ADHD Weekly 2017-08-17

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You may have experienced one or more of the normal transitions in hormonal levels during adulthood that can affect ADHD symptoms in women: pregnancy, perimenopause, and menopause. During pregnancy, women can experience significant improvement to their ADHD symptoms as levels of estrogen increase. Later, during perimenopause and menopause, estrogen levels decline and can lead to ADHD symptoms becoming more severe.

What can you expect at each stage of life? What steps can you take to more effectively manage your symptoms during these life changes? It varies for each woman, but here are some common experiences and a few strategies to help.

ADHD during pregnancy

Estrogen levels rise during pregnancy to help your baby develop and enable a full-term pregnancy. For women affected by ADHD, this can cause a marked improvement in ADHD symptoms that may continue through breastfeeding. 

However, up to 25 percent of women experience postpartum depression within six months of giving birth. In the weeks after childbirth, estrogen levels drop to 1/100 to 1/1000 of the high during pregnancy, which decreases dopamine levels and causes mood swings.  

Women affected by ADHD may also be at higher risk of postpartum depression because they are more likely to have a co-occurring condition, such as anxiety and depression, before becoming pregnant. Be proactive—discuss your ADHD symptoms, and any changes in symptoms, along with changes in mood and feelings of happiness and sadness with your healthcare provider before you give birth or end breastfeeding. 

Menopause, before and after

Perimenopause occurs in the years leading up to menopause. It may take a few months or 10 years, though the average amount of time is four years. During this time, your estrogen levels decline until your ovaries stop releasing eggs. Menopause occurs when you haven’t had a period for 12 months.

Dropping estrogen levels include a drop in dopamine levels, which are already low in the brain affected by ADHD. Although there are several symptoms associated with perimenopause and menopause, two in particular are common for women affected by ADHD: changes in mood, primarily depression and anxiety, and increased inattention. 

“I have found [estrogen] to be a very critical, but often overlooked area in treating women with ADHD,” says Patricia Quinn, MD, a developmental pediatrician specializing in the issues confronting women and girls with ADHD. “I often hear from women who report that as they enter perimenopause and the ‘flashes’ begin, they have more problems with their ADHD symptoms or that their stimulant medication does not seem to be working as well as it did previously.” 

Educate and anticipate

For any of these life changes, you can gain the upper hand by tracking your daily symptoms related to your menstrual cycle. Include both physical changes and mental or emotional swings. What do you notice about your ADHD symptoms? Are they typical for you, or have they changed in some way? After a few months of tracking your symptoms, you will begin to see patterns. You may have a change in symptoms at the same time each month. Or, you may notice your cycle has changed—rather than being its normal 28 days, now could be 25 days or 32 days in length.

By keeping a journal of your ADHD symptoms, you can anticipate when you are likely to have issues—with a drop in estrogen following pregnancy and breastfeeding, and during perimenopause and menopause. When you notice that your symptoms are increasing, you and your doctor can take steps to modify your treatment approach. 

Learning to take care of yourself

Self care is crucial during hormonal transitions. Work with your healthcare provider if stimulant medication is part of your treatment plan to determine the right dose for your changing symptoms. In addition, eating well, getting exercise, and stress reduction techniques are three keys to helping you more effectively manage your symptoms. 

• A healthy and balanced diet is helpful for managing ADHD symptoms, and can affect your hormones. For more information on the relationship of diet and hormones, check out Healthline and Hormones & Balance. 
• Exercise can be an important addition to your treatment plan. It can help improve cognitive functions, improve how well you sleep, and enhance self-esteem, all of which are affected during menopause. For ideas about starting, and staying with, an exercise plan, read Fitness & Your Brain: How to Start and Stick with Exercise from Attention magazine.  
• Mindfulness training can help improve awareness of the present moment, and allow you to shift from the multiple thoughts that typically bombard someone affected by ADHD. It can help you let go of self-judgment—that inner voice that pops in with criticism.
• Cognitive-behavioral therapy for ADHD is focused on changing behaviors to overcome impairments. Positive outcomes include greater self-control and higher self-esteem, both negatively impacted during hormonal fluctuations. 

Growing older with ADHD

Hormonal shifts associated with pregnancy, perimenopause, and menopause affect neurotransmitters in the brains of women with ADHD. By taking steps to better understand your unique symptoms and hormonal changes, you can adapt your treatment plan to more effectively manage your symptoms. Work with your healthcare provider to determine the best approach and strategies for you.

Resources for Women:

• In Part One of this series, we learned that women and girls are less likely to be diagnosed with ADHD because the guidelines used to assess individuals were created based on research on boys. In Part Two, we learned about the effect of puberty and menstrual cycles on ADHD symptoms. 
• Understanding Women with ADHD, Kathleen Nadeau, PhD and Patricia Quinn, MD
• Gender Issues and ADHD: Research, Diagnosis and Treatment, Patricia Quinn, MD and Kathleen Nadeau, PhD. You find this through your local library or favorite bookstore.
• Survival Tips for Women with AD/HD: Beyond Piles, Palms, & Post-its, Terry Matlen, MSW, ACSW
• The Queen of Distraction: How Women with ADHD Can Conquer Chaos, Find Focus, and Get More Done, Terry Matlen, MSW, ACSW
• Women with Attention Deficit Disorder: Embrace Your Differences and Embrace Your Life, Sari Solden

How have your ADHD symptoms changes through the stages of pregnancy, perimenopause or menopause? What suggestions do you have that could help other women?

As a woman with ADHD, how are your symptoms affected by the normal life changes common to female adults–pregnancy, perimenopause, and menopause? We take a look at the impact of these changes, and provide tips on how you can deal with them.