Professor Amanda Kirby, CEO of Do-IT Solutions., Campaigner for Neurodiversity, Medic, Knowledge Translator, researcher

Originally published as part of The Neurodiversity 101 LinkedIn Newsletter.

Neurodiversity 101: Neurodiversity and Menopause

Menopause happens when a woman has gone 12 months without menstruating. The phase before menopause – the peri-menopause – involves large fluctuations in hormones. When the menopause happens can vary widely from one women to another and the length of time to move from perimenopause to post menopausal can also vary in length of time too.

Amazingly, till relatively recently there had been few studies or discussions focusing on an occurrence that impacts on around 50% of the population!

Going down!

If you want to understand the intersection between ADHD and menopause you need to just think about how oestrogen and dopamine and other neurotransmitters work together. For example, we know that dopamine, plays a central role in ADHD and executive functioning. Other hormones include serotonin, which we know if is lower can also lower mood.

Hormonal fluctuations can influence mood, concentration, and executive functioning. Cognitive changes that can occur with aging, such as reduced attention and slower reaction times, may also contribute to falls.

We know that lower or variable oestrogen and progesterone levels are associated with various cognitive deficits and also with neuropsychiatric disorders like Alzheimer’s disease and mood disorders including depression. Postmenopausal women run a higher risk of osteoporosis and cardiovascular conditions.

Oestrogen, progesterone and testosterone all decline in females during this time but during the peri-menopause levels can fluctuate a lot before declining. This can compound with varying dopamine levels and cause some symptoms and signs which can be worse for some women with ADHD.

Neurodivergent traits and menopausal symptoms

Remember that Neurodivergent traits and conditions often overlap. So many women will have a variety of traits that may not fit into one a neat box.

In recent studies ND women have been shown to have more hot flushes, night sweats, poor sleep, poor concentration  and memory lapses than the neurotypical group in comparison (Groenman et al, 2021).

What do we know?

ADHD

For so long ADHD was thought more of as a ‘male condition’ and because of that few studies considered the impact of varying levels of oestrogen or lack of oestrogen on ADHD symptoms.

Some women with ADHD may experience changes in their symptoms during menopause. ADHD symptoms tend to be less at times when oestrogen levels are higher in your body, like during and shortly after your period. When oestrogen levels start to drop in the peri-menopausal phase ADHD symptoms can increase.

In a recent paper by Wasserstein and colleagues (2023) who had surveyed women with ADHD.61% reported that ADHD had the greatest impact on their daily lives between 40 and 59 years of age. Interestingly the largest group of respondents (43%) were first diagnosed between ages 41 and 50. ” More than half indicated that a sense of overwhelm, brain fog and memory issues, procrastination, poor time-management, inattention/distractibility and disorganization had a ‘life altering impact’ during the critical menopausal/perimenopausal window”. Symptoms seemed to get less over 60 years and this may related possibly to changes in life demands. Again more research is needed.

Autism Spectrum Conditions/Disorder

Hormonal changes during menopause may interact with existing sensory sensitivities and sensory processing differences in autistic individuals.

Understanding the person’s communication preferences is important when providing support for women with ASC.

We also need to remember that individuals with autism spectrum conditions/traits also have increased risk of other endocrine health issues (Simantov et al,2022) e.g. pre-diabetic and reminds us again and again about taking a person centred holistic approach.

Developmental Coordination Disorder/DCD ( also known as Dyspraxia)

Falls and accidents in women post-menopause are a significant health concern, and several factors contribute to an increased risk of falls during this life stage. Changes in proprioception and balance control can occur with age. These changes may affect a person’s ability to maintain balance and react quickly to prevent falls. This may be worse for those who already have co-ordination challenges. There has been little work undertaken so far considering the implications. One paper by colleagues and friends Scott-Roberts and Purcell discusses this.

What do we need to do as a society?

  • More research++ is needed in this area of work!
  • Awareness of neurodivergent traits is important for all professionals coming into contact with women at all stages of their lives.
  • Community and advocacy: Advocacy and support groups for neurodivergent individuals should consider the intersection of neurodivergent traits and menopause in their efforts to raise awareness and provide resources.
  • Employers need to be aware too of how this can impact on a person in the workplace and not be seen to discriminate.(NB There is an employment case going through the courts relating to menopause and discrimination which could be a landmark case and is being backed by the Equalities and Human Rights Commission.)

What can you do if you have menopausal symptoms and are neurodivergent?

  • Keeping a symptom diary to track your symptoms on a daily basis. Learn more about both your traits and menopause, and how they may affect your everyday life.Also consider what is also going on in your life. Many women at this stage may also be ‘sandwiched‘ between being a carer to parents, and a parent to children while juggling work and home life!
  • Share the information with health professionals/GP to show the fluctuations that are happening for you and how they impact on your day to day functioning.
  • Discussing your hormonal changes with your GP. There are blood tests which can help identify if you are either perimenopausal or menopausal. The health professional may suggest an increase in ADHD medication ( this may not always be helpful).Some people may also be offered hormone replacement therapy (HRT) if appropriate.
  • Try to get regular exercise and eat a healthy and varied diet and ensure you are eating sufficient calcium rich foods and Vitamin D.
  • Use reminder tools to help with self organisation if you are forgetting things. Put everything into your electronic diary in phone/computer and set reminders as well at the same time.

References and resources:

ACAS – menopause at work

Antoniou E, Rigas N, Orovou E, Papatrechas A, Sarella A. ADHD Symptoms in Females of Childhood, Adolescent, Reproductive and Menopause Period. Mater Sociomed. 2021 Jun;33(2):114-118. doi: 10.5455/msm.2021.33.114-118. PMID: 34483739; PMCID: PMC8385721.

Wasserstein J, Stefanatos GA, Solanto MV. 2 Perimenopause, Menopause and ADHD. Journal of the International Neuropsychological Society. 2023;29(s1):881-881. doi:10.1017/S1355617723010846

Groenman, A.P et al (2021). Menstruation and menopause in autistic adults: Periods of importance? Autism Journal.

Guidance on the menopause:https://www.nice.org.uk/guidance/ng23

British Menopause Society:https://thebms.org.uk/

British Dietetic Association: https://www.bda.uk.com/resource/menopause-diet.html

Simantov T, Pohl A, Tsompanidis A, Weir E, Lombardo MV, Ruigrok A, Smith P, Allison C, Baron-Cohen S, Uzefovsky F. Medical symptoms and conditions in autistic women. Autism. 2022 Feb;26(2):373-388. doi: 10.1177/13623613211022091. Epub 2021 Jun 29. PMID: 34184558; PMCID: PMC8814970

Prof. Kooij YouTube webinar on ADHD and menopause

 

Blog Author

I am Amanda Kirby, CEO of Do-IT Solutions a tech-for-good company that delivers thought provoking consultancy and neuroinclusive guidance and training. We have developed cutting edge web-based screening tools that have helped 10s of 1000s of people. We strive to deliver person-centered solutions relating to neurodiversity and wellbeing.

I am a mixed bag of experiences and skills, an odd ball… and have 25+ years of working in the field of neurodiversity.

I am a medical doctor, Professor, and have a Ph.D. in the field of neurodiversity; parent and grandparent to neurodivergent wonderful kids and am neurodivergent myself.

Theo Smith and I wrote the UK award-winning book Neurodiversity at Work Drive Innovation, Performance, and Productivity with a Neurodiverse Workforce. My 10th book came out called Neurodiversity and Education in March this year. Excitingly, Theo and I have another book coming out next year!

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