Living at the Intersection of ADHD and Perimenopause
Perimenopause ended my life.
At least the life I had been living until perimenopause hit.
I wasn’t ready for it.
I didn’t even know it was a thing.
What is Perimenopause?
Perimenopause is a life stage, just like puberty. And just as puberty was the stage between childhood and your reproductive age (adulthood), perimenopause is the stage between your reproductive age and your post-reproductive age (oldish age).
Perimenopause usually starts in the mid forties and lasts until menopause which is actually a moment in time. When you haven’t had a period for a full 12 months, you have hit menopause. And every day after that you are post-menopause.
Estrogen is best known as the female sex hormone. You may not know this, but estrogen also regulates most things in your body, including brain function, cholesterol levels, bone and muscle mass, circulation, your metabolism and collagen production (for your skin).
Estrogen is also responsible for perimenopause.
During perimenopause, estrogen levels begin to drop from their stable levels during the reproductive years, beginning the long inexorable decline into old age, where women end up with about 10% of their adult estrogen levels. Estrogen levels don’t drop smoothly. Rather they bounce around, up and down and it is this variability (not the absolute levels) that triggers disruptive perimenopause symptoms.
The top 6 perimenopause symptoms are:
1. Irregular periods
2. Hot flashes and night sweats
3. Insomnia and sleep difficulties
4. Vaginal dryness
5. Bladder issues
6. Mood changes and mood swings
There are over 35 other symptoms as well. Some not too bad, some devastating. Some resolve some don’t. For example, mood swings, joint pain, migraines, and anxiety will likely resolve on their own. Other symptoms, like skin changes, hot flashes (less frequent but can still hit into your 80s), and vaginal dryness will continue into your older years.
Which, if any, symptoms you experience is a guessing game. So is knowing how bad your symptoms will be. For example, you may have one hot flash a week, or you may have 20 hot flashes a day.
Getting Help Didn’t Happen
Trying to get help from my doctor was a challenge. I had the occasional hot flash, but my really bad symptoms were brain fog, concentration problems, anxiety, depression, tearfulness, irritability, rage, and constantly feeling overwhelmed and exhausted. Hormone therapy was never discussed. Nor was there any discussion about anything else that could be going on.
In my gut, though, I started to connect experiences from my life with these huge disruptive symptoms I was feeling.
I’ve always known something was off but I didn’t fit the mold for anything obvious, I was just super sensitive, cried a lot, talked a lot and couldn’t sit in one position for too long. I was a day-dreaming, bookworm of a girl. Who quietly bounced from interest to interest, hobby to hobby because boredom would set in and I’d need to switch it up. As I grew, I bounced from job to job, degree to degree, relationship to relationship.
No surprise (in retrospect) I had myself a severe case of ADHD.
Like hundreds of thousands, if not millions, of other women living with ADHD, I lived through most of my adult years believing that I was crazy, a loser, broken, worthless, and useless. All these feelings were strong inside but hidden from the world – where I appeared to be a dynamic overachiever with some interesting ‘quirks’. Like taking 20 minutes to tell a 2 minute story. Like crying every time I saw roadkill or imagined animals suffering.
What is ADHD?
ADHD. Attention deficit hyperactivity disorder. Talk about a misnomer. The formal symptoms are hyperactivity-impulsivity and inattention. Anyone familiar with ADHD knows that there is also a huge emotional component – emotional dysregulation – seen in over 80% of people with ADHD (men too!!). Emotions are too big, too reactive, too intense.
ADHD happens when the connections inside your brain don’t work the same way as connections in a typical brain. And that is key, because people with ADHD don’t fit the mold. They still get things done. They’re smart. They’re totally capable. But the way they naturally think and act doesn’t align with the typical way people think and act.
Neural networks (networks of nerve cells) relay information throughout your nervous system. And in order for the information to move from one nerve cell to another on the message’s pathway, you need neurotransmitters.
Neurotransmitters are like a shuttle service. They physically carry a message (in the form of an electric pulse) from one neuron (nerve cell) to another. Different neurotransmitters move different types of messages. The key neurotransmitters involved in ADHD are dopamine (the happiness molecule), serotonin (the mood stabilizer) and norepinephrine (the fight or flight molecule) that impacts alertness, attention and focus.
Essentially, if you have ADHD there aren’t enough of these key neurotransmitters, so the messages they are sending don’t make it to their destination. Think of stamps and Christmas cards. If you don’t have enough stamps, you can’t send all your cards and only some of the cards will get through to their destination until you get more stamps.
ADHD and Perimenopause
ADHD and estrogen are very tightly linked. Because amongst all its other jobs, estrogen also regulates the production of dopamine, norepinephrine, and serotonin.
Yes. That is correct. Estrogen, the same molecule that drives perimenopause, also impacts your ADHD. So as estrogen levels go down in perimenopause, so do the number of neurotransmitters that are made by the actions of estrogen. The lower your estrogen the worse your ADHD.
There is significant overlap in symptoms between perimenopause and ADHD.
What does it all mean?
It means you don’t want to be a perimenopausal woman with ADHD.
In all seriousness though, it means hard times. And in hard times, the most important thing you can do is grow your resilience, and find ways to care for yourself.
I spend time in nature – hiking, skiing, even just driving in the mountains. There are lots of green urban spaces as well, where I walk my pups, especially when I’m feeling overwhelmed.
Meditation has been interesting. I can now sit for about 10 minutes without wanting to scream myself out of my chair, but it’s progress. I’m nowhere near floating in the potentially mythical timeless space, but it is calming. I practice breathing – which conveniently, I already know how to do, and then when I get upset or irritable, I can take some deep breaths. And it helps.
Self-kindness, positive self-talk, self-compassion – all of these are critical. Anytime I get sucked into an ADHD symptom (like procrastinating), everything becomes better if I’m gentle with myself and remind myself that I’m doing my best, I’m progressing, and I’m allowed to make mistakes. And I remind myself I’ll get it next time.
I don’t want anyone to suffer like I have. It’s my mission to help other women who have ADHD or suspect they might have it. And if those other women are in perimenopause, I hope you have supportive friends and family and a healthcare professional that can connect the dots and help you.
All my best wishes,
Dr. Jenna