Are you a woman or an individual who was assigned female at birth? Are you in your 30’s, 40’s or 50’s and have suddenly noticed worrisome changes in your memory or attention? Are you doing things that you rarely did before, like losing your keys, forgetting things, struggling to finish tasks, etc.?
This can be a troubling experience. Some of you may be wondering, even, about whether these are early signs of dementia. Others of you may be correctly chalking these experiences up to normal hormonal changes related to perimenopause or menopause.
One thing that you may not have considered is ADHD. After all, you have coped extremely well your whole life and did not need medication to do so, right? How could it be ADHD?
ADHD and neurochemistry: A quick introduction
ADHD is associated with a deficiency of the excitatory neurotransmitter dopamine in the brain’s reward centers (or, technically, too much reuptake of dopamine, i.e. dopamine being reabsorbed into cells faster than is optimal). Not enough of it here makes ordinary activities out there less intrinsically rewarding. Teeth brushing, for example. It makes us less motivated to sustain effort towards long-term goals and makes us more likely to engage in both compulsive and impulsive behaviors (to get that surge of dopamine, understandably). Low dopamine in the prefrontal cortex also impairs attention, organization and planning, emotion regulation and inhibition, among other so-called executive functions. Cue Robin Williams: “It’s not your fault. It’s not your fault.”
GABA (gamma-aminobutyric acid) is an inhibitory neurotransmitter. It acts to calm down various centers in the brain associated with movement, mood, and anxiety. You guessed it: ADHD is also associated with lower levels of GABA. This contributes to restlessness, impulsivity, difficulty controlling attention (and by extension, working memory), emotional lability and anxiety, plus some surprising ones like sensory issues (which is a common concern shared by individuals being assessed for ADHD, while not reflected in the DSM’s diagnostic criteria). Mind racing, or feel like you’re being driven by a motor? Maybe low GABA.
So, what does all this have to do with perimenopause?
Estrogen and progesterone are both critical steroid hormones affecting reproduction in women and individuals assigned female at birth (AFAB). Estrogen and dopamine have a strong synergistic relationship. Estrogen increases dopamine synthesis and activity in synapses and receptor sites by slowing reuptake. Likewise, progesterone and GABA work together. Progesterone is metabolized into allopregnanolone, which makes GABA more effective at calming us down. Here’s the crux of it: Anytime these hormones dip significantly, ADHD symptoms get louder.
“Here’s the crux of it: Anytime these hormones dip significantly, ADHD symptoms get louder.”
Perimenopause
During perimenopause (the two to twelve years before your periods stop) huge hormonal changes are occurring. Again, to oversimplify, the onset of perimenopause brings first a rapid decline in progesterone levels followed by high and drastically fluctuating estrogen levels until menopause (i.e. the complete cessation of menstruation). For a comprehensive and highly accessible read, see Lara Briden’s Hormone Repair Manual. Early perimenopause commonly brings anxiety; while the later stages can bring about memory loss, brain fog, confusion, forgetfulness, among many other symptoms. Many people with previously undiagnosed ADHD feel as though they’ve reached an impasse. The ADHD symptoms they’ve lived with their whole lives start to become unmanageable. Clever adaptations like flying under the radar, developing systems upon systems for staying organized, or burning the midnight oil to meet a deadline, start to break down.
“Many people with previously undiagnosed ADHD feel as though they’ve reached an impasse. The symptoms they’ve lived with their whole lives start to become unmanageable.”
In short, women and other individuals with female hormones across life stages can experience drastic changes in their functioning and wellbeing due to fluctuations in brain chemistry.
There is a dearth of research into how hormone replacement therapy affects ADHD symptomology, much less how men and individuals assigned female at birth with ADHD experience fluctuations. However, a foundational understanding of how hormones interact with ADHD symptoms can inform important conversations with our healthcare providers.
ADHD assessment can help answer long asked questions, provide clarity and a roadmap for going forward including lifestyle changes, pharmacological and non-pharmacological interventions, and provide an often long overdue starting place for cultivating self-compassion. And if you are looking for support in putting the roadmap and recommendations into concrete practice, consider ADHD coaching. Your coach can be effectively your second brain to compensate for areas of weakness and shine a light on –and build upon– your doubtless areas of remaining strength.
