and early 50s. The decline in estrogen levels, in particular, is significant because estrogen is thought to have a protective effect on the brain, influencing neurotransmitter systems that regulate mood and cognition. Cognitive change, which is a normal challenge during perimenopause, can pose an extra difficulty for women with ADHD and perimenopause.
Changing Symptoms
Women with ADHD often report difficulties with “executive functions.” During perimenopause, cognitive functions can be further compromised due to a decline in estrogen levels. The combined effects of ADHD and hormonal changes can lead to pronounced memory lapses, decreased concentration, and increased distractibility—impacting women’s day-to-day lives, work function, relationships, and mental health.
Perimenopause can worsen symptoms of emotional dysregulation that are common in women with ADHD, including mood swings, irritability, and heightened emotions. Due to fluctuating hormone levels, this can lead to increased anxiety, depression, and worsening emotional instability, where women may find it more challenging to manage stress and may experience more frequent and intense mood swings.
On their own, both ADHD and perimenopause can cause sleep disturbances, resulting in decreased levels of restful sleep. ADHD often leads to difficulties in falling asleep and maintaining sleep, while perimenopause is often associated with night sweats and poor-quality sleep. The interplay between these conditions can cause significant sleep deprivation, further impairing cognitive function and emotional well-being.
COPING STRATEGIES & TREATMENT OPTIONS
Working alone or with a qualified health professional to make changes in day-to-day habits, balance your diet, or add in daily movement can significantly improve the quality of life for many women with either ADHD, perimenopause, or a combination of the two.
Changes You Can Start Now
- Include regular physical activity. As per Health Canada guidelines, aim for 150 min (or approx. 30 minutes, 5 times weekly) of movement per week.
- It’s also recommended to add in 2–3 sessions of strength training (body weight, dumbbells, barbells, or bands) each week
- Maintain adequate hydration (i.e., drink more water than coffee).
- Focus on getting high-quality sleep by practicing good sleep hygiene and allotting sufficient time for it and associated routines.
- Include daily mindfulness practices, such as meditation and yoga, which enhance emotional regulation and reduce stress.
- Try Cognitive Behavioural Therapy (CBT) to address the cognitive and emotional challenges of ADHD. CBT can provide strategies for organisation, time management, and coping with negative thought patterns.
NUTRITION
Nutrition plays a crucial role in managing ADHD symptoms. While no diet can “cure” ADHD, certain dietary patterns and nutrients may help improve attention, focus, and behaviour. A balanced diet that includes a variety of nutrients is essential for brain health and overall well-being. Emphasising whole foods over processed foods can provide the necessary vitamins and minerals for optimal brain function.
- Complex carbohydrates such as brown rice, quinoa, and whole grains provide sustained energy and support stable blood sugar levels, which can help maintain focus.
- Lean proteins such as chicken, turkey, fish, beans, and legumes are important for neurotransmitter production, supporting attention and cognitive function.
- Fruits and vegetables are rich in vitamins, minerals, and antioxidants to support brain health and reduce inflammation.
- Healthy fats, including omega-3 fatty acids found in fish, flaxseeds, chia seeds, and walnuts are particularly beneficial for brain health and can improve impulsiveness.
MEDICATION & SUPPLEMENTATION
For many women, medication and/or supplementation remains an important piece of ADHD treatment. Various pharmaceutical medications and supplements can help manage symptoms associated with this condition; however, during perimenopause, it’s crucial to monitor and adjust medication dosages as symptoms ebb and flow.
HORMONE REPLACEMENT THERAPY (HRT)
Some women may benefit from HRT to alleviate perimenopausal symptoms. Estrogen replacement can help stabilise mood and improve cognitive function, while progesterone therapy can improve sleep and night sweats. HRT, however, is not suitable for everyone and should be considered on an individual basis with the support of qualified medical professionals to weigh the benefits against potential risks.
You don't need a formal diagnosis to start making positive changes that can support symptoms of ADHD and perimenopause. By adopting healthier lifestyle habits—such as incorporating a balanced diet rich in nutrients that support brain health, engaging in regular physical activity, and practicing mindfulness techniques like meditation or yoga—you can improve your overall well-being. These changes can help enhance focus, stabilise mood, and reduce stress.
Building and maintaining a strong support network is essential. This can include family, friends, support groups, and professionals. Sharing experiences with others who understand the challenges of ADHD and perimenopause can provide emotional support and practical advice to help you succeed in challenging times.
The interplay between ADHD and perimenopause is complex, affecting cognitive, emotional, and physical well-being. Recognising and addressing the unique challenges faced by women during this transitional period is essential for improving their quality of life. Through a combination of medication/supplementation, lifestyle modifications, therapy, and support, women can navigate the dual challenges of ADHD and perimenopause with confidence.
