“The Change” and ADHD
Ten years ago, Ranjini Pillai, M.D., of Mt. Pleasant, South Carolina, had a hysterectomy, which sent her into menopause. “Suddenly, I felt anxious all the time,” she says. “I was tired, disorganized, and out of focus; I couldn’t think clearly.”
A month after her surgery, she started estrogen replacement therapy, and her symptoms improved slightly. But she still struggled with disorganization and anxiety. Doctors prescribed antidepressants, which didn’t help.
Five years ago, a doctor diagnosed her as having ADHD, and prescribed Strattera. “The improvement was dramatic,” says Pillai. “My thinking was clearer, my anxiety lifted, and everything started to make sense.” Pillai needs both hormone- replacement therapy (a combination of estrogen and a small amount of testosterone) and twice-daily Strattera to control her ADHD symptoms. She learned behavioral strategies to help her stay organized and to remember things, like a basket near the front door to hold her cell phone and keys.
“I’ve also learned to delegate, and to accept the fact that I can’t do everything,” says Pillai. “My husband now handles our finances, and my two sons, ages 23 and 14, do chores to keep the house running, so I can focus on my work and things I enjoy, like cooking.”
Hormonal Effects on ADHD
By menopause (average age, 51), estrogen levels drop about 65 percent, a gradual decrease that begins 10 or more years before menopause (known as perimenopause). The loss of estrogen leads to a decrease in serotonin and dopamine levels in the brain. Women going through perimenopause report moodiness, sadness, irritability, fatigue, fuzzy thinking, and memory lapses. These may be more pronounced in women with ADHD.
“Given a brain that, in effect, has less cognitive energy to begin with, it can be especially hard for women with ADHD at this time in their life to concentrate and to make good decisions,” says Quinn.
Solutions: Oral contraceptives taken during perimenopause can stabilize hormone levels and improve brain function. After their patients’ periods have stopped, many doctors recommend hormone-replacement therapy, at least for the first few years after menopause. “Studies have shown that women receiving hormone-replacement therapy perform better on cognitive testing, as well as on memory and reasoning-skills tests,” says Quinn.
For many women, the best course of treatment is estrogen alone, for three to four months, followed by 10 days of progesterone. “As in Pillai’s case, combining hormone-replacement therapy with ADHD medication often improves symptoms most effectively,” says Quinn. Quinn says it’s important, at every stage in your life, to keep ADHD symptoms under control. This may mean working with several professionals — a psychiatrist or psychologist, an internist, and a gynecologist. Educate yourself about ADHD and what’s going on with your body, keep lists of medications, chart symptoms, and, above all, demand the help you need from professionals.