I want to start by acknowledging the deeply pathologizing language of the DSM-5-TR in regard to ADHD and Autism. I honor that all of us have unique strengths such as creativity, hyper-empathy, the ability to hyper focus, to see patterns, and to excel in our careers—-especially when they intersect with our interests. That being said, for many of us there is also the reality that some of these differences can be deeply disabling across some, or all, domains. For better or worse, for now, the DSM is the framework that many providers are using for diagnosis. This post aims to help readers begin to parse out the differences between brain fog from perimenopause and ADHD traits. After seeing an influx in women in their 40s and 50s coming to me for assessments, it seemed worth writing about.
With ADHD there is a historical pattern of either inattention and/or hyperactivity/impulsivity, or both, dating back to childhood between ages 5 and 12 and during adulthood. Some examples of inattention during childhood may include doodling all over your papers or staring out the window and missing a teacher’s instructions. During adulthood, it may be missing parts of a conversation you had with your spouse or boss, and having to use context clues to piece together the rest. As a child, you may have rushed through assignments, misread instructions, and made careless errors. As an adult, you may have read through an email too fast, skipping over a key detail, resulting in a missed deadline.
Some examples of hyperactivity/impulsivity from childhood may include constantly leaving your seat to sharpen your pencil, get a drink of water, use the bathroom, or incessant talking. If you are a Gen Xr, you may remember those pesky comments on your report card from teachers. Or maybe your desk was separated from others or put closer to the teacher. Just me? During adulthood, this restlessness may show up as constant trips to the staff lounge or needing to turn your camera off because you are multi-tasking, because sitting still for so long is excruciating. There may be an inability to sit through a church service, watch a movie without scrolling on your phone, or to wait in long lines at Disney to meet a princess without feeling like you are crawling out of your skin. The only way I survived the lines was to listen to my favorite podcasts—-game changer! It might look like impulsively taking things from stores when younger. In adulthood it may look like taking over others’ chores or tasks without asking if they need assistance.
The forgetfulness or confusion started in your late 30s or 40s. At the same time this is accompanied by sleep disturbances, fatigue, hot flashes, a decrease in libido, and weight gain. The systems that you previously used to function proficiently at work or home, no longer seem to be as effective. As your estrogen drops, there is an impact on dopamine, serotonin, and acetylcholine. These levels will fluctuate depending on the time of the month, and brain fog may be significantly worse during the luteal phase, when your progesterone is also declining. If you decide to pursue management through nutrition, nervous system regulation, and other science-backed methods such as hormone replacement therapy, your symptoms will likely resolve. ADHD is a lifelong condition. We may mitigate symptoms but we are not trying to cure or fix it. There are many strengths an ADHDr possesses!
There is a pattern of executive functioning differences present throughout the lifespan. This may include differences in time perception, often referred to as time blindness. This involves over or underestimating the time it takes to finish any given task or showing up to events significantly early or late. I once had a friend show up to dinner while we were paying the check! You may struggle with problem-solving such as inefficient planning to the point it draws the attention of your supervisor. Maybe you are able to slay it at work but you come home and drop the ball by booking your child’s therapy at the same time as music lessons. Do not ask how many times I have arrived at my destination only to find out I booked the hotel or Airbnb for a different date! Or maybe you feel like you can plan things effectively, but it is because you have elaborate to-do lists, alarms, and calendars to track all of the things. You are exhausted by the effort that a person without ADHD, juggling all the same things, does not experience.
If you resonate with some of these points, it may be worth finding a therapist who can help you navigate self-identification or the formal assessment process. You may also find it helpful to discuss this with your PCP, gynecologist, or other healthcare provider if you suspect that it is both ADHD and perimenopause. There are many routes you can take to address symptoms that can include medication, therapy, executive function coaching, and nervous system regulation. You don’t have to slog through this alone!
Here are some additional resources: https://add.org/adhd-and-perimenopause-menopause/
https://www.adhdwomenswellbeing.co.uk/adhd-podcast
https://www.embracethemuchness.com/adhdresources/#women
Very timely read for me! Diagnosed with Inattentive ADHD just two weeks ago. There is a grieving process that goes along with the “well, that does make a lot to sense”. Gen X women were definitely left behind on this one!