One of the persistent and unhelpful myths around ADHD is that it is a disorder of young males. There are clear differences in the rates of diagnosis of ADHD between males and females in childhood, with as many as nine males diagnosed for every female. In adults however, ADHD is found at almost equal rates in each sex. In adult-diagnosed ADHD, females tend to be older than males when diagnosis is made.
There are several reasons for the seemingly higher rates of ADHD in male children, including males being more likely to externalise their symptoms and exhibit overt behaviours, whereas females are generally better at developing coping strategies and ‘masking’, or hiding, their symptoms. Girls also tend to be less hyperactive and internalise their ADHD symptoms, and so get noticed less. Missed diagnosis of ADHD in females may occur when co-existing anxiety or depression is present as several symptoms of ADHD may mistakenly be attributed to that coexisting condition.
ADHD in adult women
The coping strategies that often lead to missed diagnoses as young females can start to fail however as they grow and start to face life’s challenges, such as university, employment and relationships. In addition, there are issues unique to females related to the effects of sex hormones on ADHD symptoms and response to treatment. The normal monthly changes in hormone levels, and major hormonal changes such as puberty, pregnancy, perimenopause and menopause can significantly impact ADHD symptoms.
The reason for this is that oestrogen, the primary female sex hormone, regulates the levels of the brain chemicals such as dopamine which do not work as effectively in ADHD. Clinical research has shown that attention and ‘executive thinking skills’, such as planning and working memory, can improve when oestrogen levels are higher but that ADHD symptoms can worsen when oestrogen levels are lower.
Around perimenopause and menopause, when oestrogen levels change significantly, symptoms like ‘memory fog’ and difficulty focusing occur, which can be even more difficult for women with ADHD.
Managing ADHD and hormonal changes
There are practical steps which can help women who have to deal with the dual challenge of menopause and ADHD symptoms. These include:
- Keeping a symptom diary to track your symptoms on a daily basis.
- Speaking to your GP about whether you need a referral for an assessment for ADHD.
- Discussing your hormonal changes with your GP. There are blood tests which can help identify if you are either perimenopausal or menopausal. It might be recommended that you have access to hormone replacement therapy (HRT) if appropriate.
- Leading a healthy lifestyle, including getting regular exercise and eating a healthy diet
- Learning more about both ADHD and menopause, and how they affect your everyday life (known as psychoeducation)
How treatment can help
ADHD can be effectively treated once diagnosed, through medication and/or psychotherapy. Treatment of ADHD with medication can improve the symptoms which both ADHD and menopause share, and have a positive impact on everyday tasks. Equally, where appropriate, accessing HRT to help stabilise hormonal levels can help out with some of the shared symptoms of menopause and ADHD.
The relationship between hormones, ADHD symptoms and stimulant medication commonly used to treat ADHD can be complex, and there is evidence that the stimulant medications used to treat ADHD, such as Vyvanse, actually improve executive functioning in healthy menopausal women, and that the latter, as shown by neuroimaging, activates executive brain networks. These findings suggest that some women may benefit from ADHD medication to treat cognitive impairments during menopause. on functioning during key times of hormonal change
If you already have a diagnosis of ADHD and find that hormonal changes impact how your medication works, talk to your doctor, as changes to dose or even type of ADHD medication can be offered, as well as psychotherapy if needed.
This article was edited on 24/1/2023.