How peri meno pause / meno pause affects females with adhd
jebkinnisonforum.com/post/46931/ADHD and ADD in females and the influence of hormones - before puberty, as a teenager, the first menstraution, childbirth, pre meno pause - menopause. (Lotta Borg Skoglund from Karolinska Institute)
"We overlook girls with ADHD because we look for symptoms that are common in boys. Girls and young women lose the opportunity to receive effective treatment because most studies of drugs and dosages have been conducted on boys and men. Both biological differences and a society that still has different social and cultural expectations for girls and boys, women and men, contribute to this.
Women's hormonal fluctuations and ADHD / ADD
ADHD symptoms do not exist in a vacuum and this is especially true for women. Unfortunately, there is not much knowledge and research on how hormonal fluctuations affect ADHD. And we know even less about how the body's own hormones can be affected by or even affect a treatment with medication. But there are exciting experiments and theories that can help us understand more about what many girls and women with ADHD describe.
Animal studies have shown that estrogen stimulates the brain's dopamine cells and is important for the production of dopamine. Natural fluctuations in the female sex hormones estrogen and progesterone during the menstrual cycle affect several of the areas of the brain involved in making decisions, in social skills and in being able to control emotions. That is, many of the features that people with ADHD have difficulty with.
The effect of stimulant drugs also seems to be affected by sex hormones, and studies suggest that the effect may be different / more pronounced in the first part of the menstrual cycle (follicular phase). Where estrogen levels rise and progesterone levels are still low compared to the last part of the cycle where the effect of estrogen is attenuated by rising progesterone levels.
Unfortunately, no major studies have examined whether ADHD symptoms vary with the hormonal fluctuations, nor anyone looking at a possible need to adjust medication or doses accordingly. Eg. it may even be the case that some women with ADHD would get better from medications that even out hormone levels during the menstrual cycle.
Thus, a large gap in our knowledge is about how natural hormonal fluctuations can change and in some cases exacerbate the underlying ADHD symptoms.
Case: A and the recurring aggressions
A was diagnosed with ADHD already in primary school. It was very unusual for girls to be diagnosed with what was then called ADHD, but A had many of the symptoms of hyperactivity and impulsivity that are usually more common among boys at the group level.
It took many years before A put two and two together and began to see a pattern in here relationships. After another failed love affair, she received a tip from a friend about downloading a 'menstrual cycle app'. A pattern of recurring periods of extra low self-esteem and pessimism, discomfort with body contact, particularly high sensitivity to impressions and an aggression that was very easily aroused, appeared one to two weeks before she was going to have her period.
The certainty that it is actually about biological phenomena has in itself helped her not to panic and impulsively make quick decisions
In hindsight, A can easily identify several relationships that were interrupted during periods when she was negatively affected. Quarrels that she bitterly regretted, and relationships that she could not save and afterwards mourned for several years. It has by no means become easier over the years, quite the contrary. At the age of twenty, it could be a few days before menstruation.
Now that she's forty-plus, it's more than two weeks, that's more than half the month.
Her ADHD symptoms are intensifying and the defense mechanisms and strategies she has developed are not adequate these weeks. For A, the solution was to keep track of her cycle using a menstrual app and, together with her doctor, tailor a treatment plan in which she adjusts her ADHD medication to the different phases of her menstrual cycle.
The certainty that it is actually about biological phenomena has in itself helped her not to panic and impulsively make quick decisions that in the long run lead to unwanted consequences, during the periods when she is more vulnerable."
www.partnersinstories.se/lottaborgskoglundADHD: THE JOURNEY FROM GOOD GIRL TO BURNT OUT WOMAN.
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Women with ADHD in Menopause
Let us take a closer look at the subject of women, ADHD and menopause. And explore how these aspects bring new challenges to women’s lives and some potential perks.
What is Menopause?
First things first, since the topic of menopause has been neglected for too long, let us deep dive into what it is.
Perimenopause is the transitional period leading up to menopause and may last between 4 to 10 years. This is when hormonal fluctuations start to cause physical and psychological changes. Maybe your PMS symptoms have increased and you’ve found yourself in a mental rollercoaster? Or are you surprised by the sudden sweat running down your back during an important meeting at work?
The formal definition of menopause is when a woman hasn’t menstruated for 12 months. However, it will have much more effects on a woman’s life than the fact that she does not menstruate anymore.
Menopause is a state of minimal estrogen levels and no progesterone at all. Since the ovaries produce not only estrogen and progesterone but also testosterone, this hormone will also decrease when the ovaries become inactive.
Today, when we live longer than ever before, menopause can make up to as much as one-third of a female’s life. Quite a significant part of a woman’s life!
When should I expect Menopause?
The average age for menopause is around 51 years of age.
However, between 5 to 10 % of all women enter menopause between the ages of 40 and 45 (early menopause). And 1 to 2% experience premature menopause, entering menopause before age 40 (premature menopause).
If you wonder at what age you should expect menopause, the best person to ask is your mother! That is because hormones are affected by heritable factors. So, have a chat with your female relatives to get an idea about menopause and other hormonally influenced events in life.
Menopausal Symptoms – what to be on the lookout for?
Menopause may bring about significant changes in life, not only physically but also psychologically. Let us explore the common symptoms and challenges women can face during this natural and inevitable state.
The physical symptoms may be the easiest to recognize. Most have probably heard about the hot flushes ranging from
“the feeling a little bit warmer now and then to flooding hot and cold sweats”.
These flushes are often most intense leading up to menopause and will affect sleep quality, productivity, mood and quality of life. Less known but equally important are other symptoms such as loss of hair, dryness of mucous, changes in the breasts and even joint stiffness.
The psychological symptoms may operate more undercover. Hormones affect much of how women behave and feel, so it is not a surprise to undergo some challenges. During early menopause, many may experience cognitive changes that might include forgetfulness, many times referred to as “brain fog”, difficulties completing complex tasks, as well as a shortened attention span.
Living with ADHD and having already struggled with many of these symptoms since childhood, you may get concerned that the worsening of these symptoms could be signs of dementia.
A worry that needs to be taken seriously, due to the fact that persons with ADHD have a higher risk of dementia. However, you probably can rest assured, because what you are experiencing could just as well be signs of menopause.
Emotional regulation, verbal abilities and overall executive functions are other challenges that the perimenopausal brain might face. Together with a higher risk of developing depression and anxiety. Particularly if you have a history of these conditions, but even if you never have suffered from it before.
Hang in there – potential positive post-menopausal perks!
Even if the menopausal transition might feel overwhelming, can the end of the fluctuating hormones bring some positive aspects too?
Yes, we think so! Because, following menopause you will experience freedom from menstrual issues, and many women report increased confidence, and a chance to focus on personal and professional goals. So it’s not all bad.
Menopause and ADHD medication
Ever wondered about ADHD medication and menopause?
There is limited research on how ADHD medication affects menopause, especially for women over 50. Some women may need to adjust their medication based on possible menopausal symptoms. Nonetheless, few women get this opportunity due to a lack of evidence-based guidance.
Studies hint that ADHD medication may have a positive effect on mental menopausal symptoms in women without ADHD. Yet, there is no evidence how this works for women with ADHD. Room for growth here!
Who is Menopausal Hormone Therapy for?
Guidelines around Menopausal Hormone Therapy (MHT) have changed over the years. Once used routinely, the treatment was halted due to large clinical trials indicating health risks. Now paired with new knowledge, the use of MHT is rising again.
Menopausal Hormone Therapy (MHT) is not all good or bad. Individual factors must be considered by you and your doctor before deciding it is the way for you.
MHT might be worth considering if you are healthy and experience for example; hot flushes or cognitive symptoms, dry mucosa, increased risk for fractures, early menopause or estrogen deficiency. And also, if you have an increased risk of heart disease, stroke or dementia.
Are there any risks?
When the largest clinical trial of MHT was first analyzed, it was initially interpreted as hormone replacement therapy with oral estrogen and progestin increased the risk of heart disease and stroke, blood clots and breast cancer.
However, when reviewing the data refining the analyses researchers could show that the benefits outweigh the risks if:
You start MHT before the age of 60 or within 10 years of menopause.
Estrogen is given in low dose and together with a local progestin to protect the uterus.
You have a family history without cancer, heart disease, stroke, blood clots, and osteoporosis.
Other treatment options
Hormonal treatment is far from the only treatment for ADHD. Many, other types of behavioral interventions could also help women through perimenopause.
All methods that have proven effective build on some measure of cognitive behavioral therapy (CBT), where the goal is to find strategies to support, for example sleep quality and regular physical activity.
A cousin of CBT is dialectical behavioral therapy (DBT) focusing on improving emotional regulation and decreasing consequences of, for example mood swings.
Mindfulness, as part of CBT or DBT practices have for some women shown to relieve menopausal symptoms too.
Lifestyle changes and healthy habits are perhaps the most important of all. Including a balanced diet, regular exercise, good sleep and stress reduction. They do require effort and consistency, which might be tricky with ADHD, but not impossible!
Which way is best for me?
Before taking further action, talk to your doctor about your symptoms, risks and benefits going into perimenopause. As we continuously learn more about MHT and optional treatments, recommendations may change.
So always make sure to check in and review treatment options with your doctor regularly!
Do you want to learn more or want to share your reflections?
Sign-up for the Letterlife app to get more insights and share your thoughts with the Letterlife community.
Letterlife here for you on your ADHD journey!
Lotta Borg Skoglund MD PhD
Co-Founder Letterlife
