How menopause affects ADHD

While it may not be common knowledge or even widely discussed, oestrogen levels can exacerbate ADHD (attention deficit hyperactivity disorder) symptoms, particularly during menopause. Even before menopause, when oestrogen levels are higher, women can experience ADHD symptoms during and immediately following their period.

Dr. Rachel Gow (BSc, MSc, PhD, RNutr), Nutritional Neuroscientist, Child Neuropsychologist and Registered Nutritionist, is an ADHD expert and explains everything you need to know about the impact of hormone changes during menopause on ADHD.

Menopause, oestrogen and ADHD

During perimenopause and menopause, oestrogen levels fluctuate and these changes impact neurotransmitter function, impacting attention, concentration and focus, and even leading to memory lapses, brain-fog-type symptoms, anxiety, low mood or depression. Specifically, low oestrogen impacts the production of dopamine (the neurotransmitter linked to feelings of pleasure, reward and motivation) and serotonin (the chemical linked to feelings of wellbeing and a happy, stable mood). If you think you're going through peri-menopause or menopause, learn more in 'How to know if you’re starting menopause'.

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Women aged between 40-55 and experiencing hormonal change may experience a range of ADHD-type symptoms, including:

Impaired memory
Difficulty paying attention and concentrating for long periods of time
Emotional dysregulation (tearful, low mood)
Other cognitive problems, including forgetfulness.

As these symptoms coincide with perimenopause, they are unlikely to be ADHD, and instead a direct consequence of hormonal changes at this time in life. However, if these symptoms have been present prior to perimenopause and appear to be even greater, overwhelming or unmanageable, then it is advised to consult with your GP for an assessment for ADHD. Learn more about how your diet can improve your mental health.

Women who are already diagnosed with ADHD are more likely to find perimenopause symptoms exacerbated when their oestrogen levels begin to decline. Changing your diet and eating healthily during menopause and regular exercise during menopause can both help relieve relieve symptoms.

It is also important to restrict or completely avoid alcohol during menopause, because alcohol will worsen menopause symptoms and increase the risk of depression and anxiety. Weight gain may also occur, especially around the abdomen and prove problematic to lose. This is the result of a complex interplay between declining hormone levels, ADHD symptoms and stress.

Progesterone, GABA and ADHD

Progesterone is a critical hormone for feelings of calm and interacts with GABA receptors (Gamma-Aminobutyric Acid), which are neurotransmitter inhibitors. One of the main roles GABA is associated with is its calming effect, which controls nerve cell hyperactivity associated with anxiety and stress. Higher progesterone is linked with increased GABA function, controlling anxiety and stress, while lower GABA is linked to heightened anxiety during menopause.

Depleted oestrogen impacts serotonin production, which can result in decreased mood, anxiety and depression. In short, lower oestrogen and progesterone equals lower serotonin, which in turn equals lower GABA. As a result, women in their 40s and 50s going through menopause can suddenly become anxious when their levels of progesterone decrease. Learn more about why menopause causes anxiety and mood swings.

Low progesterone and ADHD

Low progesterone can lead to a range of symptoms, including irritability, irregular cycles, increased water retention, bloating, anxiety, sleep disturbances, night sweats and more. Low progesterone can also impact gut health by increasing the release of pro-inflammatory 'cytokines' from immune cells, resulting in general feelings of being unwell, lethargy, brain fog and a depressed mood. In a menopause customer survey by DR.VEGAN^®, brain fog was the most common reported symptom of menopause. The research of over 1,000 women also showed mood swings and anxiety were among the top 3 symptoms of menopause, with 76% of women saying they experienced these. If you want to learn more about your own gut health and hormone status during menopause, the DUTCH test provides an analysis of hormone metabolites and provides gut health markers, which can provide greater insight into overall health and hormone status.

Releasing stress and tension is critical as oestrogen declines and cortisol levels often rise, triggering our stress response, which has physiological impacts on our body, including an inability to manage inflammation. Inflammation, along with chronic cortisol release, is the greatest threat to our brain health, impacting cognition, sleep, weight gain, accelerating the ageing process and increasing the risk of neurodegeneration.

Low oestrogen levels can also result in gut health disturbances and the inability to maintain the diversity and balance of the gut microbiome. An imbalance of the microbiome can result in an inability to protect the gut from hostile bacteria and gut dysbiosis. Gut-health imbalances will negatively impact mood and cognition. In DR.VEGAN's customer survey into gut health, it was found that 66% of people felt their gut health symptoms worsen when anxious. Read more on the 'Gut-Hormone Connection'.

Thankfully, there are many ways to mitigate perimenopause, menopause and ADHD symptoms. Creating your own toolkit and nutritional armour can increase resilience during this challenging transition and a healthier lifestyle and diet play an important role.

The dopamine deficit hypothesis

ADHD is habitually associated with low dopamine and norepinephrine (a neurotransmitter and hormone). It is important to note that the dopamine deficit and ADHD hypothesis is not proven and is arguably overly simplistic and controversial. It's also important to be aware that the prescription of ADHD medications, including MPH (Methylphenidate) can be rather generic and relies on a self-experimental approach in terms of dosing and efficacy. At least one-third of patients with ADHD do not respond to stimulant medication, or the side effects are so severe they warrant discontinuation of the medication.

Emerging neuro-imaging research points to potential structural differences in the grey matter of the brain. In one study, healthy volunteers without a diagnosis of ADHD and treated with MPH, had an increased ability to concentrate and pay attention in an identical fashion to those diagnosed with ADHD. The study, led by Professor Trevor Robbins at the University of Cambridge, also reported that dopamine receptor levels in the striatum brain region were similar in both patients and non-diagnosed individuals (neuro-typicals). The study suggests that having ADHD goes beyond the potential dopamine dysfunction hypothesis. Given that there are natural ways to improve dopamine function, following a healthy diet is key, especially during the menopause.

Your personal health checklist

Here is a checklist to follow if you're concerned about enjoying a comfortable menopause:

Take a DUTCH test that can help assess your hormone status.
Have an Omega 3 index home testing kit to measure your Omega 3 levels. Low levels of Omega 3 are linked to both depression and ADHD symptoms. Learn more in 'What is Omega 3 good for'.
Consider effective supplements.

Contact Dr. Gow from Nutritious Minds for a full nutritional evaluation.

About Dr. Rachel Gow

Dr. Rachel V. Gow works in a field called Nutritional Psychiatry or Nutritional Neuroscience, which is concerned with a personalised holistic approach to brain health. Dr. Gow is a neuropsychologist, a registered nutritionist, the founder of Nutritious Minds and the author of Smart Foods for ADHD and Brain Health.

Buy 'Smart Foods' by Dr. Gow on Amazon

Dr. Gow's key area of specialisation is ADHD, autism, and other neuro-developmental conditions. Dr. Gow believes that the future of medicine must move beyond the prescription pad and behavioural descriptions of mental health by assessing biological markers, which are known to be critical for the health and function of the human brain at molecular and cellular levels.

Her private clinic assesses for nutritional insufficiencies in key nutrients that help facilitate neurotransmitter function and tests for a wide range of food intolerances and allergies that could be impacting gut health and, in turn, brain health (known as the gut-brain axis). Microbiome analysis, which involves a stool test, can reveal the composition and diversity of microorganisms present in the gastrointestinal tract and identify associations between how these markers correspond to the individual’s dietary patterns and psychological health. There are specific tests that can measure the presence of inflammatory cytokine levels, which is important given the global consensus in the field of nutritional psychiatry that underlying much of all mental (or brain) health conditions is inflammation. The gut-brain connection alongside vagus nerve functioning determines a range of significant bodily functions linked to mood regulation, the control of heart rate, our immune response and so much more. Hence, anyone presenting with poor mental health should first look at the health of the gut and critically consider what they eat and drink.

Nutritious Minds Clinic

The Nutritious Minds Clinic adopts a personalised, integrative approach to brain and mental health that enables prescriptive dietary modifications and, where appropriate, the use of nutrient-based supplements to optimise brain function at molecular and cellular levels, reduce inflammation and help regulate neurotransmitter activity, including those that govern mood, namely serotonin and dopamine.

The Nutrition Minds approach is integrative, including prescriptive exercise, gut-health modifications, sleep-promoting advice, coaching and lifestyle advice, meditation and other health-promoting activities.

*Based on a UK survey conducted by DR.VEGAN^® of 996 customers, nationally representative, during January 2024. All customer survey findings reflect our own efforts and have not been influenced by any external organisations or third-party entities.

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