Experts say there is a lack of menopausal care, leading to delays in care.
Dr. Stéphanie Fabion, president of the Menopause Society, said medical schools need more training on menopause to prevent misdiagnosis and improve patient care.
First, Grace Presley sometimes forgot why she came into the room. Then she lost her mind mid-sentence. Starting simple tasks like unloading the dishwasher seemed impossible.
The 39-year-old has always been able to maintain a balance, including raising a teenage girl and a new baby. She entered perimenopause last year and started hormone replacement therapy, which was more than the brain fog that came with it.
One afternoon, she returned home from a project in the garage and discovered that she had left the kitchen sink faucet running, the refrigerator door open, and water boiling on the stove.
“I was losing my mind,” says Presley, a St. Louis nurse and program coordinator. “I’ve always been a perfectionist. When you go through perimenopause, the mask of coping falls off. Now that you have a family and manage a household, everything falls apart.”
She saw a therapist who told her what women are hearing more and more in midlife. It was that she had ADHD.
The number of women ages 30 to 49 diagnosed with ADHD nearly doubled from 2020 to 2022, according to a 2023 Epic Research study. This does not mean that women suddenly develop ADHD.
In fact, ADHD often becomes apparent or worsens during perimenopause.
“Many women lived with ADHD for years and didn’t know it. They learned how to cope and did well,” says Sasha Hamdani, a psychiatrist who practices near Kansas City, Kansas. “Then menopause happens. Menopause changes everything and takes away your ability to cope. 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 maybe I have ADHD?
This is the same question Atlanta gynecologist Dawn Mandeville hears from her patients.
“She will tell me she can’t think anymore. She used to be smart, but she can’t remember her name. She feels stupid,” says Mandeville, who organizes menopause and mocktail events to support women’s education. “The question that arises is: do I have ADHD, am I developing dementia? Or is this just menopause?”
Most women who are currently going through menopause were not diagnosed with ADHD as children. That’s because when they were young, ADHD was thought to only affect boys. Symptoms in girls often manifest differently, sometimes with anxiety, emotional dysregulation, or confusion rather than a lack of concentration. They developed coping skills.
However, during perimenopause and menopause, the decline in estrogen can reduce your ability to use coping mechanisms. Estrogen helps regulate dopamine, a neurotransmitter that plays a role in executive function and concentration. When estrogen levels drop, it becomes less effective and can cause problems with concentration.
Additionally, as hormones fluctuate, ADHD symptoms can also fluctuate.
“We have to explain to women that menopause is not the cause of ADHD,” says Mandy Dixon, a menopause therapist in Dallas. “But for women who have had ADHD all their lives, they may lose the hormonal cushion that helped them cope. Or, in the case of ADHD, it may get worse.”
Depending on the severity of their ADHD and how they have adapted their lives to cope with it, a sudden drop in estrogen can leave them unable to cope.
Some symptoms of perimenopause are similar to those of ADHD. If a patient has had symptoms for years and their symptoms worsen during perimenopause, they likely have ADHD, Dixon says.
“People said I was too sensitive.”
Hadmani says new ways to screen women are helping improve ADHD diagnosis. Now she wants to help some middle-aged women redefine ADHD.
“This is not a failure,” Hudmani said. His book Too Sensitive will be published this fall. “We need to reframe this as a neurological phenomenon.”
For Julie Murillas, understanding more about her ADHD is a relief.
“All my life I thought there was something wrong with me. I was overwhelmed. People told me I was too sensitive,” says Murilas, 49.
She was diagnosed with ADHD in college, but her symptoms worsened when she went to graduate school at age 42 while working full time. It was around the same time that perimenopause began.
She forgot words and details. She struggled to read for more than 15 minutes. She postponed the project.
“I didn’t know that ADHD could get worse,” says Murilas, now a therapist in Houston. “There was a lot of sadness involved.”
She began hormone therapy and treatment for anxiety and ADHD.
How to treat ADHD in menopause
Mandeville says many of her patients’ symptoms improve with hormone replacement therapy. She sends some to a psychiatrist for evaluation for ADHD.
The majority of Hamdani’s patients are diagnosed with ADHD during perimenopause. Some people require treatment. Some people require medication to manage anxiety and other symptoms.
The Centers for Disease Control and Prevention reports that stimulant use among men and women in midlife increased “significantly” from 2020 to 2021. One of the biggest increases was among women ages 50 to 54, according to the CDC.
In Presley’s case, she was diagnosed with ADHD and started taking medication, which improved her life.
“As women and mothers, we’re taught to do nothing and just keep making ends meet the same way we’ve always done it. But we can’t do that,” she says. “When I started taking the medication, it felt like my brain was quiet for the first time in my life. I was able to focus on one task and get it done. I wasn’t in my head all the time, and I felt relieved.”
Laura Trujillo is a national columnist focused 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.
