Menopause can mimic ADHD, says prof

There is a little-known aspect to menopause that deserves real pause: it can create cognitive difficulties that mimic the symptoms of attention deficit hyperactivity disorder (ADHD).

To the point that some women, unaware of this link, fear the memory problems, concentration issues and word-finding difficulties are signs of them developing early Alzheimer's disease.

That’s worrying enough for women without ADHD, but what about those who already have this neurological disorder?

Professor Renata Schoeman, a psychiatrist in private practice, confirms that for women with ADHD, the symptoms can worsen significantly.

Professor Schoeman is the head of the MBA in Health Care Leadership programme at the University of Stellenbosch Business School and co-founder of the Goldilocks and The Bear Foundation.

The non-profit foundation was established by her and entrepreneur/athlete Nic de Beer to raise awareness of ADHD in girls and women and provide ADHD-screening and an early intervention service in poor communities.

"Girls are often not as hyperactive. They are quiet or more controllable, and, especially if they are intelligent, they still perform fairly well, despite their difficulties, so ADHD is often overlooked in them," says Professor Schoeman.

She says 70% of patients with previously undiagnosed ADHD present later in life with anxiety and/or depression and that many women are also misdiagnosed as having bipolar disorder.

Edward “Ned” Hallowell, MD, is a child-and-adult psychiatrist and a leading authority in the field of ADHD internationally.

He says that women’s oestrogen levels drop about 65% during menopause. "If you have ADHD, the further decrease of dopamine, from your already-low levels, means that existing symptoms get worse and new ones pop up.“

This drop in oestrogen affects both dopamine and serotonin levels.

Professor Schoeman says oestrogen determines how quickly we produce the feel-good hormone serotonin, and that is why women often battle with depression and anxiety around menopause.

"We know that as a result of the drop in oestrogen, and as a result of the changes it causes, there is a worsening of previously diagnosed ADHD around menopause," she says.

Women who experience these symptoms have not now developed ADHD.

"ADHD has to have existed your whole life. If you do not have it but suffer the same symptoms, it is menopause-related, cognitive impairment, which presents the same way," she says.

She says for women who do not have ADHD, hormone-replacement therapy, guided by their gynaecologist, is often enough to right the balance. She says taking omega supplements and anti-oxidants, exercising, eating a healthy diet and scheduling proper sleep will help.

She recommends getting a proper psychiatric assessment to be absolutely sure of ADHD, as sometimes sleep deprivation, excessive screen time, or technology addiction, can also create ADHD-like symptoms.

Once ADHD is confirmed, she recommends getting proper treatment, including medicinal help, as this prevents the development of its associated co-morbidities.

She says while exercise cannot treat ADHD, it effectively improves concentration, decision making and thinking, and it also helps to reduce anxiety, depression and provide better quality sleep.

Diabetic women face a further complication. Professor Schoeman says an unfortunate aspect of the drop in oestrogen and dopamine, is that diabetics unconsciously gravitate towards high-sugar, high-carb foods to try create more dopamine in their bodies.

This has negative consequences for their blood sugar levels.

Professor Schoeman says ADHD affects about 5% of school-age children, but it doesn't just go away, and the reported number of roughly 4% of adults have it too, often undiagnosed or misdiagnosed.

Boys and men are more readily diagnosed because they typically exhibit more of the “hyperactive” aspect, she says.

"Girls who go undiagnosed because they have the inattentive version of ADHD often present later in life with anxiety or depression, as they become steadily more overwhelmed by life.“

Professor Schoeman says she has dedicated herself to bringing awareness to ADHD in girls and adult women, both through the Goldilocks and The Bear Foundation, and through the ADHD special interest group of the South African Society of Psychiatrists (SASOP).

"This is why the book All of these things are Important to me, was written. The book tells the story of a day in the life of Zee, a South African girl, living with ADHD," she says.

The book, co-written by Professor Schoeman and author Refiloe Moahloli, aims to increase awareness and educate all communities about ADHD (and related mental health disorders) and also to de-stigmatise the disorder, and its treatment.

Marie Robb, of Fish Hoek, says her experience of menopause was sheer hell, and led to a very late-in-life diagnosis of ADHD.

She was 50 when she learned that her shot memory, her cognitive decline and her deepening depression were all related to previously undiagnosed ADHD.

She'd known her entire life she was “different”: others could do necessary but mundane tasks without drama, but her mind was mercurial, and while she flitted from one passion to another, she seldom, if ever, finished anything.

And then, there was the clutter in her home. And constantly losing/misplacing things.

“My diagnosis, through a psychiatrist, was profound. It took a while for me to process that all of the shame, all the self-blame I had piled on myself, all the criticism I had endured, was the result of a neurological 'wiring' in my brain, not a character failing.”

The diagnosis explained the depth of her emotions and also her vibrant creativity - both definitive ADHD traits.

"The next thing was a deep regret, and some anger, about the lifetime of sub-par functioning," she says. Her diagnosis was five years ago. She is still learning new coping strategies and recently tried a new medication.

"ADHD doesn't go away, but now that I understand it better, I may yet have the best years of my life ahead of me.“