Health Update: Health Update: Is it ADHD or menopause? – What Experts Say– What Experts Say.
Menopause care is lacking, leading to delays in care experts say
Dr. Stephanie Faubion of the Menopause Society says medical schools need better menopause training to prevent misdiagnosis and improve patient care.
First Grace Presley would occassionally forget why she walked into a room. Then she lost her thoughts mid sentence. Simple tasks like unloading the dishwasher seemed impossible to start.
The 39-year-old had always been able to balance things including raising her teenager and a new baby. She began perimenopause in the past year and started hormone replacement therapy, but this was beyond the brain fog that came with it.
One afternoon she walked back into her house after finishing a project in her garage and realized she’d left the kitchen sink faucet running, the refrigerator door open and water boiling on the stove.
“I thought I was losing my mind,” says Presley, a nurse and program coordinator in St. Louis. “I’ve always been a perfectionist. When you hit perimenopause, it removes that mask that allows you to cope. Now you’ve got a family, you manage a household and everything just breaks down.”
She met with a therapist who told her what more women are hearing in midlife: She had ADHD.
The number of women aged 30 to 49 diagnosed with ADHD almost doubled from 2020 to 2022, according to a 2023 Epic Research Study. This doesn’t mean women are experiencing a sudden onset of ADHD.
Instead, perimenopause often reveals ADHD or exacerbates its symptoms.
“Many women lived with ADHD for years and didn’t know it. They learned to cope and did well,” says Sasha Hamdani, a psychiatrist who practices near Kansas City, Kansas. “And then perimenopause happened. It changes everything and your ability to cope is gone. It feels like everything is falling apart.”
Is it menopause or ADHD?
Many of Hamdani’s patients come to her with a simple question: Is this menopause? Or do I have ADHD?
It’s the same question that Dawn Mandeville, an Atlanta obstetrician and gynecologist, hears from her patients.
“She will tell me that she can’t think anymore. She used to be smart. She can’t remember names. She feels like she’s stupid,” says Mandeville, who hosts Menopause and Mocktails events to help educate women. “The question that comes – do I have ADHD, am I developing dementia? Or is this just menopause?”
Most of these women hitting menopause now weren’t diagnosed with ADHD as children. That’s because when they were young, ADHD was thought to have afflicted only boys. Girls’ symptoms often present differently – sometimes with anxiety, emotional dysregulation or disorganization rather than an inability to focus. They adopted coping skills.
But when perimenopause or menopause hits, the drop in estrogen can remove their ability to use their coping methods. Estrogen helps regulate dopamine, a neurotransmitter that plays a role in executive function and focus. When estrogen drops, that help is reduced and can lead to problems focusing.
And with fluctuations in hormones, ADHD symptoms can also fluctuate.
“I have to explain to women that menopause doesn’t cause ADHD,” says Mandi Dixon, a therapist who specializes in menopause in Dallas. “But for women who’ve had ADHD their whole lives, it can remove that hormonal cushion that helped them cope. Or if they have ADHD, it can get even worse.”
Depending on the severity of their ADHD and the ways they adapted their life to manage it, the sudden drop in estrogen left them unable to cope.
Some symptoms of perimenopause are similar to ADHD symptoms. When a patient has had symptoms for years and they worsened during perimenopause, it’s likely they have ADHD, Dixon says.
“People called me too sensitive”
Hamdani says new ways of screening women are helping to better diagnose ADHD. Now she wants to help some midlife women reframe ADHD.
“It’s not a failure,” says Hamdani, whose book “Too Sensitive” will be published this fall. “We need to reframe it as a neurological phenomena.”
For Julie Murillas, better understanding her ADHD was a relief.
“For my entire life I thought something was wrong with me,” says Murillas, 49. “I got overwhelmed. People called me too sensitive.”
She had been diagnosed with ADHD in college but it wasn’t until she went to graduate school at 42 while working full time that her symptoms escalated. It was the same time perimenopause began.
She forgot words and details. She struggled to read for more than 15 minutes. She procrastinated projects.
“I didn’t know that my ADHD could get worse,” says Murillas, who now is a therapist in Houston. “There was a lot of grief that came with it.”
She started hormone therapy as well as medication for her anxiety and ADHD.
How to treat ADHD in menopause
Mandeville says many of her patients improve with hormone replacement therapy. She sends some to a psychiatrist for ADHD evaluation.
The majority of Hamdani’s patients are diagnosed with ADHD during perimenopause. Some need therapy. Others need medication to manage their anxiety or other symptoms.
Stimulant use among men and women in midlife increased “substantially” from 2020 to 2021, the Centers for Disease Control reports. One of the largest increases was in women ages 50 to 54, according to the CDC.
For Presley, getting diagnosed with ADHD and starting medication has improved her life.
“As women and moms, we are taught to just suck it up and just keep on managing the way you previously have. But you can’t,” she says. “When I started the medication, it was like my brain was quiet for the first time ever. I was able to focus on one task and complete it. It’s a relief to not be in my head all of the time.”
Laura Trujillo is a national columnist focusing on health and wellness. She is the author of “Stepping Back from the Ledge: A Daughter’s Search for Truth and Renewal,” and can be reached at ltrujillo@usatoday.com.