Am I losing my mind? Perimenopause, cognitive changes and ADHD

Are you a woman or an individual who was assigned female at birth? Are you in your

30’s, 40’s or 50’s and have suddenly noticed worrisome changes in your memory or

attention? Are you doing things that you rarely did before, like losing your keys,

forgetting things, struggling to finish tasks, etc.?

This can be a troubling experience. Some of you may be wondering, even, about

whether these are early signs of dementia. Others of you may be correctly chalking

these experiences up to normal hormonal changes related to perimenopause or

menopause.

One thing that you may not have considered is ADHD. After all, you have coped

extremely well your whole life and did not need medication to do so, right? How could it

be ADHD?

ADHD and neurochemistry: A quick introduction

ADHD is associated with a deficiency of the excitatory neurotransmitter dopamine in

the brain’s reward centers (or, technically, too much reuptake of dopamine, i.e.

dopamine being reabsorbed into cells faster than is optimal). Not enough of it here

makes ordinary activities out there less intrinsically rewarding. Teeth brushing, for

example. It makes us less motivated to sustain effort towards long-term goals and

makes us more likely to engage in both compulsive and impulsive behaviors (to get

that surge of dopamine, understandably). Low dopamine in the prefrontal cortex also

impairs attention, organization and planning, emotion regulation and inhibition, among

other so-called executive functions. Cue Robin Williams: “It’s not your fault. It’s not your

fault.”

GABA (gamma-aminobutyric acid) is an inhibitory neurotransmitter. It acts to calm down

various centers in the brain associated with movement, mood, and anxiety. You

guessed it: ADHD is also associated with lower levels of GABA. This contributes to

restlessness, impulsivity, difficulty controlling attention (and by extension, working

memory), emotional lability and anxiety, plus some surprising ones like sensory issues

(which is a common concern shared by individuals being assessed for ADHD, while not

reflected in the DSM’s diagnostic criteria). Mind racing, or feel like you’re being driven

by a motor? Maybe low GABA.

So, what does all this have to do with perimenopause?

Estrogen and progesterone are both critical steroid hormones affecting reproduction in

women and individuals assigned female at birth (AFAB). Estrogen and dopamine have

a strong synergistic relationship. Estrogen increases dopamine synthesis and activity in

synapses and receptor sites by slowing reuptake. Likewise, progesterone and GABA

work together. Progesterone is metabolized into allopregnanolone, which makes GABA

more effective at calming us down. Here’s the crux of it: Anytime these hormones dip

significantly, ADHD symptoms get louder.

“Here’s the crux of it: Anytime these hormones dip significantly, ADHD symptoms get louder.”

Perimenopause

During perimenopause (the two to twelve years before your periods stop) huge

hormonal changes are occurring. Again, to oversimplify, the onset of perimenopause

brings first a rapid decline in progesterone levels followed by high and drastically

fluctuating estrogen levels until menopause (i.e. the complete cessation of

menstruation). For a comprehensive and highly accessible read, see Lara Briden’s

Hormone Repair Manual. Early perimenopause commonly brings anxiety; while the later

stages can bring about memory loss, brain fog, confusion, forgetfulness, among many

other symptoms. Many people with previously undiagnosed ADHD feel as though

they’ve reached an impasse. The ADHD symptoms they’ve lived with their whole lives

start to become unmanageable. Clever adaptations like flying under the radar,

developing systems upon systems for staying organized, or burning the midnight oil to

meet a deadline, start to break down.

“Many people with previously undiagnosed ADHD feel as though they’ve reached an impasse. The symptoms they’ve lived with their whole lives start to become unmanageable.”

In short, women and other individuals with female hormones across life stages can

experience drastic changes in their functioning and wellbeing due to fluctuations in brain

chemistry.

There is a dearth of research into how hormone replacement therapy affects ADHD

symptomology, much less how men and individuals assigned female at birth with ADHD

experience fluctuations. However, a foundational understanding of how hormones

interact with ADHD symptoms can inform important conversations with our healthcare

providers.

ADHD assessment can help answer long asked questions, provide clarity and a

roadmap for going forward including lifestyle changes, pharmacological and non-

pharmacological interventions, and provide an often long overdue starting place for

cultivating self-compassion. And if you are looking for support in putting the roadmap

and recommendations into concrete practice, consider ADHD coaching. Your coach can

be effectively your second brain to compensate for areas of weakness and shine a light

on --and build upon-- your doubtless areas of remaining strength.

Want to know more?

Book a free consult >

Chelsea Smith is a candidate psychologist who loves to work with people to understand

their challenges in a way that resonates and answers long asked questions. She works

with a trauma-informed, neurodiversity and gender diversity affirming lens. She is

currently taking referrals for Adult ADHD assessment.