It’s hard enough having attention deficit hyperactivity disorder (ADHD). But if you’re a woman going through perimenopause or menopause, you might find it getting even harder.

Diminishing estrogen levels can actually exacerbate symptoms, and for some women, the decline is sudden and dramatic. Hormonal fluctuations affect our brain’s biochemistry and thereby ADHD symptoms, according to Dr. Patricia Quinn, M.D., a developmental pediatrician and director of the National Center for Girls and Women with ADHD.

Specifically, estrogen affects the release of the neurotransmitters serotonin and dopamine. “[A deficiency in] dopamine is responsible for increasing ADHD symptoms,” she said, while less serotonin leads to depressed mood. (That’s why women feel so miserable during their menstrual cycles when estrogen levels dip.)

“Because a lack of dopamine is a hallmark sign of ADHD, this additional change in dopamine can lead to even greater difficulties with concentration and focus,” said Stephanie Sarkis, Ph.D, a national certified counselor and licensed mental health counselor and author of 10 Simple Solutions to Adult ADD and Adult ADD: A Guide for the Newly Diagnosed.

Some women also find that their ADHD medications are less effective during perimenopause and menopause. As a result, doctors often increase the dose. But this may be ineffective, Dr. Quinn said, because there’s nothing being done about the low estrogen levels.

What You Can Do About ADHD and Menopause

“A lot of women are blindsided by [worsening ADHD symptoms],” Dr. Quinn said. But she and Sarkis emphasized that women with ADHD do have effective options, and by addressing their symptoms can successfully minimize them and function and feel better. Here are several of their suggestions.

1. Consult your psychiatrist.

If your symptoms are getting worse or your medication isn’t working as effectively, share this information with your psychiatrist. If you aren’t working with a psychiatrist now, find one that specializes in ADHD, Sarkis said.

Stimulants and non-stimulants are highly effective in easing ADHD symptoms (along with behavioral changes). And studies have shown that both improve cognitive functioning and attention in menopausal women without ADHD. (For instance, this study looked at the efficacy of non-stimulant atomoxetine.)

2. Consult your gynecologist, too.

Make sure that your gynecologist knows about your ADHD (or cognitive concerns, if you haven’t been diagnosed) and the medications you’re taking. Sarkis also suggested signing “releases so that your psychiatrist and gynecologist have open communication about your symptoms.”

Hormone therapy may be helpful for some women in improving cognitive functioning. However, it is controversial, so Dr. Quinn suggested patients and their gynecologists extensively weigh the benefits and risks. For instance, hormone therapy may be too risky for women with a family history of breast or endometrial cancer, she said. But for women without such a history and whose functioning is dramatically exacerbated, hormone therapy may provide major relief. Also, she noted that more recent research contradicts some of the findings from the Women’s Health Initiative postmenopausal hormone therapy trials.

Dr. Quinn added that oftentimes women end up educating both their psychiatrist and gynecologist about menopause’s effect on ADHD. She suggested readers bring information to their physicians (such as this handout on hormonal fluctuations).

3. Assess your strengths and weaknesses.

Identify the areas of your life that are being affected and the activities that have become difficult for you, Dr. Quinn said. Women may have extra trouble with everything from staying organized and managing their time to making decisions, being impulsive and forgetting things. As Dr. Quinn said, it can feel like “you’re slogging through mud,” and everyday activities are extra overwhelming.

Also, keep in mind that you can experience cognitive difficulties even when you still have your period. In fact, according to Dr. Quinn, “your estrogen starts going down 10 years before your period stops,” which can occur in your late 30s or early 40s. You also might find yourself unable to manage activities that you were able to before.

4. Create an “ADHD-friendly life.”

Dr. Quinn suggested that readers simplify their lives and set up what she calls an ADHD-friendly life. This simply means taking your symptoms, strengths and challenges into account. You may want to hire a professional organizer, work with an ADHD coach, get active and “take time for yourself,” which you absolutely deserve, she said.

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Here’s additional insight on working through various areas of your life:

And here are links to for the books mentioned in this article: