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Posted 18 Oct 2023

Menopause And ADHD: Bouncing Back With Boundaries

It is World Menopause Day on the 18th October and ADHD Awareness month for the whole of October. The two particular health issues work together to create a very serious health and productivity issue for women, unless they are treated together.

ADHD And Cognitive Fog

ADHDers tend to struggle with “executive functions” which means the part of thinking where you make plans, pay attention, work out how long things will take. Our everyday experience is similar to the cognitive fog reported by people with long covid symptoms and other long term health complaints, however it is not related to ill health.

Cognitive fog for ADHD is thought to be, in part, related to the levels of the neurotransmitters dopamine and norepinephrine. Norepinephrine, in particular, has an optimal window of functioning – too little and we can’t focus, the right amount and we are firing on all cylinders, too much and we shut down. ADHDers start from a lower baseline, which is why we are often great in a crisis – our stress response raises norepinephrine and we hit the zone, and we stay there longer than neurotypicals. However day to day, we don’t have enough and find it hard to stay on track. Some ADHD medications address norepinephrine directly, helping us to think at our best.

Perimenopause And Cognitive Fog

Women enter the perimenopause years before we finally menopause. During this time, our estrogen levels fluctuate, meaning that on any day we can have too much or too little. This can last between four and eight years before the menopause, which happens at an average age of 51. During perimenopause and post menopause, ADHD women experience a double compromise, because a side effect of low estrogen is also cognitive dysfunction, difficulties with memory, remembering words, planning and organising. It’s another layer of cognitive fog, coming from a different direction, causing a double whammy. For ADHD women, the start of perimenopause can be severe and disrupt the usual coping strategies. It can reduce the effectiveness of our medication because of the biochemical changes in the brain. However, since estrogen is not stable during perimenopause it can be very difficult to adjust a medication or routine to accommodate. Many of us hit overwhelm.

Menopause Policies

There has been a sharp rise in menopause awareness in recent years, in part due to the activism of celebrities such as Davina McCall. Businesses, occupational health practitioners, human resources teams and managers are putting in place policies that recognise the destabilising impact of menopause and act supportively. This can include making adjustments and being flexible around workplace temperatures, access to toilets, flexible hours and more. However, many women drop out of work at this point, or lose momentum in their careers. For ADHDers, the risk is compounded by a lifetime of imposter syndrome that usually accompanies hidden disability. By middle age, we are tired of masking, of working twice as hard as our peers to perform, of struggling with basic tasks. The menopause hits and it is easy to see why we quit. Many women simply fade away at this point.

Finding Our Boundaries Can Be Positive

All that said, the experience of ADHD and menopause can be one of catharsis. It can be the point when we finally have enough of doing everyone else’s chores, of being a doormat, of playing to the female stereotype that is always there for everyone else and never there for ourselves. Women get stuck in helping roles at work, no matter the seniority. We are often expected to do less glamorous tasks that don’t have career capital but “just need doing.” We often fall into traps of doing the tasks our teams left over at the end of the week rather than pushing back and encouraging them to complete on time. We are chastised when we buck these trends. However, in perimenopause, many women finally say “enough.” This doesn’t need to mean the stalling of our careers, it could mean finally focusing on our careers and not having our attention split in fifty different ways. It could mean setting boundaries with others – our direct reports, our families, our friends. Note, have you have put yourself last for years – raising children, facilitating others at work? Finding the edge of one’s limitations, the point where “just working harder” is no longer possible is sometimes the transformation needed for us to find our niche and start focusing on our own talents.

Such a positive interpretation of menopause and ADHD is much more likely if you have a good doctor and / or a good coach. Investing in yourself at this stage of life is essential. Do some research and find practitioners with whom you have an instant rapport, no compromises. Wouldn’t it be great if the menopause signalled your time to shine? There’s something very liberating about getting to a point in life where you no longer crave other’s approval and just want to get on with your own work.