This is a blog about ADHD and menopause, and how it felt to be finally diagnosed in my 50’s. Firstly let’s be clear I am not an ADHD specialist. I only had it confirmed earlier this year that I have it. OK I have suspected it for years, but I really didn’t want yet another label. Neither am I a menopause specialist, I have no special training in either of these areas. This blog is just the musings of a woman with ADHD who also happens to be menopausal. Lucky me, eh?
What Does ADHD look like in Women?
ADHD was originally defined based on behaviour in young boys. Much of the research even now is on males not females. We have the stereotypical lively boy who can’t pay attention and won’t sit still. Often loud and disruptive. So much for the boys. ADHD shows up differently in females. Girls and women often present with inattentive ADHD. We are more likely to be inattentive than hyperactive. It’s more subtle and trickier to recognise. Girls and women can often “mask” their symptoms and manage to comply with social norms and expectations. It’s exhausting but we do it! We internalise how we feel and often women describe it that the hyperactivity seen in boys is all inside their brains.
Masking can often make it seem as if women are in control of things even when they are not.
Inattentive ADHD can show up as:
Fails to give close attention to details or makes careless mistakes.
Has difficulty sustaining attention, does not appear to listen.
Struggles to follow through with instructions, has difficulty with organisation
Avoids or dislikes tasks requiring sustained mental effort, loses things easily.
Is easily distracted, is forgetful in daily activities.
Many women and girls report and describe “internal” hyperactivity and other unrecognised symptoms, with behaviours often ascribed culturally to very “social” girls:
Talks excessively
Fidgets and often needs to get up and walk around
Acts impulsively or speaks before thinking
Appears to daydream but will explains that her thoughts feel like they are “going a million miles a minute” and she has trouble keeping her mind on one topic
Easily makes friends but has difficulty sustaining friendships
Self-harming activities, or activities that require extreme and unhealthy self-discipline.
Adopts compensatory strategies, leading to working two to three times as hard as her peers in order to be equally successful.
Fears rejection by peers or friends and clings to other people or remains in unhealthy relationships.
For me ADHD showed up when I was at school, but we didn’t call it that then. If I had a pound for every school report that said, “Fiona would do well if she paid attention” or “Fiona needs to stop day dreaming” I would be very rich and be writing this blog from a tropical beach! My parents just thought I was lazy and not applying myself.
As an adult I would lose things regularly, forget appointments and social events, turn up for stuff late or on the wrong day entirely. I love the fact that all my life is now on my phone, I am less likely to lose that than all the paper diaries I mislaid! Friends would suggest I write lists, I would lose the damn list. I tried SO hard to be organised, but nothing ever seemed to work.
Women with undiagnosed ADHD can find life really challenging. We often don’t understand ourselves and feel like we don’t fit in with societal expectations or gender norms. That myth of the organised wife and mother with everything under control. This really impacted my sense of self-esteem and mental health.
Alcohol and ADHD
When it was suggested that our youngest son had ADHD there wasn’t much help available and we were told his best support was us. I do remember thinking oh that’s him buggered then because I am useless. At the time it crossed my mind that I might have it too. But at that point I had just stopped drinking and felt like I had enough labels already. “Alchy Mum” was a heavy label to carry and I just wanted to be normal, not to deal with another damn disorder! Oh, and I have since discovered that ADHD and alcohol and substance abuse often go hand in hand. Terrific!
ADHD and Menopause is a Wonderful Mix!
Fast forward 20 years. I am post-menopausal, after 15 years sober I drink in moderation, I’m a therapist and I have a lot of strategies to manage being “scatty” and “a bit flaky.” By now everyone is talking about being neurodivergent and about ADHD and autism. I joined a FB group for neurodivergent therapists. and the penny started to drop. All those behaviours that I had berated myself for were evident in the other women in that group. One thing that we all seemed to agree on is that ADHD symptoms got a lot worse in menopause.
ADHD and Menopause
Think about it, ADHD symptoms can include being easily distracted, executive function issues, difficulty completing tasks, problems staying organised, what feels like brain fog. Then along comes perimenopause and menopause, brain fog, forgetfulness, exhaustion. It can be an horrific double whammy when these very similar symptoms collide.
During perimenopause and menopause, the body makes less oestrogen. As this drops it can lead to worsening ADHD symptoms. This could explain why so many women who have masked successfully for years end up being diagnosed in their 40’s.
A drop in oestrogen levels, which occurs in menopause, impairs the brain’s ability to produce serotonin and dopamine. Less serotonin can lead to mood changes. Dopamine promotes pleasurable feelings and plays a role in executive function, that’s things like focus, concentration and memory. Just this can seriously increase ADHD symptoms. It’s like a perfect storm.
I have found being on HRT incredibly helpful. Replacing the oestrogen has improved symptoms. Exercise seems to help so I drag myself to the gym and walk quite a bit. I would suggest finding something you love doing, it's easier to keep up.
Having ADHD Confirmed
I have a terrific therapist who has done the training for assessing ADHD. She agreed to go through the forms with me and give me her opinion. She was so kind to me! She simply said “you already know don’t you?” When she agreed that I have Inattentive ADHD I cried. It was such a relief. She also reminded me gently of all the things I have achieved in life despite having undiagnosed ADHD. You see this means that I am not flaky, or ditzy, or stupid, or lazy. I’m actually fairly smart, I have a brain that processes things differently, that’s all. I can start to dismantle the image I had internalised of a disorganised feckless woman and to start to view myself with compassion instead. It means that on the days when the wheels fall off I can be a little bit more kind to myself.
Society doesn't always make it easy for women over 45 with ADHD. We're supposed to have it all together, right? The perfect career, the perfect family, the perfect Pinterest-worthy life. Well, newsflash – perfection is overrated, and sometimes, the messiness is where the magic happens.
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