Menopause can be a particularly challenging time for those with ADHD. For some, it may even be the prompt that sparks a late diagnosis. But why? Here, psychotherapist and counsellor Lottie Storey explores how midlife hormonal changes affect ADHD and some other neurodivergences, and how therapy may help.
(7 minute read)
Over recent years, huge advances have been made in terms of awareness, understanding and treatment of neurodiversity. With this awareness has come an increase in people seeking a diagnosis for ADHD and autism. A 400% rise in adult ADHD referrals in the last four years takes the current UK total ADHD population to 2.6 million, while a recent paper in The Lancet (O’Nions, et al., 2023) estimates that there are potentially 750,000 (National Autistic Society, 2024a) autistic people in the UK.
Menopause, however, is an experience directly affecting 13 million people (NHS, 2022) in the UK right now. That’s a third of the population, from their twenties upwards, who are currently experiencing a wide range of physical and psychological menopausal symptoms that can last for years. And yet awareness is still lacking.
What is menopause?
Technically, menopause refers to one day only, the day that marks a year since periods stopped. Menopause happens at 51 years old in the UK, on average, with 45–55 being the generally accepted range. After menopause comes post-menopause, while the time leading up to menopause is termed perimenopause. What has only recently reached mainstream awareness is an understanding of quite how long and how hard this perimenopausal lead-up can be. We’re talking a decade or more.
The perimenopause can be a difficult enough time for neurotypicals. For menopausal people with neurodivergent conditions, it can be utterly life-changing.
Hormonal hell
Perimenopause begins with changes to hormone levels, specifically oestrogen, progesterone and testosterone.Oestrogen, in particular, plays a key role in regulating attention and emotions, sleep, memory and executive function, all areas that can be challenging for people with ADHD. Levels of oestrogen drop by about 65% during menopause, which has a knock-on effect on dopamine levels.
Dopamine is a neurotransmitter that affects mood, motivation and reward. Low dopamine levels can cause difficulty concentrating, lack of motivation and an inability to feel pleasure – again, these are areas that people with ADHD may already struggle with.
Oestrogen plays a critical role in regulating dopamine. As oestrogen and dopamine levels decline during perimenopause, those with ADHD may experience the following.
Worsened cognitive symptoms: Forgetfulness, difficulty concentrating and disorganisation can become more severe, affecting focus, planning and managing daily tasks.
Mental fog or “brain fog”: This can be more intense for people with ADHD, further impairing their ability to concentrate and remember things. It can also impact co-occurring conditions such as dyslexia.
Decreased emotional regulation: Mood swings, irritability, anxiety and depression are common during menopause, but may become more intense in those with ADHD.
Heightened anxiety and depression: The combination of hormonal shifts and ADHD-related emotional dysregulation can amplify anxiety and depression.
Increased insomnia: Lower oestrogen levels and night sweats can disrupt sleep patterns. People with ADHD may find it even harder to fall asleep or stay asleep.
Greater difficulty managing restlessness: ADHD symptoms such as restlessness or hyperactivity can make it difficult to wind down at night. This can worsen with menopause-related insomnia.
Fatigue: Tiredness exacerbates cognitive symptoms such as attention, forgetfulness and disorganisation. Managing ADHD becomes even more difficult when menopause-related fatigue sets in.
Lowered motivation: Reduced energy levels and motivation can lead to procrastination, which may already be an issue for those with ADHD. Managing day-to-day tasks can become more overwhelming.
In addition to the symptoms above, those with an AuDHD or an autistic neurotype might consider the suggestions from the National Autistic Society (2024b) that those with autism may also experience the following during menopause: intensified sensory sensitivities and overload; increased difficulty with social interaction and communication; difficulty with the lack of predictability around your bodily or sensory experience; difficulty identifying internal states, such as hunger and temperature (this is known as “atypicalinteroception”); and difficulty recognising and communicating emotions (known as “alexithymia”).
When the mask no longer works
Because of the intensity of the hormone changes and their impact on daily functioning, perimenopause strips many people of their usual coping strategies, making life much more difficult. When neurodivergent traits become more apparent, previously diagnosed people may seek extra help such as adjustments to ADHD medication or hormone replacement therapy (HRT).
For undiagnosed people, menopause can be a catalyst. They may realise that life has become much more challenging and that possible traits have come to the surface. Getting a diagnosis at this stage is helpful to better understand themselves in general as well as understanding why their experience of menopause is different to their neurotypical counterparts.
Managing menopause/neurodivergent intersections in the therapy room
As therapists, we often work with clients who have difficulties regulating their mood and emotions, their communication and/or relationships with others. We may also be used to working with neurodivergent clients. It’s essential that practitioners become just as familiar with the symptoms of menopause because of the ways in which they can affect clients’ lives more generally, as well as the possibility of previously masked neurodivergence becoming un-maskable.
Medical misogyny is already an issue for women and menstruating people. Often, patients presenting with low mood as a result of menopause may be offered treatment for depression or anxiety. The likelihood of misdiagnosis of perimenopause and consequent lack of appropriate treatments being offered is very real, with anecdotal evidence suggesting finding an informed GP can be hit-and-miss. Likewise, those seeking diagnosis for a neurodivergent condition may struggle to get the help they need because their menopausal symptoms worsen their cognitive function, making it even more difficult to advocate for themselves.
By informing ourselves, as therapists, we can avoid perpetuating further harm. Instead, we must do our own work, being mindful of the many ways in which menopause may impact identity. Staying curious to the experiences of our clients is critical, applying different – even multiple – lenses through which to understand their lives. We can facilitate self-reflection, self-compassion, self-awareness and validation. We can support clients to develop new strategies to make adjustments at home or at work in order to manage their lives more effectively. Think laterally – could you offer sensory-friendly spaces for autistic clients? Or tailor your mindfulness exercises to work for clients with ADHD? Could you advocate for better awareness within our profession?
The therapy room should always be a place of safety for clients. For our neurodivergent, menopausal clients, we must offer an indestructible shelter from this particularly turbulent storm.
References
National Autistic Society. 2024a. Accessed 17 February 2025: www.autism.org.uk/advice-and-guidance/professional-practice/under-diagnosis-of-autism-in-england-a-population#:~:text=Through%20examining%20the%20data%2C%20the,as%20the%20government%20typically%20quote
National Autistic Society. 2024b. Accessed 17 February 2025: www.autism.org.uk/advice-and-guidance/topics/physical-health/menopause
NHS. 2022. Accessed 17 February 2025: www.engage.england.nhs.uk/safety-and-innovation/menopause-in-the-workplace/#:~:text=It%20is%20estimated%20that%20there,can%20last%20for%20several%20years
The Lancet (O’Nions, et al.). 2023. Accessed 17 February 2025: www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00045-5/fulltext
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Published 23 February 2025
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