Attention deficit hyperactivity disorder (ADHD) and the menopause transition

What is ADHD?

Attention deficit hyperactivity disorder (ADHD), also sometimes referred to as attention deficit disorder (ADD) or hyperkinetic disorder (HKD), is a neurobiological disorder. A neurobiological disorder is an illness of the nervous system caused by genetic, environmental, or metabolic factors.

ADHD results in difficulties with inattention, impulsivity and hyperactivity. This condition does not affect intelligence in any way but life can become more challenging.

It is recognised that there are 3 main combinations of symptoms:

• Some have mostly inattentive type symptoms
• Some people have mostly hyperactive-impulsive type ones
• Some have a combination of the two

Symptoms can vary from person to person and can be more or less severe.

How many people have ADHD?

ADHD affects around 5% of school-aged children ^{[1] [2]} and the male-to-female ratio in diagnosed ADHD prevalence is at least 4 to 1.5. In other words, a diagnosis of ADHD is more prevalent in men than women.

Whilst ADHD is perceived to be largely a childhood disorder, research suggests that up to 2 out of 3 children diagnosed with ADHD (65%) continue to experience symptoms into adulthood^[3].

It is thought that ADHD is under-recognised in women and girls as their symptom profile can differ to that of boys, with more inattentive and less hyperactive symptoms that are less disruptive, particularly in the classroom.

How is ADHD diagnosed?

To be diagnosed with ADHD you will need to be referred to a specialist.

ADHD is diagnosed after a series of testing by a health care professional with specialist training in the assessment of ADHD. This may be a  doctor,  usually a psychiatrist, but may also be a specialist ADHD nurse or other specialist health care professional. The assessment will involve finding out whether the symptoms of ADHD were present during childhood, if they continue to be evident in adulthood and if they also have an impact on the functioning of the individual across different settings.

There are two main medical guidelines that detail the criteria for diagnosis of ADHD – the American Psychiatric Association DSM-IV3 (The Diagnostic and Statistical Manual of Mental Disorders) and the World Health Organisation ICD-10 (The International Statistical Classification of Diseases and Related Health Problems). Diagnosis will also take into account a significant amount of information from other sources, including parents, teachers, social workers and the GP.

Diagnosis of ADHD can be difficult because other problems (such as autism, Asperger’s Syndrome, epilepsy, depression, brain injury or family dysfunction) can result in behaviour similar to ADHD. ADHD can exist in conjunction with many other conditions whose symptoms can overlap and mask those of ADHD. It can be difficult to separate out the different conditions which will need to be excluded during the process of diagnosis.

Example behaviours in adults

Some specialists have suggested the following as a list of symptoms associated with ADHD in adults ^[4]:

• carelessness and lack of attention to detail
• continually starting new tasks before finishing old ones
• poor organisational skills
• inability to focus or prioritise
• continually losing or misplacing things
• forgetfulness
• restlessness and edginess
• difficulty keeping quiet, and speaking out of turn
• blurting out responses and often interrupting others
• mood swings, irritability and a quick temper
• inability to deal with stress
• extreme impatience
• taking risks in activities, often with little or no regard for personal safety or the safety of others – for example, driving dangerously

What causes ADHD?

The cause of ADHD is generally unknown. For some there may be genetic factors – i.e. factors you were born with – and for others there may be environmental factors involved, or there may be a combination of the two.  The key point is that ADHD is unlikely to occur as a result of anything that you or did not do. It’s important to remember that there is no way to prevent ADHD.

ADHD may be more likely if any of the following apply:

• low birth weight and preterm delivery
• maternal smoking or alcohol exposure during pregnancy
• epilepsy
• acquired brain injury
• lead exposure
• iron deficiency
• being in the care of others who are not parents (‘looked after’)
• maternal mental health problems
• substance misuse
• the presence of other neurodevelopmental or mental health disorders such as oppositional defiant disorder or conduct disorder, mood disorders (e.g., anxiety and depression), autism spectrum disorder, tic disorders, learning disability and specific learning difficulties

ADHD and the menopause transition

ADHD can worsen in the menopause transition. This may be a direct effect of hormone changes and an indirect effect of the impact of other symptoms of the menopause.

Let’s recap on the menopause transition. Oestrogen is an important hormone made by the ovaries. Early in the menopause transition – the perimenopause – oestrogen levels start to fluctuate erratically and ultimately drop. Amongst other multiple actions, oestrogen plays a part in the production of dopamine and how much is available to the brain. Differences in the level of dopamine may be one of the important factors in the brains of women with ADHD. The drop in oestrogen may impact the level of dopamine present, explaining why ADHD can worsen in the menopause transition.

Oestrogen has an active part to play in brain function. It is thought that changes in oestrogen levels also impact available levels of:

• serotonin – and this can have a negative impact on mood
• acetyl choline, which can affect memory

In addition to this perfect storm of changing hormones and changing neurotransmitters in the brain, common symptoms of the menopause transition such as brain fog, poor concentration, poor memory, poor sleep, and changes in cognitive function and mood may overlap with those of ADHD and exacerbate symptoms. Or, for women with ADHD who had been managing to function up until then, menopause symptoms may trigger a tipping point making ADHD symptoms more obvious and impact function.

How is ADHD treated?

After a diagnosis has been made, treatment can be started, usually initiated by a specialist. This typically involves a combination of medication and/or therapy. There are a number of different medications that can be initiated by specialists – for more information on medication see here.

Different talking therapies can help manage symptoms of ADHD and help teach behaviours and social skills if needed.

Lifestyle changes in diet and exercise can be helpful for some in helping manage symptoms.

Managing other symptoms of the menopause may alleviate the pressure and there are many options, including hormone replacement therapy (HRT), to help

Next steps

If you are concerned that you have ADHD, speak to your GP or healthcare practitioner about a referral to a specialist. If you chose to pay to see a private provider, you may not need a referral.